A one year old child presented with multiple fractures seen in various stages of healing. The most probable diagnosis in this case is -

Ans. is 'c' i.e., Battered baby syndrome The key to diagnosis of battered baby syndrome is multiple fractures at different sites and of different ages, especially if they are associated with clinical signs of neglect. Battered baby syndrome It is a term used to define a clinical condition in young children usually under 3 years of age who have received non accidental violence or injury, on one or more occasions at the hands of an adult responsible for child's welfare. This syndrome must be considered in any child In whom degree and type of injury is at variance with the history given. When injuries of different ages and in different stages of healing are found. When there is purposeful delay in seeking medical attention despite serious injury Who exhibits evidence of fracture of any bone subdural hematoma failure to thrive, soft tissue swelling or skin bruising? Who dies suddenly About other options Scurvy and rickets can also rarely present with multiple fractures. But this is a rare feature and seen very late in the course of these disease and certainly not before the classical clinical features of these diseases are seen. Classical features of scurvy - Gum bleeds Petechiae may be seen over the skin Orbital and conjunctival hemorrhages Hemorrhage under the periosteum Classical features of Rickets Craniotabes is the earliest manifestation Bossing of frontal and parietal bones Rachitic rosary Pigeon breast Harrison's grooves Knock knee, coxa vera