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Vitamin D deficiency was mistaken for child abuse in a small fraction of 2800 cases – April 2014

Non-cutaneous conditions clinicians might mistake for abuse

Arch Dis Child 2014;99:817-823 doi:10.1136/archdischild-2013-304701
James B Metz1, Kimberly A Schwartz2, Kenneth W Feldman3, Daniel M Lindberg4 for the ExSTRA investigators
1General Pediatric Division, Seattle Children's Hospital & the University of Washington School of Medicine, Seattle, Washington, USA
2Child Protection Team, Boston Medical Center, Boston Medical Center, Pediatrics, Shrewsbury, Massachusetts, USA
3General Pediatric Division and Children's Protection Program, Seattle Children's Hospital & the University of Washington School of Medicine, Seattle, Washington, USA
4Department of Emergency Medicine, Kempe Center for the Prevention and Treatment of Child Abuse, University of Colorado Medical School, Denver, Colorado, USA
Correspondence toL Dr James Metz, General Pediatric Division, Seattle Children's Hospital & the University of Washington School of Medicine, 4800 Sandpoint Way NE, Seattle, WA 98105, USA; James.Metz at seattlechildrens.org, Received 20 June 2013, Revised 28 March 2014, Accepted 1 April 2014

Objective To determine the frequency of non-cutaneous mimics identified in a large, multicentre cohort of children evaluated for physical abuse.

Methods Prospectively planned, secondary analysis of 2890 physical abuse consultations from the Examining Siblings To Recognize Abuse (ExSTRA) research network. Data for each enrolled subject were entered at the child abuse physician's diagnostic disposition. Physicians prospectively documented whether or not a ‘mimic’ was identified and the perceived likelihood of abuse. Mimics were divided into 3 categories: (1) strictly cutaneous mimics, (2) strictly non-cutaneous mimics and (3) cutaneous and non-cutaneous mimics. Perceived likelihood of abuse was described for each child on a 7-point scale (7=definite abuse).

Results Among 2890 children who were evaluated for physical abuse, 137 (4.7%) had mimics identified; 81 mimics (59.1% of mimics and 2.8% of the whole cohort) included non-cutaneous components. Six subjects (7.4%) were assigned a high level of abuse concern and 17 (20.1%) an intermediate level despite the identification of a mimic. Among the identified mimics, 28% were classified as metabolic bone disease, 20% haematologic/vascular, 16% infectious, 10% skeletal dysplasia, 9% neurologic, 5% oncologic, 2% gastrointestinal and 10% other. Osteomalacia/osteoporosis was the most common non-cutaneous mimic followed by vitamin D deficiency.

Conclusions A wide variety of mimics exist affecting most disease categories. Paediatric care providers need to be familiar with these conditions to avoid pitfalls in the diagnosis of physical abuse. Identification of a mimic does not exclude concurrent abuse.

Abstract does not state, but it appears that vitamin D deficiency was the cause of perhaps 50 of the 2890 abuse cases investigated = 2%

See also VitaminDWiki

See also Vitamin D Council

  • Dr. John Cannell was asked to serve as an expert witness on two cases of alleged child abuse. Aug 2014
    Infant #1: The parents repeatedly brought their four-month-old winter-born infant to medical professionals due to an unexplained swelling over the left clavicle and symptoms of failure to thrive.
    Infant #2 The parents repeatedly brought their three-month-old winter-born infant to the attention of medical personnel for bruising, swelling over the left femur and failure to thrive.
    Extensive, interesting discussion