Case report: multiple neonatal fractures--dietary or deliberate?

A case of multiple fractures in a 3-month-old Asian girl with rickets is presented, in which difficulty in excluding child abuse was encountered. No firm conclusions were reached, and the child later died suddenly at 5 months of age. Post-mortem confirmed rickets histologically and the principal cause of death was recorded as sudden infant death syndrome. Three years later evidence of child abuse was found against a subsequent sibling in the same family. If the typical injuries associated with child abuse are present, these must be taken as strong points in favour of this diagnosis, even in the presence of metabolic bone disease.