Multiagency involvement: no concerns about the family.

Vitamin D level low (<8 nmol/l - normal 50-170 nmol/l). Normal parathyroid hormone and Alk Phos.

'Low vitamin D levels have been proposed as a cause of unexplained fractures in the Court Setting despite normal radiology. There is currently no scientific evidence base to support this hypothesis. The direct relationship between levels of vitamin D and the risk of bone fractures is ill understood. There is also a lack of evidence in children as to what levels of vitamin D constitute deficiency or insufficiency.'
(Paragraph 9.5.46, Child Protection Companion 2013, Royal College of Pediatrics and Child Health Second edition.)

This is a difficult case. Single metaphyseal fracture in the context of no other concern. It was the view of the gathered medical professionals that the fracture was the result of a twisting/shearing mechanism and while this type of fracture is highly sensitive for non-accidental injury, in this case, the offered history of fall down stairs may have caused the fracture.

Review in place.