By Matthew B. Seeley
Ultimately, researchers may have little power to prove or
disprove by direct evidence whether child abuse is the cause of
unexplained infantile fractures in a given case because of ethical and
practical constraints. Medical practitioners do, however, have the
technology to prove, by direct evidence and with a high degree of
accuracy, whether a given infant with fractures has low bone density
that may have predisposed the child to fractures during nonabusive
handling. Mandating the use of this commonly available and
relatively inexpensive technology would close a major evidentiary
gap, which, ironically, allows room for both innocent caretakers to
be convicted and guilty caretakers to be acquitted. Our
understanding of nonabusive conditions that can mimic child abuse
has evolved to the point where it is simply no longer appropriate to
presume child abuse based solely on the presence of unexplained
fractures—even when those fractures are paired with intracranial
hemorrhaging. Since the technology to measure infant bone density
exists and is relatively ubiquitous, its use should be mandated in cases
where unexplained fractures will be used as evidence of abuse so that
“beyond a reasonable doubt” will mean in practice what it says on
paper in cases of alleged infant abuse
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