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Age of children with skull fractures

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.


  • All studies included pre-school children, five only included children less than one year of age  1,4,7,8,9
  • Skull fractures of either aetiology (abuse or accident) appear commoner in younger infants 1,2,4-7,9
  • In children less than three years of age 80% (75/94) of accidental and 88% (23/26) of abusive skull fractures were in infants under one year of age 3
  • Skull fractures were more frequent in accidental trauma than abuse (p=0.002 in those aged less than 18 months, p<0.001 for those older than 18 months) 6

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  1. Billmire ME, Myers PA. Serious head injuries in infants: accident or abuse? Pediatrics. 1985;75(2):340-342 [Pubmed]
  2. Kowal-Vern A, Paxton TP, Ros SP, Lietz H, Fitzgerald M, Gamelli RL. Fractures in the under-3-year-old age cohort. Clinical Pediatrics. 1992;31(11):653-659 [Pubmed]
  3. Leventhal JM, Thomas SA, Rosenfield NS, Markowitz RI. Fractures in young children. Distinguishing child abuse from unintentional injuries. American Journal of Diseases of Children. 1993;147(1):87-92 [Pubmed]
  4. McClelland CQ, Heiple KG. Fractures in the first year of life. A diagnostic dilemma. American Journal of Diseases of Children. 1982;136(1):26-29 [Pubmed]
  5. Meservy CJ, Towbin R, McLaurin RL, Myers PA, Ball W. Radiographic characteristics of skull fractures resulting from child abuse. American Journal of Roentgenology. 1987;149(1):173-175 [Pubmed]
  6. Pandya NK, Baldwin K, Wolfgruber H, Christian CW, Drummond DS, Hosalkar HS. Child abuse and orthopaedic injury patterns: analysis at a level I pediatric trauma center. Journal of Pediatric Orthopaedics. 2009;29(6):618-625 [Pubmed]
  7. Rosenberg N, Bottenfield G. Fractures in infants: a sign of child abuse. Annals of Emergency Medicine 1982;11(4):178-180 [Pubmed]
  8. Skellern CY, Wood DO, Murphy A, Crawford M. Non-accidental fractures in infants: risk of further abuse. Journal of Paediatrics and Child Health. 2000;36(6):590-592 [Pubmed]
  9. Stewart G, Meert K, Rosenberg N. Trauma in infants less than three months of age. Pediatric Emergency Care. 1993;9(4):199-201 [Pubmed]


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