Did you know that babies have more bones than adults? We’re born with about 300 bones. They fuse together over time, leaving us with just 206 bones as adults. However, the first six months of a baby’s life involves the rapid increase of bone mineral content. (R)
Baby bones are also different than adult bones. Thirty-two weeks into your pregnancy, babies’ bones are fully formed, but still soft. Their higher cartilage content makes them softer and more flexible than adult bones. That’s a good thing — it allows babies’ skulls and shoulders to squeeze through the birth canal during delivery. However, it also makes baby bones more fragile. (R)
What causes bone fractures in infants?
Babies are at risk for broken bones during labor and delivery and occur in about 1 per 1,000 live births. The most common bone fractured is the clavicle, in about 45% of cases. These fractures may occur as a result of twisting and pulling by doctors and nurses or improper use of delivery assistance tools. In addition, some babies have congenital diseases that make their bones brittle and prone to breakage. (R)
Let’s take a deeper look at some of the common causes of an infant bone fracture.
Fractures During Delivery
It usually only takes a few moments for your baby to get through the birth canal. Sometimes, however, the baby can get stuck on the way out. That can happen for several reasons. The baby may get stuck because the mother’s pelvis is too narrow or has an unusual shape. The baby may be “macrosomic,” which refers to high birth weight. Macrosomia may be caused by a number of factors. Maternal diabetes and obesity increase the risk of macrosomia, and male babies are more likely to be macrosomic than female babies. Macrosomia may also be genetic — some families simply have large babies. (R)
Finally, unusual birth positions can cause babies to get stuck in the birth canal. Babies are ideally delivered head first, but are sometimes positioned feet first (breech) or buttocks first, making the passage through the birth canal more difficult.
Whatever the cause, getting stuck in the birth canal can be dangerous. Just like you, the baby needs a constant supply of oxygen to survive. In the womb, the baby’s oxygen comes from the umbilical cord. In the birth canal, the umbilical cord is compressed and can’t deliver enough oxygenated blood. At the same time, the baby doesn’t have enough room to breathe air. Without enough oxygen, the baby can suffer brain damage. That means your doctor wants to make the baby’s passage through the birth canal as quick as possible.
If the baby gets stuck, your doctor may attempt to move the baby into a better position. That may involve turning the baby over or twisting it around. While babies’ bones are strong and flexible, they’re at risk for fracture if the doctor is too rough. The most common type of bone fracture during delivery is a clavicle fracture. The clavicle is the bone that connects your arm to your neck — you may know it as your collarbone. As the doctor pulls and twists the baby into position, it may put enough stress on the collarbone to break it. (R)
Sometimes, the doctor will pull on the baby to speed up the delivery process and avoid the risks of oxygen deprivation. Pulling on the baby’s head and arms can also put too much pressure on the baby’s shoulders and cause a clavicle fracture. If the baby is born in a breech or buttocks-first position, the doctor may need to pull on the baby’s legs or feet. Pulling too hard can break bones in the baby’s legs or feet, though the most common type of injury is extensive muscle trauma. It also forces the baby’s arms up near the ears, which can cause clavicle fractures. (R)
Your doctor may use a special kind of vacuum or a pair of forceps to help pull the baby out. While that speeds the process, improper placement of these tools can actually fracture the baby’s skull. Even with proper placement, pulling on the baby that way can cause clavicle fractures. In addition, the force on the baby’s head can actually dislocate the baby’s vertebrae and damage the spinal cord. (R)
Your doctor may need to reposition the baby even if your labor is not particularly difficult. Sometimes the umbilical cord wraps around the baby’s neck during labor. Your doctor has to get the cord off of the baby’s neck before delivery or the baby could choke. That may require moving the baby around and turning the baby’s head and shoulders to free the cord, which can cause clavicle fractures. (R)
“Osteogenesis imperfecta,” also known as “brittle bone disease,” is a congenital disorder that affects bone formation. As the name suggests, it causes weak and brittle bones that are prone to breaking. It can also cause deformities in the bones, curved legs and spine, weak teeth, and other side effects. Most cases are mild, but the disease is occasionally fatal. (R)
Babies who suffer from brittle bone disease are especially prone to bone fractures during delivery. It occurs in 1 in 20,000 people, equally among males and females. Babies with this condition may suffer broken bones just because of the pressure of contractions and being in the birth canal. If labor becomes difficult and the doctor needs to pull on the baby, the risk is even higher. (R)
Your doctors may be able to detect brittle bone disease using an ultrasound, but mild cases are often undetectable.
Avoiding Infant Bone Fractures
In most cases, infant bone fractures are the result of pulling or twisting the baby during delivery. Doctors want to speed the baby through the birth canal to avoid the risk of brain damage from oxygen deprivation but sometimes use too much force. The only sure way to avoid these risks is to schedule a cesarean section (c-section). However, most births are uncomplicated and a c-section presents its own risks to both mother and child.
Talk to your doctor about the risks associated with your delivery, such as macrosomia, and work with your doctor to decide if vaginal birth is the best choice for you or if it’s safer to schedule a c-section. If you do decide that vaginal birth is right for you and your baby, talk to your doctor about how she handles difficult deliveries and about when an emergency c-section is appropriate.
What are the symptoms of an infant bone fracture?
If you break a bone, you know it. You can tell a doctor where it hurts. You can feel that something isn’t right. When a baby breaks a bone, it’s much harder to tell. They only communicate by crying, so it’s tough to know whether they’re hungry, tired, or in pain. They don’t move around much, so they don’t give obvious signs like limping.
When a baby’s bone is broken, how can you tell?
Sometimes, it’s easy to tell the baby has a broken bone because the doctor feels it happen during delivery. If the doctor is turning or twisting the baby into a better position, she may feel the bone break. Your baby will need an x-ray after delivery to determine the location and severity of the break.
Signs of a Fracture
If you and the doctor don’t know the baby has broken a bone, there are still other signs to watch out for. If your labor was difficult, you’ll need to be particularly vigilant for the symptoms of a break.
Swelling, redness, and bruising will likely occur near the site of the break. The site will be tender to the touch, so your baby will cry if you touch that area or move a nearby limb. Babies may also be unwilling or unable to use a limb if it’s broken, so watch out for one arm or leg that stays still. Sometimes the baby will be able to move the affected limb, so you should still watch for the other symptoms.
If your child has any symptoms of bone fracture, you should seek immediate medical attention. First, fractures are painful and should be set properly to alleviate pain. In addition, untreated fractures can cause serious side effects including nerve damage, blood clots, infection, deformity, and more. (R)
Types of Fractures
The type of fracture your baby suffered will determine how painful it is, how difficult it is to treat, and whether there is any risk of long-term consequences. The two main types of bone fractures are simple and compound. A simple fracture is a broken bone that doesn’t break the skin. A compound fracture is one that does break the skin. Almost all infant bone fractures are simple fractures. (R)
There are several types of simple fractures. One of the most common in infants is the “greenstick fracture,” where the bone breaks on one side — picture bending a green twig until it starts to break. “Torus fractures” are also common and occur when the bone is twisted and weakened but doesn’t actually break. Similarly, “bend fractures” occur when the bones are bent and damaged but not broken. (R)
In rare cases, an infant may suffer a “growth-plate fracture.” The growth plate is the area at the end of a bone that controls the bone’s growth. A growth plate fracture requires careful treatment because damage to the growth plate impacts the bone’s ability to grow in the future. (R)
Fractures caused by brittle bone disease or other bone defects are called “pathological fractures.” These fractures often cause the bone to break into several pieces. (R)
How do I treat an infant bone fracture?
Infant bones have a higher cartilage content than adult bones, making them more flexible but also more fragile. In an ordinary delivery, those flexible bones make it easier for the baby to pass through the birth canal. In a difficult delivery, the doctor may need to reposition the baby and may break the baby’s bones.
It can be difficult to tell when a baby might have a broken bone. In some cases, your doctor may suspect that a fracture occurred during delivery. In other cases, you’ll notice redness, swelling, or bruising or that the baby won’t move one limb. When you or your doctor suspects that your baby may have a fracture, you’ll head to the radiology department for an x-ray.
The good news is that most bone fractures are easily treated.
Clavicle Fracture Treatment in Babies
The most common bone fracture in infants is the clavicle, or collarbone. The clavicle is particularly vulnerable to the twisting and pulling required by a difficult labor. For most fractures, your baby won’t need a splint or cast. You’ll just need to be extra gentle picking up and laying down your little one until the break heals on its own. In rare cases, your doctor may want to immobilize the baby’s arm on the side of the fracture. Rather than getting a newborn-sized sling, you can usually just pin the baby’s sleeve to the front of the clothes. Your doctor may also recommend anti-inflammatories or painkillers to make your baby more comfortable.
Within a few weeks, you should see a bump form over the site of the break. That’s called a “fracture callus.” It means the bone is healing properly. Until the break is completely healed, be extra gentle when lifting your baby. You’ll need to use clothes that have snaps or buttons so you don’t have to pull the baby’s arm above the head to put on or take off the clothes. (R)
Fractures in other areas may require more treatment. Your doctor may need to realign the bones to ensure they heal in the correct position and may put your little one in a splint or cast to immobilize the break during healing. Your doctor may also recommend anti-inflammatories or painkillers.
Warning Signs of an Untreated Fracture
It’s important to seek medical attention if you see any signs that your baby may have a bone fracture. Left untreated, a fracture can cause serious side effects. The broken edges of the bone may cause permanent damage to nearby nerves, muscles, and ligaments. An untreated fracture may lead the bone to heal improperly, causing a deformity. If the break is on the growth plate, that bone may never be able to grow properly.
Untreated fractures can also cause blood clots. If the fracture is severe enough, the bone marrow may be exposed to the tissues and fluids outside the bone. That can lead to “osteomyelitis,” a serious bone infection. Finally, a fracture can decrease or cut off the blood flow to part of the bone. Without treatment, that part of the bone can die. This is called “avascular necrosis” or “osteonecrosis” and can result in the collapse of the bone as well as other side effects. (R) (R)
Broken bones are very treatable and most children recover completely within a few weeks. However, you should be alert for signs of complications. Most importantly, watch out for a fever or increased swelling or discoloration around the site of the break. This can be a sign of serious infection and requires immediate medical attention.
What are the legal issues surrounding infant bone fractures?
Your new arrival has a broken bone. It’s painful for the baby and upsetting for you. Worse, most broken bones are caused by doctors and other medical care providers in the course of delivery.
While some of these breaks are unavoidable, others are the result of negligence. If your child was injured by medical negligence, you may be entitled to compensation.
Compensation for Medical Malpractice
When you’re injured by the negligence of another person, you have the right to sue for compensation for your loss. If the negligent party is a doctor or other medical care provider, it’s called “medical malpractice.” When you file a medical malpractice lawsuit, you may be suing the doctor, the hospital, the nurse, another care provider, or any combination of these. We’ll use doctors for purposes of explanation, but the process is the same for each type of defendant.
The point of a medical malpractice suit is to get compensation for the injuries suffered. This compensation comes in the form of monetary “damages.” Damages may be economic, such as past and future medical expenses and future lost wages. Damages may also be non-economic, such as pain and suffering or loss of quality of life. If the medical malpractice lawsuit goes all the way to trial, the jury will decide the amount of damages due. If you settle before trial, the amount will depend on what each side believes the jury would award at trial, considering the strength of the case.
Medical Malpractice Case Elements for Broken Bones
In order to win a medical malpractice case, you’ll need to prove several things to the court. First, you’ll need to prove that the doctor had a legal duty to you. If the doctor treated you at all (including performing and evaluating tests, assisting in your labor, etc.), the doctor had a legal duty. That’s an easy element to prove.
Next, you’ll need to show that your little one was injured. In the case of a broken bone, that’s easy to do. You’ll just need an x-ray.
Third, you’ll need to prove that the doctor was “negligent.” That’s a legal term that means the doctor did not treat you or your child with the appropriate standard of care. The standard of care is a tricky concept; it’s not actually written down anywhere as a set of hard and fast rules. Instead, the standard of care is a sort of best-practices standard. Usually, a doctor who works in the same field will testify as an expert witness about what doctors should do in a given situation and about how your doctor didn’t do that. Of course, your doctor will present expert witnesses to argue the opposite side.
Finally, you’ll have to link your doctor’s negligence with your child’s injury. For example, if your child suffered a fracture due to brittle bone disease, your doctor isn’t liable. In contrast, your doctor is liable for using forceps improperly and fracturing your child’s skull.
Filing a Lawsuit for Your Child’s Broken Bones
Fortunately, most broken bones don’t cause lifelong trouble. In the short term, however, treating those injuries can be expensive and time-consuming. You may choose to file a lawsuit against your doctor or other care provider to recoup the cost of the care your child needed because of the fracture and the pain and suffering associated with it.
If you believe a doctor or other care provider’s negligence caused your little one’s bone fracture, gather all of the relevant medical records and make an appointment with an experienced local attorney. Most attorneys offer free consultations and case evaluations so you can decide whether a lawsuit is the best choice for you. You should ask about what damages you can expect to win, how long the case is going to take, how often you’ll need to appear in court (if at all), and how much the lawyer will charge for her services.
Remember that you have a limited amount of time to file a suit. A law called the “statute of limitations” gives you a certain amount of time in which to sue. After the statute of limitations has run, you no longer have the right to sue. State law determines the statute of limitations but most states allow a couple of years after you become aware of the injury. If you think your child may have been injured by a doctor, it’s best to talk to an attorney sooner rather than later to ensure that you have enough time to make a decision.
What questions should I ask my doctor?
Babies aren’t just tiny adults. Their bodies work differently than ours. Their bones are softer and more flexible. While that allows them to pass through the birth canal during delivery, it also puts them at risk for fractures.
Below are some questions you should ask your doctor if your child has suffered from a bone fracture.
1. Where is the break?
Collarbone (clavicle) fractures are the most common, but other types of fractures do happen. Make sure to ask where the break is.
2. Does my child need immediate treatment?
Clavicle fractures generally don’t require any treatment, but your doctor may ask you to immobilize the baby’s arm for a few weeks. More serious breaks may require setting and casting.
3. What problems should I watch out for?
Ask your doctor what you should be looking for — redness, swelling, and fever can be signs of infection and require medical attention. Your doctor can also give you a list of signs that may indicate that the break isn’t healing properly.
4. What care do I need to do at home?
If the baby’s collarbone is broken, you’ll generally just need to be extra gentle and support the arm. Other breaks may require more intensive care.
5. Will my child need physical therapy?
If the break is serious, your little one may need physical therapy to ensure that the bone and surrounding muscles heal properly. Ask your doctor if therapy will be necessary. You can also ask for a recommendation for a pediatric physical therapist. (R)
6. How did this break happen?
If the fracture was caused by an unusual birth position, macrosomia (high birth weight), or certain other issues, the same problems may arise in future pregnancies. Some bone fractures are caused by medical mistakes, in which case you may want to pursue legal action for compensation for your medical expenses and your baby’s pain and suffering.
What should I expect if my baby has a broken bone?
Your little one won’t be able to tell you where it hurts, so you’ll have to keep your eyes peeled for signs of a break. There will probably be swelling, redness, and bruising around the site of the break. The baby may be unwilling or unable to move one limb. Breaks are painful, so crying and fussing without apparent cause also can indicate a break or other injury. If you see any of these signs, you should head in to see the doctor to check for breaks.
Your doctor may physically inspect the suspected site of a break. She’ll also order x-rays to get a clear picture of the injury.
Treatment of the Broken Bone
Infants most often suffer broken clavicles. The clavicle connects the neck and shoulder. You may know it as your collarbone. It’s very difficult to cast or splint a bone in that position, but fortunately it’s not necessary. Your baby’s clavicle will heal on its own within 3-6 weeks. (R)
If your child has a broken clavicle, your doctor may recommend immobilizing the arm on the side of the break. You can usually do this by pinning the baby’s sleeve to the side of the shirt or onesie.
You’ll need to be extra gentle when you pick up and put down your baby. That break is painful and you don’t want to aggravate it. For the same reason, you should choose clothes that can snap or button so you don’t have to move the baby’s arm around. Other than that, you just need to keep an eye on the break to make sure it’s healing. You’ll see a lump on the site of the break within a couple of weeks. That lump is a “fracture callous” and is a sign that the bone is healing.
If your child has broken a bone other than the clavicle, a cast or splint may be required. Your doctor will set and stabilize the bone and tell you what to do to maintain the cast or splint. For example, most casts must be kept dry. You’ll have regular followup appointments to check on the progress and to change the cast or splint as necessary.
Babies may have fragile bones, but they also have powerful healing capabilities. Your little one will be right as rain within a few weeks or months. In most cases, there will be no long-term effects.
What is brittle bone disease?
Any baby can suffer a fracture, but some children suffer from “osteogenesis imperfecta,” or brittle bone disease. This condition causes the bones to form improperly, making them weak and likely to break. Bone fractures in children with brittle bone disease tend to be more serious and the bone is likely to break into several pieces.
There are eight different types of brittle bone disease. Type I is the most common and is mild. It makes the bones more likely to fracture and causes muscle weakness. It may also turn the whites of the eyes blue. Other types of brittle bone disease are more serious. The most serious, Type II and Type VII, are usually lethal. (R)
Diagnostic tests for the disease could include a skin lesion biopsy, but the symptoms are often clear. The most common symptom is unexplained bone fractures. In some cases, ultrasound may reveal numerous bone fractures while the baby is still in the womb. (R)
Brittle bone disease is rare, but can seriously impact your little one’s life. The most serious cases are untreatable. More mild cases may benefit from courses of bisphosphonates, which are used to treat osteoporosis in adults. In addition, children with brittle bone syndrome may need mobility aids and physical therapy. Some children may benefit from surgery to implant metal rods in the bones to strengthen them. (R)
Infant Bone Fracture Resources for Parents
Caring for an injured child can be a strain on your mental health and your wallet. These resources can help.
- Medicare and Medicaid: Your child may need expensive treatment. Medicare and Medicaid can give you the coverage you need so you’re not stuck paying out of pocket for your little one’s care.
- Social Security Disability Benefits: If your child suffers a severe fracture and is expected to suffer lifelong disability, Social Security disability benefits can help cover the costs.
- United Healthcare Children’s Foundation: This organization provides financial assistance to the families of sick and injured children.
- State Disability Services Office: Each state runs a Disability Services Office dedicated to helping disabled children and adults get the care and resources they need. Your local office can help you find doctors, therapists, and low-cost mobility assistance devices such as wheelchairs and scooters.
- Online communities: The emotional toll of caring for an injured child can be tough to bear. Online communities exist for families of children with every kind of injury and disability. You can find advice, support, and other resources through these online communities — and you can offer your advice and support to others.