How many breaks/fractures is "normal" for a 3 year old?

[MrsOverTheRoad]

I am a little concerned about someone I know in that their 3 year old has seemingly injured himself very often.

In the past 6 months he has fractured his arm, "broke his sternum" and had a fall in which he hurt his other arm quite badly but which the Mother didn't get checked out...she said she was worried about social services considering his other recent injuries.

The arm fracture occurred, she said when he was with his Grandparent...I spoke to the grandparent and they confirmed this. The sternum break when he ran into the corner of a table and the arm injury when he fell off a child's slide in their garden.

Is this a lot or pretty normal for an active boy?

The only reason I do have concerns is that when I have spent some time with him, he's shouted at me in a very adult way..."acted out" being agressive if you will.

Lots of "NO! YOU DON'T DO THAT!" etc in a loud shouty voice with finger wagging..again this could be normal but my DC never did it so I don't know.

But he otherwise seems happy and healthy...another person close to his Mother said that he worried that his Mum was agressive to him in the way she spoke to him.

Writing it all down it seems like an obvious "Tell someone" situation but it's hard to tell when you're closeish to the family.

DS (5 at the time) in the space of two days fractured his elbow and broke his shoulder. Absolutely shit myself going back to a&e (but ofc took him!) Turned out he has bone cysts meaning that he can easily severely injure himself, even when doing normal child things like running around playing. He's since had quite a few severe bumps but thankfully no full on broken bones again, they do keep an eye on his cysts too.

Point is, it could be that the child isnt being harmed and has bone cysts himself. If they'd not xrayed DS we'd never have found out and it's very likely a safe guarding report would have been made. However that's no reason at all not to seek medical treatment for the child

I have 5 kids and none have broken any bones. One we thought had - the hospital said it was, then said it wasn't!

But my youngest was very accident prone and had many eggs on his head, had his head glued, been to A&E a few times.

My niece broke her arm 3 times. The last time was in public which her parents were actually relieved about as it was seen as suspicious. Only doing silly kids things like jumping on the bed (same thing my DS did that ended with his sprained ankle)

I would always take them to the doctor though. I had to explain to my youngests teacher at least a couple of times a week for months how he'd got yet another head injury. It used to happen on the walk to school - he could trip over thin air.

Normal? None.

I have four DC, two of whom are the most accident prone kids imaginable. Whilst I'm amazed that they haven't broken any bones (touch wood), it wouldn't be "normal" as such for it to happen by age 3.

That said, my non accident prone DD technically had a break before age 3 - in fact, she was born with a fractured arm and had a teeny pot on her arm from being about 3 days old!

Better to have an upset mum on your conscious than a dead child. Call someone.

As soon as I read "how many broken bones in a 3 YO is normal", I thought 0. My DS is 3 and hasn't had any breaks, my DD is 2, no breaks. My nephews are 8, 5 and 4. No breaks. I am one of six, among all my siblings and myself only one of us broke one bone in childhood and I don't think we've had any adult breaks either.

It is unusual, especially the sternum one as PP have said. I would also be worried that friend hadn't checked out another injury for fear of "looking bad".

As for the shouting, my DS(3) tells off my DD when she's not doing what he wants or whatever, something along the lines of "that's naughty, you don't do that!" In a loud cross voice with finger wagging. It's a caricature of what he's heard me saying, though I admit he sounds more shouty than I ever do . Coupled with the breaks though, it could be a red flag that the mother has a short fuse with him, shouts and behaves aggressively and then lashes out which causes the injuries.

I think you need to clarify more about the injury he got to his arm that she didn't seek attention for?

The two breaks/fractures he has had clearly haven't caused any concern to the professionals he has seen so this injured arm is really the only new 'evidence' you have that you suspect neglect or abuse.

What did he actually do to his arm? Does the story the mother gave seem realistic to you? Have you seen the injury yourself and did he appear to be in pain or still suffering?

Also, if you suspect the injury is suspicious why would the mother have offered the information to you and told you about it?

I'm not saying doubt your instincts because I'm a big believer in them, I'm just trying to think about questions that may arise if you do report it to someone.

"clearly haven't caused any concern to the professionals"

This is a huge assumption. You absolutely cannot say they clearly haven't caused concern. You have no idea whether they have or they haven't.

I'm not going to jinx us by saying it out loud but no broken bones here although my oldest was incredibly boisterous and accident prone and we had several visits to a and e due to falling and cutting his head, sticking his fingers in things he shouldn't etc. He was a complete liability and I used to follow him around like a nervous wreck until he was a little older and calmer.

Still haven't heard a peep out of my youngest who has made it to 6 without any major incident (touch wood).

This is a huge assumption. You absolutely cannot say they clearly haven't caused concern. You have no idea whether they have or they haven't.

Well seeing as the child was allowed to retun home following both injuries and there has not been any SS or Police involvement then yes, I would assume all the professionals involved were satisfied that the injuries were accidental.

My own children have never had a fracture
I've worked in my current nursery for 5 years and 2 children have had broken bones
One fell out of bed and broke his collarbone
The parent missed a follow up appointment at the hospital and social services phoned us to see if we had any concerns
Another broke her arm falling off a sofa at home. We had no call from social services that time
The only other time we had contact from ss following a child having an accident at home was when a child fell through a glass coffee table and had puncture woulda from the glass
They did ring and ask if we had concerns
If a child had 3 breaks I would be referring to ss especially as mum is avoiding seeking medical care. That's a big red flag
Op, you can report anonymously by ringing the nspcc and I strongly urge you to do so, as I expect this family is already on the radar

"there has not been any SS or Police involvement then yes, I would assume all the professionals involved were satisfied that the injuries were accidental."

You do realise that concerns can be raised without the parents being aware; and that in some cases it's stipulated that parents are not made aware of investigations whilst they are being carried out don't you?

You have no idea what is going on in this situation, or what else has happened that the OP may not be aware of (people rarely say to people IRL that they are being investigated if they are aware for instance). Please stop telling the OP your "assumptions" and stating nothing could have happened because quite frankly you may be putting a child's life at risk.

OP - please go with your gut feeling and report. You know the situation far better than any of us.

My three children are 9, 7 and 3 and none of them have broken a bone. They are active and adventurous children. Ds1 has ADHD so has no idea about risks or danger so I do find it surprising that he's not broken anything given what he gets up to. So I would say that at 3 breaking a bone would be quite unusual.

I think you need to look at the big picture, if there are several things that concern you then follow them up.

I've done a few A&E Visits with risk-taking gymnastic DC1 but nothing major - just some patching up. I agree with PPs - act on your concerns. If all is well, fine, but it sounds very odd.

I didn't think enquires could be made without seeking consent and parents being made aware actually. So all these calls to a nursery sounds a bit odd!
Same as if a nursery or school had concerns the correct protocol is to speak with the parents to make them aware you've referred to social services. The only time this wouldn't be done is if this may pose a threat to the child but this is in cases that are severe and the parents will still be spoken to by social services, just not warned beforehand, more of an unnanounced visit kind of thing.

You do realise that concerns can be raised without the parents being aware; and that in some cases it's stipulated that parents are not made aware of investigations whilst they are being carried out don't you?

I have 6 years experience of working alongside child protection teams, SS and the Police as part of my job with children aged 0-4 and I can't tell you how many cases I've been involved with regarding babies, infants, toddlers and young children with broken bones. If there is ANY suspicion that the injury is not accidental the child is not allowed home and further investigations are carried out - which parents are ALWAYS informed about. It is only when all professionals are satisfied that there are no concerns of abuse is the child allowed home. This can sometimes take days and sometimes it can take weeks.

SS and Police will have been informed straight away and they are attend all meetings about the child and if a decision is made that the injuries were not purposeful the case is closed.

If the SS has concerns about neglect or supervision then they tend to follow the families up and monitor them for a while but from what OP has said though this isn't the case.

I can only talk about my own professional experiences and what happens in the Counties surrounding me but no child is allowed home if there is any abuse suspected and nothing is ever kept from the parents about what we suspect, or what tests we do or what follow-up they will be receiving upon discharge.

I didn't think enquires could be made without seeking consent and parents being made aware actually.

Absolutely. If it may increase the risk to the child if the investigation / enquiries are discussed with the parents/guardians then they are not discussed with the parent/guardian. Same with women who may be experiencing DV (this was me; the concerns were not raised with me until the shit hit the fan and they had me a in a place that I couldn't easily get out of and which they knew was safe).

If there's any reason to believe the alleged abuse may escalate, if the parents may run away with the child, if there's a risk of further harm/death to a child/parent than these allegations are not always discussed with the parent.

"the correct protocol is to speak with the parents to make them aware you've referred to social services. "

This isn't actually correct - the correct protocol is to safeguard the child; there are times when that means not disclosing information has been passed on to the parent (very sadly).

akani - plus, in both my previous posts I have told OP to follow her gut instincts and to report her concerns so I'm not sure how I'm risking a child's life? Despite my experiences I still believe OP should report her concerns and I have never implied differently.

" but no child is allowed home if there is any abuse suspected and nothing is ever kept from the parents about what we suspect,"

This is not inline with safeguarding protocol. You must know, as you work in the field, there are cases where evidence and investigations are not discussed with parents/guardians when it's deemed to be in the best interest of that child.

Go with your gut feeling. I echo everything that has been said - I used to avoid a&e with my dc (never anything fracture or breaks - bumps to the head) because I had paranoia about social services, spoke to my hv about it and turned out I had underlying MH issues and that's where the avoidance stemmed from & have now had the help I need. Just another view on this.

This is not inline with safeguarding protocol. You must know, as you work in the field, there are cases where evidence and investigations are not discussed with parents/guardians when it's deemed to be in the best interest of that child

In situations where parents are arrested on the ward upon admission and are forbidden to visit or phone they are not privy to what we do, but for parents who are allowed to stay with the child they are generally kept fully informed.

We are totally directed by the Police as to what we can or can't say.

About 50% of parents who have been arrested are allowed supervised visits a few times a week (supervised by SS) and again we are guided by the Police as to what information we can pass on.

Thankfully, in my 6 years experience I've probably only come across 10 cases where parents have been arrested and refused access to their child.

But they would be informed at some point, they don't just do a whole investigation behind parents backs!
They may not be told at the beginning per se, but they certainly would be informed of something.

"they don't just do a whole investigation behind parents backs! "

Yes. They can. It's rare, but it does happen. Concerns can also be raised without parent's being made aware through markers on medical notes in A and E (if the child was taken to the same A and E).

The biggest issue now is children often aren't taken to the same A and E department.

So it's possible that A) Parent's aren't aware that there is an investigation ongoing, B) The investigation would have only started after the last incident (potentially), C) Parents haven't told OP that they are being investigated, and D) Hospital(s) are unaware of catalogue of injuries and are treating each on as individual cases.

It really shouldn't be a case of "well this child has been to hospital and so therefore will be safe". This is why we have failed at safeguarding children previously.

I find that difficult to believe.
If someone had a concern and was doing an investigation behind the parents backs, talking to nursery / school / hospital / GPs and so on and in that time something awful happened social services would be under massive scrutiny for not putting things in place to safeguard the child.
I've never heard of social services being able to access all this information without an initial assessment taking place in which written consent in taken to discuss the child / children with outside agencies and other professionals.

"would be under massive scrutiny for not putting things in place to safeguard the child."

Sometimes the safeguarding measure that is put in place is to not disclose to the parents/guardian.

My ds when 2 fell at nursery green stick breaks to cheek bone and eye socket exactly 1 week later fell again at nursery (same place 😠) concussion and goose egg the size of golf ball! 3 days later fell again broken arm. Both the hospital and I reported the nursery (was council run) to health and safety pulled him from their care
Nursery was closed by h &s other parents were angry with me for reporting them😞
Yes accidents happen but that's a lot someone is not looking after him properly