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BackgroundBilateral skull fractures in infancy often raise suspicion for abuse. Nevertheless, literature suggests that they may occur accidentally. However, empiric data are lacking.ObjectiveThis multicenter retrospective review aimed to characterize bilateral skull fractures in a large sample.Participants and SettingMedical records for infants younger than 24 months with bilateral skull fractures involving hospital consultation with a child abuse pediatrician (CAP) were reviewed from 2005 to 2020 at 13 nationally represented institutions.MethodsStandardized data collection across institutions included historical features, fracture characteristics, and additional injuries, as well as the CAP's determination of accident versus abuse. Pooled data were analyzed for descriptive and bivariate analyses.ResultsFor 235 cases, 141 were accidental, and 94 abuse. The majority occurred in young infants, and a history of a fall was common in 70% of cases. More than 80% involved both parietal bones. Bilateral simple linear fractures were more common in accidental cases, 79% versus 35%, whereas a complex fracture was more frequent in abuse cases, 55% versus 21% (P < 0.001). Almost two thirds of accidental cases showed approximation of the fractures at the sagittal suture, compared with one third of abuse cases (P < 0.001). Whereas focal intracranial hemorrhage was seen in 43% of all cases, diffuse intracranial hemorrhage was seen more in abuse cases (45%) than accidents (11%). Skin trauma was more common in abusive than accidental injury (67% vs 17%, P < 0.001), as were additional fractures on skeletal survey (49% vs 3%, P < 0.001).ConclusionsA fall history was common in bilateral skull fractures deemed accidental by a CAP. Most accidental cases involved young infants with biparietal simple linear fractures, without skin trauma or additional fractures. A skeletal survey may aid in the determination of accidental or abusive injury for unwitnessed events resulting in bilateral skull fractures in infants.

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The effect of all aspects of maternal health before, during, and after pregnancy on prenatal and early childhood health and well-being is well documented. Early childhood outcomes have been empirically established as predictors of well-being in later life (Heckman et. al., 2013).  Research on motherhood indicates that social and instrumental support from family of origin has a greater positive impact on adolescent mothers than adult mothers (Nath et. al., 1991). However, the absence of such forms of support among adolescent single mothers might have detrimental implications for maternal and child well-being outcomes.  The role of doulas in providing physical, emotional, and informational support to mothers during labor and post-partum, and fostering positive mother-infant relationships is widely recognized in maternal and child health research. (Ahlemeyer, J., & Mahon, S., 2015, & Hans et. al., 2013). Therefore, community-based doula programs can be an effective way to improve maternal and child health outcomes in populations of adolescent single mothers. This paper proposes adaptation of existing community-based doula programs to the unique features of adolescent parenting by integrating mobile health technology to build an alert virtual ecosystem that facilitates immediate provision of social and instrumental support, and childcare related services to adolescent single mothers at high risk of detrimental birth outcomes.