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DXA not indicated – normal fracture — RACP Paediatrics MCQ

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HardEndocrineDXA not indicated – normal fractureRACP Paediatrics

A non-mobile 5-month-old is brought with a spiral femoral fracture. The caregiver reports that the infant rolled off a floor mat, and presentation was delayed for two days. The child is comfortable after analgesia. What is the best next step?

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Correct answer: A — Initiate immediate child-protection assessment and document the history verbatim

Explanation lettering: C = shown as A · E = shown as B · A = shown as C · B = shown as E

C is correct. A femoral fracture in a non-mobile infant, implausible low-energy mechanism and delayed presentation are safeguarding red flags requiring immediate multidisciplinary child-protection assessment and meticulous contemporaneous documentation. A fracture morphology alone does not establish intent. B and E defer protection. D repeated confrontational questioning risks contaminating the account; clinicians should obtain and document an open, factual history and involve trained services.

Reference: RCH Melbourne, Child abuse: https://www.rch.org.au/clinicalguide/guideline_index/Child_abuse/