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Our neighbor's child is in and out of the doctor's office every month. His parents tell us he has a bone condition that makes it look like they abuse him. We're just not sure what to think. Is there such a thing?

Child abuse is a very serious problem in this country. Injuries from nonaccidental trauma (NAT) are probably under reported. NAT include soft tissue injuries, fractures, and internal damage. Many children never see a doctor and go undiagnosed and unrecognized.

The majority of deaths from child abuse occur in children under the age of three. The abuser is usually one or both parents or one parent acting with another person. Death from child abuse is four times more likely in children with NATs compared with victims of accidental trauma.

Any socio-economic group can be affected. Risk factors include blended families (step children), a child with a mental or physical handicap, drugs used in the home, and parents who were victims of child abuse themselves. Death is more likely among African-American children who are abused.

There are several medical conditions that can cause bruising and/or fractures that mimic child abuse. These include leukemia, osteogenesis imperfecta (OI), hemophilia, rickets, and syphilis passed from the mother to the child at birth. Some kidney disorders and reactions to drugs can cause changes in the bones that look like child abuse.

Your neighbor's child may have OI, sometimes known as brittle bone disease. This is a genetic bone disorder caused by a lack of Type I collagen. Collagen is a protein needed to make strong bones. Without it, the child with OI has weak or fragile bones that fracture easily.

Medical doctors, nurses, and other health care professionals are trained to recognize true signs of abuse. There are many ways to recognize abuse from other conditions. It might help you to find out the name of the condition your neighbor's child has. Knowing more about the disease process may help you understand your neighbor's situation.

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