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nappy was being changed; there was a "crack," and he was distressed. In our view it is unwise to label these fractures as spontaneous, although the force required may be less than that needed to fracture well mineralised bones. A difficulty arises if a non-accidental injury has occurred: if the fracture has been accepted as spontaneous the child is left unprotected. Children with disability are at greater risk of abuse than their peers, and some of these fractures will be the result of abuse.23 Have Lingam and Joester considered why the school attended by the subjects of their reports apparently has such a high incidence of fracture of the femur?

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