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Expert Q&A:
What could be the cause of my premature infant's broken ribs?

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Suzanne Dixon
Answered by Suzanne Dixon M.D., M.P.H.
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"There is nothing so amazing as the development of a child," says Suzanne Dixon, M.D., a behavioral and developmental pediatrician who was one of the founding members of the Pampers Parenting Network. "Every day is a new adventure when you have a child around you. I never get tired of learning from the children who have been a part of my life, professionally and personally."Suzanne Dixon, M.D., M.P.H., was born and raised in Minnesota and graduated from the University of Minnesota, School of Medicine. She did her pediatric training at Massachusetts General Hospital in Boston and then completed a fellowship in Child Development at Boston's Children's Hospital. Dr. Dixon joined the faculty at the University of California, San Diego, and did patient care, teaching, and research for 20 years. She ran a large newborn service, performed research in early child development, and was involved in many community outreach activities in maternal child health. Throughout her entire professional life she has maintained an interest in cross-cultural activities, living and working in many parts of the world, including Mexico, India, Kenya, Indonesia, and several countries from the former U.S.S.R. Dr. Dixon is the author of numerous research articles, review articles, and textbook chapters in pediatrics, child and family development, and public health. Her textbook, written with Dr. Martin Stein, Encounters With Children: Pediatric Behavior and Development, has become a classic in child health education and is in its fourth edition. She is Editor in Chief of the Journal of Developmental and Behavioral Pediatrics, an international journal of high standing in the professional world. She also has served as an associate editor for Infant Mental Health and currently reviews for several major pediatric journals. Dr. Dixon is a fellow of the American Academy of Pediatrics and served in national positions in that organization. She is a member of the Society for Pediatric Research, the Society for Research in Child Development, the American Public Health Association, and the Executive Council of the Society for Developmental and Behavioral Pediatrics. She serves as consultant to several national and international organizations and has received an award from Healthy Mothers, Healthy Babies.Dr. Dixon continues to lecture and consult worldwide on aspects of maternal, child, and family health. She practices behavioral and developmental pediatrics in Montana and works with local advocacy groups on education and women''s health. Dr. Dixon has been married for over 30 years and has three sons. She and her husband travel frequently, are outdoor enthusiasts, and enjoy being amateur anthropologists.
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Question


What could be the cause of my premature infant's broken ribs?

Answer


I can't be completely sure what has caused your infant's rib fractures but I can make a pretty good guess, and it has nothing to do with anyone abusing your son. Infants born prematurely often have very weak bones and will get fractures with even normal handling. This is because at the time of birth the bones of preemies have less calcium deposited than if they had been born later. Then there is the problem of getting in the calories and calcium to do the catch-up growing and hardening of the bones. I'm sure you remember how hard it was to get feedings going with your little guy. Added to that is the fact that the activity of the parathyroid gland that regulates calcium is slower to get in gear in the preemie. Finally, some of the medicines that are used and very much needed to help with lung and heart function for the early-born child actually pull calcium out of the body.

So it's unfortunately not uncommon for these weak bones to break. The good news is that they mend well: Any lumps or bumps present now over those ribs will smooth over and not be noticeable at all. At delivery, your doctor applied the forceps around the baby's head to assist in getting him out. It would be almost impossible for the forceps to get near the rib area, so a rib fracture is nearly unheard-of in that circumstance. Rib fractures can occur if the infant is in severe distress at birth and requires chest compressions as part of a major resuscitation effort. In that case, be glad your son is with us as the procedure probably saved his life.
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