Screening Infants and Children at Risk for Fractures Clinical Pathway — Inpatient

Inpatient Clinical Pathway for Screening
Infants and Children at Risk for Fractures

Goals and Metrics
Patient Education
Provider Resources
Admitted Infants and Children
No Risk Factors
Infant < 12 mos
with ≥ 1 risk factors
Child ≥ 12 mos
with ≥ 1 risk factors
Nutritional Interventions
  • TPN panel or
  • CMP and Phosphorus
  • Review available X-rays
Normal
Abnormal
Repeat Primary Screen
q2-4wks
Abnormal
Normal
  • Consider stopping primary screen
    at 37 wks corrected gestational age
  • or
  • After 2-3 normal primary screens despite chronic risk factor(s)
Abnormal
Fragile Bones Prevention
and Management
Child Primary Screening
  • Fragile Bones Sign
  • Review existing radiology reports
    • Demineralization
    • Osteopenia
    • Rickets
  • Neonatal and Pediatric Bone Health Orderset
Low or Normal 25(OH) Vit D
Other labs Normal
Low or Normal 25(OH) Vit D
Other labs Abnormal
Fragile Bones Prevention
and Management
  • Consider stopping primary screening after 2-3 normal screens despite chronic risk factors
Continued screening per Bone Health
Known High Fracture Risk
Fragile Bones Prevention and Management
Posted: January 2021
Revised: September 2024
Editors: Clinical Pathways Team
Evidence
CHOP Programs