Suspected Non-Accidental Trauma in Children and The Role of CPS

A spiral fracture of a leg bone is caused by torsion (twisting force) applied to the leg, and occurs most frequently when the foot is stationary.  The result is a fracture that runs almost parallel along the bone.  In adults, these types of fractures are commonly seen after a skiing accident or falling down the stairs.  In children, a fall on an inflatable bouncy house can cause a spiral fracture.  However, with children, spiral fractures can also result from serious physical abuse.  Because of their severity, many pediatricians treat spiral fractures in children as abuse related unless there is a good explanation for the injury.  Further, with their statutory mandatory reporting obligation, doctors must report injuries they feel were caused by non-accidental trauma to Arizona Child Protective Services (CPS) or law enforcement. 

Suspected non-accidental trauma (“SNAT”) could be a hand-print bruise on a child’s lower back, or a circular burn on a child’s forearm.  In other words, a bruise that resembles physical abuse or a burn that is the diameter of a cigarette, are commonly recognized SNAT.  These injuries, when brought to the attention of Phoenix-area doctors and nurses or Arizona CPS, will result in intervention by CPS into the injured child’s family.  Depending on the degree of abuse, the child and that child’s siblings could be removed from their parents or guardians and placed into foster care.  If the SNAT is a spiral fracture of a child’s leg, placement in foster care is almost certain, even when the parents have a good explanation for the fracture (like a fall on a bouncy house).

I have handled multiple spiral fracture cases involving Arizona CPS.  My most recent case prompted this article.  It was a case where an infant was taken to the local Glendale emergency room because his parents suspected an injury.  The injury, as told by the parents, occurred when one of them, while sitting at the kitchen table, dropped the child approximately 18 to 24 inches from their lap to the tiled floor.  The child was clearly in pain and was rushed to the ER.  Upon examination, the child was sent to Phoenix Children’s Hospital and diagnosed with a spiral fracture of the femur.  The hospital’s social worker immediately intervened after one of the many doctors who saw the child exclaimed there is no way the injury was accidental.  The parents were immediately placed on the defensive after they had done what any responsible parent would have – taken the child the ER.

We all expect ERs to be hectic places where decisions may have to be made quickly.  However, accusing parents of physical abuse is not something that should be done by one of many doctors who may or may not have spoken with the parents of the child before classifying an injury as abuse.  We can all imagine a situation where an 8 year old from Mesa was brought into an ER because their arm was broken after a fall from a bike.  However, imagining that the parents of that child are accused of physical abuse and may not be able to take their child home because of the accusation is a little more difficult to digest.

In this case, the morning following the child’s accident, the parents were not allowed to leave the hospital with their baby.  CPS informed them they were under investigation for the abuse of their 5 week old child and both their infant and their 3 year old were going to be taken into the state’s custody until the CPS and the police investigations were completed. 

In a case involving spiral fractures, the parents are essentially guilty until proven innocent.  Because of that, these clients were forced to jump through many hoops to satisfy CPS and the police.  My clients participated in numerous evaluations and screenings.  Not only were the parents subjected to evaluations, but the client’s older child, who had no visible injury, was subjected to a full-body bone scan to determine if there were old injuries.  They eventually were allowed to move in with the children’s grandparents (their parents), who were designated physical custodians of the children while the state remained legal custodian.  However, they were not allowed to spend any “unsupervised” time with their children and were forced out of their home for months.


Effectively defending abuse and neglect cases takes more than a rudimentary knowledge of criminal or juvenile court practice.  It involves understanding the science behind the allegation, knowledge of the experts in the field, and the ability to synthesize the medical and legal information to convince a judge or jury that what occurred was not abuse.