V.R.

I. BACKGROUND

S.R. was born in August 2015. On November 5, 2015, when S.R. was around three months old, Mother brought him into the emergency room with a bruised hip. Mother told the doctors S.R. had rolled off the couch onto a guitar-type toy several hours earlier. According to Mother, S.R.’s legs seemed to bend oddly, but she did not find anything else of concern until later, when she noticed blood on the child’s swing and a laceration on the back of his ear. An X-ray indicated S.R.’s femur was fractured in two spots. The doctor thought the injury was inconsistent with Mother’s explanation and possibly nonaccidental, and ordered a full-body X-ray. Further imaging showed multiple fractures of different ages, meaning there were old fractures that had healed over time.2 Lab test results did not support a rickets diagnosis. S.R. was also observed to have an avulsion injury, which could only come from pulling “ ‘very hard’ ” on the ear. Additionally, S.R.’s liver enzymes were off, suggesting there had been a blunt injury or traumatic blow to S.R.’s abdomen. Bruises were observed on S.R.’s forehead and his left jaw line. Father said the bruises were the result of S.R. hitting and…