Growth recovery lines: a specific indicator of child abuse and neglect?

  • Lora R. SpillerEmail author
  • Nancy D. Kellogg
  • Maria-Gisela Mercado-Deane
  • Anthony I. Zarka
  • Jonathan A. L. Gelfond
Original Article



Growth recovery lines are radiodense lines in long bones reported to be indicators of stress.


The purpose of this study was to understand the distribution, quantity and associations of growth recovery lines in children ages 0–24 months with high and low risk for child maltreatment.

Materials and methods

We conducted a retrospective cohort study of children ages 0–24 months who had skeletal surveys and an assessment for maltreatment. Growth recovery lines, fractures and osteopenia were assessed independently by two pediatric radiologists blinded to the abuse likelihood.


Of the 135 children in this study, 58 were in the low-risk group, 26 were in the neglect group, and 51 were in the physical abuse group. Children in the neglected and physically abused groups had 1.73 times (95% confidence interval [CI] of 1.16, 2.59), P=0.007) and 1.84 times (95% CI 1.28, 2.63, P<0.001) more growth recovery lines than the low-risk group, respectively. Growth recovery lines occurred at an earlier age in the neglect group (age interaction P=0.03) and abuse group (age interaction P=0.01) compared to the low-risk group. The specificity for maltreatment in children with at least 10 growth recovery lines in the long bones was greater than 84%, while sensitivity was less than 35%. The most common locations for growth recovery lines were distal radius, proximal tibia and distal tibia.


In the absence of a known major stressor, physical abuse and neglect should be considered in children younger than 24 months with at least 10 growth recovery lines.


Child abuse Children Growth recovery lines Infants Neglect Radiography Skeletal survey 



The authors thank Qianqian Liu, who performed statistical programming and generated tables and graphics for this manuscript. The authors thank Robert Geller, who programmed the data collection tool in REDCap.

Compliance with ethical standards

Conflicts of interest



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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Pediatrics / Division of Child AbuseUT Health Science Center at San AntonioSan AntonioUSA
  2. 2.Department of RadiologyChildren’s Hospital of San AntonioSan AntonioUSA
  3. 3.Department of Epidemiology and BiostatisticsUT Health Science Center at San AntonioSan AntonioUSA

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