A retrospective chart review was conducted at an urban U.S. academic children's hospital that involved 388 children younger than 3 years old who were hospitalized for the treatment of an acute primary skull or long-bone fracture between 1994 and 2000. Children with perpetrator-admitted child abuse, metabolic bone disease, birth trauma, or injury caused by vehicular crash were excluded from the study. The main outcome measures were the ordering of skeletal surveys and the filing of reports of suspected abuse. The study found that reports of suspected abuse were filed for 22.5 percent of white and 52.9 percent of minority children. Abusive injuries, as determined by expert examination, were more common among minority children than among white children (27.6 percent compared to 12.5 percent). Minority children ages at least 12 months to 3 years (toddlers) were significantly more likely to have a skeletal survey performed compared with their white counterparts, even after controlling for insurance status, independent expert determination of likelihood of abuse, and appropriateness of performing skeletal survey. This group of children was also more likely to be reported to CPS compared with white toddlers, even after controlling for insurance status and likelihood of abuse. Minority children at least 12 months old with accidental injuries were more than three times more likely than their white counterparts to be reported for suspected abuse. The study concluded that although minority children had higher rates of abusive fractures in the sample, they were also more likely to be evaluated and reported for suspected abuse, even after controlling for the likelihood of abusive injury. This suggests that racial differences do exist in the evaluation and reporting of pediatric fractures for child abuse, particularly among toddlers with accidental injuries. 6 tables and 28 references