Differential Diagnosis for Suspected Child Abuse

Single Most Likely Diagnosis

• Posterior rib fracture in an 11-month-old: This type of fracture is highly specific for child abuse due to the difficulty in generating the force required to cause such an injury accidentally, especially in a non-ambulatory child. The location and nature of the fracture suggest a significant and intentional application of force.

Other Likely Diagnoses

• Spiral femur fracture in a 4-year-old: While spiral fractures can occur from accidental trauma, the age and mobility of the child, combined with the nature of the fracture, raise suspicion for non-accidental injury, especially if the provided history does not adequately explain the severity of the injury.
• Distal spiral tibia fracture in a 14-month-old: Spiral fractures in young children are concerning for child abuse, as they often result from twisting forces that are not typically seen in common childhood accidents. However, the likelihood can vary based on the child's mobility and the specific circumstances of the injury.

Do Not Miss Diagnoses

• Linear skull fracture in a 10-month-old: While skull fractures can result from accidental falls, the possibility of child abuse must be considered, especially if the fracture is complex, bilateral, or if there are other signs of trauma. It's crucial to investigate the circumstances thoroughly to rule out non-accidental injury.

Rare Diagnoses

• Accidental causes for posterior rib fractures: Although rare, it is possible for posterior rib fractures to occur from severe accidental trauma, such as a high-impact car accident. However, these scenarios are less common and should be carefully evaluated in the context of the child's overall clinical presentation and history.

Each of these diagnoses requires careful consideration of the child's age, developmental stage, the mechanism of injury as reported, and any inconsistencies in the history provided. A thorough investigation, including a physical examination, imaging studies, and potentially, a skeletal survey, along with a review of the child's and family's social and medical history, is essential for determining the likelihood of child abuse.