Non‐accidental injury and bone fragility disorders: the need for a multidisciplinary perspective

A case is presented of a child who was initially diagnosed with osteogenesis imperfecta following a skull fracture. However, she later presented with multiple fractures and soft tissue injuries which were considered to be due to non‐accidental injury. It can be perplexing distinguishing accidental and non‐accidental injury in children where a bone fragility disorder has been suspected. A combination of a careful review of the history, a thorough examination and expert review of the radiology is imperative. DNA testing can be helpful. Multidisciplinary case review, taking into account the social history and any concerns professionals have about the family, is invaluable in informing a difficult diagnosis. In this context, there is a definite role for other agencies in challenging the diagnosis or exclusion of non‐accidental injury. Professionals should be willing to challenge the exclusion of non‐accidental injury when such exclusion is not evidence based.