Osteogenesis imperfecta (OI) is characterized by bones that break easily. A minor accident may result in a fracture; some fractures may occur while a child is being diapered, lifted, or dressed. It is possible for a person with OI to break a bone without being aware of it. Children who are not diagnosed at birth often suffer a series of painful fractures before health care professionals are able to diagnose the condition.

Child abuse is also characterized by broken bones. In recent years, Americans have become increasingly aware of this problem and major efforts have been undertaken to protect children. Child abuse is a pattern of behavior that often is passed down from one generation to the next. Many abusive parents were themselves abused as children. Open, honest discussion of the issue not only can ensure the safety of countless children but can also encourage parents who wish to break the cycle of abusive behavior to seek the help they need.

Diagnosis: OI or Child Abuse?

False accusations of child abuse may occur in families with children who have milder forms of OI and/or in whom OI has not previously been diagnosed. Types of fractures that are typically observed in both child abuse and OI include:

* fractures in multiple stages of healing
* rib fractures
* spiral fractures
* fractures for which there is no adequate explanation of trauma

When the fracture seems incompatible with the reported cause of the injury, child abuse is often suspected. And, unfortunately, when false accusations of child abuse occur, families become victimized.

The following practical advice, together with competent legal advice from a family law attorney, is intended to help parents who have been accused of child abuse.

1. Each state has its own policy for dealing with child abuse cases. We strongly suggest that you secure the advice and, if possible, the services of a family law attorney as soon as charges of child abuse are brought. Attorney referral services are generally offered by each state's Bar Association. If you are not satisfied with the services that your attorney is providing, don't be afraid to find another attorney to handle your case.

2. Remember, physicians and social services case workers are doing their jobs; whoever reported the suspected child abuse to the social services authorities may be bound by law to do so. Everyone involved is con-cerned about what is best for the child.

3. Seek the best medical diagnosis available. It is of utmost importance that the health care professional (including, but not limited to, an orthopedist familiar with OI) conducting the evaluation have considerable experience in both diagnosing and treating OI.

4. A consultation with a geneticist familiar with OI may reveal a family history of mild OI if symptoms such as blue-tinted sclera (the white part of the eye), presenile hearing loss, rickets, dental problems, short stature, and/or a history of broken bones are identified.

5. Most often, child abuse is suspected when the explanation given by the child or parent does not appear to match the injury found by the treating physicians and other medical personnel. The decisions of the social services agency are based heavily on the medical information given to the agency by the physician.

6. Unless you advise the case worker, do not change the hospital or physicians who are providing medical services to your child. Changes made without the knowledge of the case worker may be interpreted as an attempt to hide the child abuse.

7. Keep the case worker up to date on what is happening. Attempt to confirm with the case worker that he/she understands what you have told them. Demonstrate that you truly want to work together for what is best for your child. Resistance toward the case worker may be interpreted as guilt.

8. If your child is being taken from your home, you may request that he or she be taken to the home of a grandparent or other relative.

9. When the problem is resolved, insist that the charges be taken off all records, including computerized records. If this is not done, you may be registered as an abusive parent until your youngest child is 18 years of age.