Child Abuse & Neglect 31 (2007) 993–999
Inflicted skeletal trauma: The relationship of
perpetrators to their victims?,??
Suzanne P. Starlinga,∗, Andrew P. Sirotnakb,
Kurt W. Heislera, Myra L. Barnes-Eleya
aDepartment of Pediatrics, Eastern Virginia Medical School and
Children’s Hospital of The King’s Daughters, Norfolk, VA, USA
bDepartment of Pediatrics, The Children’s Hospital,
University of Colorado School of Medicine, Denver, CO, USA
Received 23 February 2006; received in revised form 5 January 2007; accepted 9 February 2007
Available online 17 September 2007
Objective: Although inflicted skeletal trauma is a very common presentation of child abuse, little is known about
the perpetrators of inflicted skeletal injuries. Studies exist describing perpetrators of inflicted traumatic brain injury,
but no study has examined characteristics of perpetrators of inflicted skeletal trauma.
Methods: All cases of suspected child physical abuse evaluated by the child abuse evaluation teams at Van-
derbilt University Medical Center (January 1996 to August 2000) and at the Children’s Hospital at Denver
(January 1996 to December 1999) were reviewed for the presence of fractures. All children with inflicted frac-
tures were entered into the study, and demographic data, investigative data, and identity of perpetrators were
Results: There were a total of 630 fractures for 194 patients. The median number of fractures per patient was 2,
and the maximum was 31. Sixty-three percent of children presented with at least one additional abusive injury other
than the fracture(s). Perpetrators were identified in 79% of the cases. Nearly 68% of the perpetrators were male;
from the median age of those abused by females (10 months) (p=.003).
?Presented in part at the Ray E. Helfer Society Annual Meeting, Homestead, Utah, 2000.
??Sponsored in part by the Primary Care Research Infrastructure Development and Education (PRIDE); grant funded by the
Health Resources and Services Administration (HRSA).
∗Corresponding author address: Child Abuse Program, Children’s Hospital of The King’s Daughters, 935 Redgate Avenue,
Norfolk, VA 23507, USA.
0145-2134/$ – see front matter © 2007 Elsevier Ltd. All rights reserved.
S.P. Starling et al. / Child Abuse & Neglect 31 (2007) 993–999
Early targeting of parents and other caregivers, particularly men, with information regarding appropriate
expectations for infants and children may aid in the prevention of inflicted fractures.
The authors gratefully acknowledge James Paulson, Ph.D., for his assistance in the statistical analysis
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