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Fractures in Infants: Child Abuse?-Reply

CHARLES Q. MCCLELLAND, MD; KINGSBURY G. HEIPLE, MD
Am J Dis Child. 1982;136(9):866. doi:10.1001/archpedi.1982.03970450107031.
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In Reply.—Dr Chadwick questioned the methods used to identify the cause of fractures in infants during the first year of life. His concern was that injuries displaying no obvious evidence of abuse may have been classified as accidental in origin, when their true cause may well have been nonaccidental (ie, abuse). Clearly, a detailed approach to the problem is desirable. As a conceptual basis for understanding accidental injury, we have found most useful the epidemiologic model developed by Gordon1 and by Haddon et al,2 which perceives energy to be the agent of all injury and which examines data from the point of view of the host, the agent, and the environment. Pertinent issues that relate to the host (the child) are not limited to prior health status and prior health supervision, but include the presence or absence of recurrent or chronic illnesses and the developmental and personality

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