Fractures and Undernutrition due to Child Neglect

A report describes the cases of two boys from well-off social strata who presented with rachitic fractures, indicating child neglect and abuse by omission.

The first case illustrates a 13-year-old boy who presented with sudden loss of consciousness and a history of ambulation difficulty because of backache and knee pain for one month. He had no history of seizures or fever. Examination revealed an unkempt child with florid rickets and height and BMI of <-2 SDS. Other family members were also malnourished, had psychological issues, and were facing financial crises. They had withdrawn socially and stopped the child's schooling.

The child's investigation revealed low calcium with severe vitamin D deficiency rickets. The radiograph revealed fractures in the left ulna and several vertebrae. His mother also displayed osteomalacia and vertebral fractures. The family received medical management and psychological counseling. The child welfare committee was also engaged to ensure child safeguarding.

The second case illustrates a 10.5-year-old boy who presented with spontaneous fractures in multiple long bones for six months. The patient had a history of cerebral palsy, epilepsy, and internal fixation of femoral fracture(at the age of 5 years). Examination revealed his weight as 12.5 kg, rachitic bony deformities, and displaced fractures of multiple long bones. The patient received medical management that immediately improved his irritability and controlled seizures & tone. Although the patient had a history of fractures, his precarious calcium and vitamin D levels were never checked. Bone health monitoring, dietary intake optimization, and calcium and vitamin D supplementation are essential in all children with cerebral palsy.

In conclusion, these cases highlight the adverse consequence of inadequate care and attention to the physical and psychological well-being of children.

Priyadarshini S, Paul PG, Jain V. Rachitic Fractures and Severe Undernutrition: A Manifestation of Child Neglect. Indian J Pediatr. 2024. https://doi.org/10.1007/s12098-024-05123-z