Children are active learners: They selectively attend to important information. Rhythmic neural tracking of speech is central to active language learning. This chapter evaluates recent research showing that neural oscillations in the infant brain synchronize with the rhythm of speech, tracking it at different frequencies. This process predicts word segmentation and later language abilities. We argue that rhythmic neural speech tracking reflects infants’ attention to specific parts of the speech signal (e.g., stressed syllables), and simultaneously acts as a core mechanism for maximizing temporal attention onto those parts. Rhythmic neural tracking of speech puts a constraint on neural processing, which maximizes the uptake of relevant information from the noisy multimodal environment. We hypothesize this to be influenced by neural maturation. We end by evaluating the implications of this proposal for language acquisition research, and discuss how differences in neural maturation relate to variance in language development in autism.

Numerous normal anatomical variants in the pediatric skeleton can be mistaken for fracture. It is important to be aware of variants to provide accurate diagnosis and avoid potential false interpretations of possible abuse.

Along the long bone diaphysis, in infants 1–4 months of age, smooth and thin periosteal new bone formation may be physiologic and not indicative of healing fracture. At the metaphyses in the growing skeleton, the subperiosteal bone collar is an osseous ring surrounding the metaphysis adjacent to the physis. It is responsible for variants in metaphyseal morphology, including beaking, step-offs and spurs, which can be mistaken for the classic metaphyseal lesion often associated with child abuse.

Variant ossification patterns at the acromion and pelvis, if unrecognized, can lead to concern for fracture. In addition, congenital abnormalities of the ribs and clavicles, including fusion anomalies and pseudarthroses, can simulate chronic, healing fracture.

This chapter reviews these and other developmental variants, and describes how to differentiate them from true fractures. Artifacts simulating fractures are briefly covered.

This chapter provides a summary of longstanding and updated research for the accurate diagnosis of fractures of the clavicle, sternum and scapula in the setting of suspected physical abuse of infants and young children. Findings key to diagnosing fractures by radiographic skeletal survey, computed tomography, ultrasound and magnetic resonance imaging are demonstrated with numerous representative examples. A section for each of these anatomical regions includes a detailed review of anatomy and injury mechanisms in addition to characteristic imaging features. Considerations for differential diagnosis and pitfalls in interpretation are presented specific to each anatomic area. Attention to imaging technique and careful evaluation of findings are emphasized to promote proper diagnosis.

Abusive spinal injury is important to understand and recognize as it may be the only manifestation of child physical abuse and may result in significant morbidity and mortality if undetected. In this chapter, we review historical literature about spinal trauma in the era of radiography and skeletal surveys as well as the expanding literature, epidemiology and understanding of this manifestation of inflicted injury in the era of increased CT and MRI utilization. We highlight key anatomic considerations of developing infants and young children, which make them susceptible to specific types of inflicted spine trauma with emphasis placed on the craniocervical junction, which is particularly susceptible to injury. We provide many imaging case examples to help the reader understand and recognize the myriad and specific types of injuries that occur. Considering our increased understanding of abusive spinal trauma, we discuss implications to imaging evaluation, technique and screening if inflicted spinal injury is detected or suspected.

Fractures from accidental trauma to the extremities or ribs in young infants are rare. Towards the end of the first year, when infants begin to gain mobility, accident fractures become more common and are quite prevalent in toddlers. All patterns of accidental fractures may also occur due to abuse; however, presentation and clinical and associated physical examination and imaging findings may suggest abuse. Fractures similar to high specificity abusive fractures may rarely occur from accidental mechanisms.

Iatrogenic fractures are rare in infants and young children. Careful review of the purported mechanism and for underlying bone disease is necessary. Radiographic findings may overlap with abusive fractures, suggesting mechanistic similarities.

The clinical approach to the diagnosis of abusive head trauma involves many medical specialties. Careful history, which includes an understanding of pediatric development, differential diagnosis of medical conditions and the types of injuries that can result in head trauma is necessary. The collaboration with radiologists, neuroradiologists, ophthalmologists, neurosurgeons and many other specialists provides informative insight into a child’s presentation of head trauma, whether accidental or inflicted through an abusive act. This chapter informs the clinical and biomechanical evidence associated with injuries often seen in cases of abusive head trauma, and highlights how collaboration between researchers in both fields can enhance the safety and protection of children.

The lower extremities are common sites of abusive skeletal injuries, with fractures often serving as the initial clue to raise suspicion of abuse, and prompt further clinical and imaging investigation. This chapter examines the fracture types, histologic characteristics and imaging findings of skeletal injuries in the femur, tibia and fibula. Notably, the classic metaphyseal lesion, a highly specific indicator of infant abuse, is prevalent in the lower extremities. Detecting these subtle injuries requires rigorous imaging and meticulous inspection of the initial skeletal survey images. The chapter also reviews advanced imaging with ultrasound, CT, MRI and scintigraphy for characterization of complex injuries.

The function, composition and processes underlying the formation and maturation of the skeleton, bone the organ and bone the tissue, are the focus of this chapter. Knowledge of the immature infant skeleton and its inherent weaknesses and susceptibility to physical injury, facilitates understanding the morphologic manifestations of bone injury and the body’s response to associated tissue damage. The skeleton is a complex structure that plays a variety of different roles crucial to life. It is composed of many individual bones that are constructed of proteins, minerals and the cells specific to bone, namely, the families of osteoblasts and osteoclasts. Bones form through enchondral and intramembranous ossification, and these processes are complex and tightly regulated by molecular genetics and cell-signaling pathways. Understanding the structure of the skeleton and its growth and development provides the foundation to understand its susceptibility to trauma and the pathology induced by injury and tissue damage.

This chapter presents a scheme for best estimating the age of a fracture in a young child. It describes the features of healing fractures in children. It presents the current literature, addressing rates of healing, factors that may affect healing and how the radiographic findings change during phases of healing. In addition, the authors emphasize the role a radiologist plays in the establishment of an injury timeline. By understanding the contemporary literature, a reader will be able to estimate the age of fractures using the healing features depicted on a radiograph or series of radiographs.

Osteogenesis imperfecta (OI), colloquially known as “brittle bone disease,” must be routinely considered in all children presenting with recurrent or unexplained fractures. Proper medical work-up includes careful consideration of the history of present illness, review of growth patterns including length/ height, past medical history, family history, physical examination, radiographic and laboratory findings. For decades, OI was described as four major types categorized largely based on clinical features, but in the modern era of genomics, there is more expanded molecular diagnosis and nomenclature. In general, OI can be clinically categorized into mild, moderate, and severe forms. In unexplained fractures in infants, mild forms of OI present an important differential diagnosis to child abuse; more moderate and severe types are usually readily diagnosed based on clinical and radiographical presentation. There is a role for judicious use of genetic testing in cases where OI is a possibility. Ehlers-Danlos syndrome has been purported to cause fractures and mimic child abuse in infants and young children, but this is a flawed explanation largely manufactured for courtroom purposes. By understanding the natural history of OI versus other connective tissue disorders, and by adopting appropriate clinical strategies and evidence-based practices, multidisciplinary clinical teams enhance diagnostic accuracy and improve clinical outcomes for children in our care.

Consideration of possible alternatives to child abuse as an explanation for skeletal abnormalities during a child abuse investigation is an essential element of due diligence by all healthcare professionals involved in these cases, including and, in particular, radiologists.

Conditions which may have features resembling sequelae of child abuse include bone fragility states, conditions with metaphyseal abnormalities resembling classical metaphyseal lesions and conditions featuring subperiosteal new bone formation. Further suspicion for child abuse may be raised when there are associated extraskeletal mimics of abuse, such as skin lesions.

This chapter explores a range of genetic, nutritional and other acquired disorders which may present in this fashion.

Fractures are common in physically abused infants and young children, and they are often central to the diagnosis of maltreatment. Given the anatomic and biologic framework provided in the preceding chapter, the discussion now moves on to the specific features of these important and frequently distinctive osseous injuries. The authors begin with a review of the epidemiology, anatomic distribution and specificity of fractures noted in abused infants and children. The discussion then proceeds to systematically describe the specific osseous alterations, providing radiologic correlations with histopathology to enhance the reader’s understanding of the various patterns of bony injury and repair. These correlations also help to elucidate the proposed mechanisms underlying these important indicators of abusive injury. Although this discussion of the imaging features focuses on fractures of the long bones, the principles presented here should serve as a background for subsequent chapters dealing with injuries of the axial skeleton.

This chapter asks how newborns were cared for and charts the formulaic regimen of encouraging babies to cry, watching them change colour, cutting their navel cord, searching their bodies for impediment, bathing them, swaddling them, putting them down to sleep and, finally, suckling them. Medical guides imagined that it would be mothers that did this care, but middling and elite families often hired nurses to manage this laborious regimen. These individuals were often already servants or recommended by family or friends. In the period, servants and others residing within the household were called ‘family’. In this way, making babies was a family project, albeit one in which family members did not have equal stakes and one in which mothers’ and other women’s procreative work was often subsumed within everyday expectations of domestic labour. Although nurses and others who carried out infant care were sought carefully, details about their lives and perspectives are often hard to find in family paperwork, which was often more interested in what procreative experiences said about the family and its name, rather than valuing others’ work.

This chapter has been designed to help you learn about: how others plan for play-based learning and intentionality in the The Early Years Learning Framework for Australia (V2.0); what a Conceptual PlayWorld looks like for three groups – infants and toddlers, preschoolers, and children transitioning to school; how to design a Conceptual PlayWorld to support cultural competence; and how to plan a Conceptual PlayWorld for a range of educational settings.

Taking the child’s perspective means looking at the world through the eyes of the infant or the child. This can help us to better understand play practices and better plan for children’s learning and development. But how do we do this in practice? In this chapter we explore these ideas and help you design programs where you gain insight into the importance of documenting infants’ and young children’s perspectives on their play and identify a range of practical ways to find out children’s perspectives on their play.