Sir.—I read with great interest the article by McClelland and Heiple on bone fractures in infants (Journal 1982;136:26-29). The authors noted that in their study population the frequency of nonaccidental fractures during the first year of life was higher than that of accidental fractures. The incidents of nonaccidental trauma were assumed to have been due to child abuse after a detailed review of the case history and after certain criteria had been met. I am concerned that the authors may have been too quick to assume that the cause of the nonaccidental fractures was child abuse.
In their review, no mention was made of rickets. There has been a recent surge of literature on rickets in infants with very low birth weights. It is now estimated that 13% to 32% of the infants with birth weights less than 1,500 g may have rickets.1,2 These infants may be at