by Allie Parker
Health Impact News
The method of diagnosing rickets in infants has been proven to be incorrect, yet it is still considered the standard practice used by child abuse pediatricians to diagnose abuse in infants and children with blatant disregard for laboratory testing showing a vitamin D deficiency or other metabolic bone disease.
The diagnosis of rickets in infants is left solely on a radiologist, despite blood tests showing deficiency, insufficiency, and efficient vitamin D levels.
X-rays are the standard practice or “gold standard” of diagnosing rickets in infants. Rickets is a condition that affects bone development in children. It causes bone pain, poor growth and soft, weak bones that can lead to bone deformities and fractures.
Adults can experience a similar condition, which is known as osteomalacia or soft bones  .
The dual-energy x-ray absorptiometry (DXA and DEXA scan) is the preferred technology for measuring bone mineralization, because of its ease of use, low radiation exposure, and ability to measure bone mineral density at both the hip and spine, DEXA is the most commonly used technique to measure bone mineral density  .
The American Academy of Pediatrics: Committee on Child Abuse and Neglect (AAPCCAN) has issued guidelines for the evaluation of children with multiple unexplained fractures, concluding they are almost always due to abuse.
However, common sense questions still need answering:
- Why would abusive parents repeatedly seek medical care for the infant they abused?
- Why would chest trauma severe enough to fracture ribs not also results in lung damage?
- Why wouldn’t blunt chest trauma cause some inwardly angulated rib fractures instead of all perfectly aligned fracture ends?
- Wouldn’t parents who beat their infant severely enough to cause multiple fractures show evidence of psychopathology?
- Do infants who are beaten severely enough to cause multiple fractures show fear in the presence of the abuser?
- How often do the eyewitnesses to parental/infant interactions report the parents were concerned and loving parents? 
It’s shocking what the studies show in regards to radiologists looking at the same images and coming up with two different interpretations.
For example, two radiology professors at Stanford University diagnosed multiple fractures due to rickets on several infants, and concluded that there is a “national and international epidemic” of infantile rickets  .
In another study, two board certified radiologists examined the same x-rays and diagnosed child abuse  .
Another study of 41 infants who died due to SID’s found that only 7% of bone biopsy-proven rickets was picked up by pediatric radiologists [6,7] .
In a more recent study (2014), a group of 52 children who died of various causes reported histological rickets in 10 children (19%) with vitamin D levels less that 10 ng/ml but pre-morbid x-rays missed the rickets 70% of the time.
In the same study, eight infants with vitamin D levels between 10-20 ng/ml had histological rickets, but pre-morbid radiology was normal in 100% of the infants, three of which had fractures. Again, radiologists missed biopsy-proven rickets more than 80% of the time  .
Bone biopsy and (DEXA) scans are still not considered the gold standard when it comes to diagnosing rickets in children. A current textbook of orthopedic pathology states,
“In subtle cases absolute certainty requires tissue examination.”
The author goes on to say,
“a bone biopsy is indicated in every patient in whom a cause of fracture is unexplained.” (p.127) 
It’s a shame child abuse pediatricians don’t have the same train of thought, which is to be absolutely certain.
They aren’t diagnosing a disease, but a crime. A crime which, if founded, will result in the destruction of a family. The parents will lose parental rights of their child, who is often adopted out to strangers, and also sends one or both of the parents to jail. Not to mention the damage that occurs to the child, who is losing loving parents.
Despite all this knowledge, bone biopsies and even (DEXA) scans are rarely done when children present to a children’s hospital with unexplained fractures.
Instead, the hospital goes into “non-accidental trauma” auto-pilot, ordering tests that are not needed, subjecting the infants to unnecessary radiation exposure.
They are dilating the infant’s eyes to check for retinal hemorrhage when no neurological signs, symptoms or injuries have been noted.
Even when all of these tests come back negative, and all they have are fractures, they still only rely on the radiologist’s conclusion, which is any unexplained fracture is “highly specific” for abuse.
Even when a parent or guardian has a true and reasonable reason for the fracture, the child abuse pediatrician claims the “type” of fracture does not provide an adequate mechanism for the fracture.
A simple (DEXA) scan, which most children’s hospitals have on site, can be done to check for bone mineralization, and still, child abuse pediatricians disregard blood work suggestive of rickets simply because the x-rays do not confirm rickets or any metabolic bone disease.
Instead, they choose to accuse the parents of a crime. Some stating it is “diagnostic of abuse” which is an extreme amount of medical certainty.
Once the accusation of child abuse is made by a child abuse pediatrician, the family is guilty. Even though the burden of proof is on the prosecution in the civil case, the family is still the one tasked with finding and paying an attorney, if they are able, and finding and paying expert witnesses to review their case and testify on their behalf.
This doesn’t include the fact their children have been taken away from them, often put in foster care, and the parents are now on the central registry of child abusers. See:
Parents Routinely Denied Legal Representation in Child Abuse Cases: More Likely to Have Children Medically Kidnapped by the State
All of this because child abuse pediatricians refuse to educate themselves on the new science and medical data available.
We still have to go back to why the gold standard for diagnosing Osteomalacia in adults is the (DEXA) scan, but traditional x-rays are the standard practice for diagnosing rickets in children. Traditional X-rays show changes in bone density after bone loss of about 40 percent; a DEXA scan can detect changes as small as 1 percent, making it more sensitive and accurate  .
With all the studies and medical data, child abuse pediatricians and radiologists are testifying against parents without doing a DEXA scan to check bone mineralization when it is readily available, more accurate and has less radiation exposure than the traditional x-ray.
Even when blood tests acknowledge a vitamin D deficiency/insufficiency (<20 ng/ml), they still rely on the results of the traditional x-ray, and the opinion of a radiologist, to rule out rickets and other metabolic bone diseases.
Based on the radiographic results alone, a diagnosis of child abuse is made, and a child is medically kidnapped.
The child abuse pediatricians often go so far as to say there is no evidence of a bone disease or rickets. This makes it difficult for CPS and the courts to accept another doctor’s conclusion for the fractures, which can be due to a metabolic bone disease and/or rickets.
The child abuse pediatrician has already diagnosed abuse, they have ruled out MBD and rickets, and because they are “experts” in child abuse, they have already acted as judge and jury for the family. See:
By not utilizing all the diagnostic tools available, such as the (DEXA) scan, these physicians are not acting in good faith. Many times they are claiming there is no evidence of rickets or a metabolic bone disease based solely on the x-rays, disregarding the laboratory data, but still treat the infants for rickets claiming, “vitamin D level is a laboratory value and not a diagnosis of disease.” 
The circular reasoning used by the child abuse pediatrician regarding rickets, MBD, and SBS is continuously called into question. Not only by the falsely accused, but by the defense attorneys, the public, and most importantly, other physicians who are questioning this circular reasoning and flawed science used to “diagnose” abuse, and ultimately destroy a family.
With so much controversy surrounding Shaken Baby Syndrome, the The Swedish Council on Technology and Social Evaluation and the Swedish National Medical Ethics jointly investigated the scientific basis for the diagnosis of Shaken Baby Syndrome and concluded:
There is insufficient scientific evidence on which to assess the diagnostic accuracy of the triad in identifying traumatic shaking (very low quality evidence), and there is limited scientific evidence that the triad and therefore its components can be associated with traumatic shaking (low quality evidence)  .
Spokesmen/women for these hospitals claim the child abuse pediatric teams do not make decisions or recommendations about whether or how cases are pursued, including criminal prosecution, termination of parental rights, or removal of children from their homes.
To that, I ask this: why would the child abuse pediatrician in my case say:
“…he is at risk for further, possibly more significant injuries, including deathin the environment in which he was physically abused”? 
This is the statement that caused a family, my family, to be medically kidnapped.
About the Author
 Small, R.E., Uses and limitations of bone mineral density measurements in the management of osteoporosis, MedGenMed.com (2005)
 Cannell, J.J., Holick, M.F., Multiple unexplained fractures in infants and child physical abuse, Journal of Steroid Biochemistry & Molecular Biology (2016)
 Keller, K.A., Barnes, P.D., A national and international epidemic, (2008)
 Slovis, T.L., Chapman, S., Evaluating the data concerning vitamin D insufficiency/deficiency and child abuse, (2008)
 Cohen, M.C., Offiah, A., Sprigg, A., et al Vitamin D deficiency and sudden unexpected death in infancy and childhood: A cohort study, (2013)
 Ayoub, D., Limitations of radiology in rickets, [Letter to the editor] Pediatric and Developmental Pathology. 2013 Sep-Oct.
 Scheimberg, I., Perry, L., Does low vitamin D have a role in pediatric morbidity and mortality? An observation study of vitamin D in a cohort of 52 postmortem examinations, (2014)
 V. Vigorita, Orthopedic Pathology, Chapter 3, Metabolic Bone Disease, 2nd Edition, Lippincott Williams & Wilkins, New York 2007.
 Carol Eustice, Medically reviewed by Richard N. Forgoros, MD, What is a DEXA scan? What to expect when undergoing this test (Updated March 13, 2049)
 Mohr, B., Medical record of D. Parker, University of Michigan (April 2018)
 SBU – Swedish Agency for Health Technology Assessment and Assessment of Social Services, Traumatic Shaking: The role of the triad in medical investigations of suspected traumatic shaking, a systemic review, (2016)