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June 7, 1976

Re: Child Abuse

Author Affiliations

San Francisco State University
University of California Medical Center San Francisco

JAMA. 1976;235(23):2475. doi:10.1001/jama.1976.03260490011003

To the Editor.—  Biber in his article, "Iatrogenic Skull Fracture Depression by Use of a Head Clamp" (235:414, 1976) has made an important contribution to the literature of diagnostic radiology, neurology and traumatic medicine. We are, however, concerned that the case report did not mention child abuse as a possible source of the original trauma. The history of a 6-week old infant rolling out of a crib is incompatible with his expected motor development. While a fall of less than 1 meter could result in an injury of this degree, it seems likely that greater force was involved. Weston has found that the most common history reported by first-time abusing parents is a fall from crib, lap, or down stairs.1A case such as reported should contain assurances that child abuse was evaluated through appropriate radiologic screening, interview, or follow-up. Medical and allied health professionals should be suspicious of an