Imaging recommendation · Musculoskeletal

Suspected non-accidental trauma (child < 2)

Q: What's the alternative imaging for suspected non-accidental trauma (child < 2) when repeat assessment at 10–14 days?

XR — Repeat skeletal survey (healing fractures visible) (no contrast).

Q: What's the alternative imaging for suspected non-accidental trauma (child < 2) when abusive head trauma suspected?

MRI — CT Head + MRI Brain (with SWI for microhemorrhages) (no contrast).

Recommended: Skeletal Survey + CT Head + Ophthalmology consult is the preferred imaging study for suspected non-accidental trauma (child < 2). Follow-up skeletal survey at 2 weeks.

Recommended study

Skeletal Survey + CT Head + Ophthalmology consult

XR No contrast Preferred Musculoskeletal EmergencyAcute inpatient Reviewed 2026-05

Follow-up skeletal survey at 2 weeks. Add bone scan if clinical concern remains.

If the default doesn't apply

Repeat assessment at 10–14 days

XR Repeat skeletal survey (healing fractures visible) No contrast

Abusive head trauma suspected

MRI CT Head + MRI Brain (with SWI for microhemorrhages) No contrast

Watch-outs

Classic metaphyseal lesions (CML) and posterior rib fractures

Highly specific for NAT — call CPS / child protection team and pediatric radiology.

Sentinel injuries in pre-mobile infants

Bruising, oral injuries, fractures in non-mobile infants warrant full evaluation.

Pearls

ACR / AAP skeletal survey protocol: 19 dedicated views, not a 'babygram'.
Retinal hemorrhages on dilated fundoscopy are characteristic of shaken baby syndrome.
Document carefully — these images and reports are often used in legal proceedings.