Rationale and evidence
Rationale
There is no consensus protocol on bone-age assessment of younger children and infants, particularly those under the age of 2. Skeletal growth and maturation is most rapid in infants and toddlers, so accurate bone-age assessment in these children is challenging.
Of the bone-age measurement techniques available, there is a major inadequacy with one of the most used methods, the limited change in the appearance of the ossification centres of the hand/wrist change in the first months of life. A recent survey found much lower rates of confidence in the accuracy of this technique when applied to the 1-to-3-year-old group. Although a recently reported and validated bone-age measurement technique based on fibular shaft length was found to outperform other methods, it still yielded significant errors when applied to infants (i.e. under 1 year).
Evidence
Breen, M.A., Tsai, A., Stamm, A. et al. Bone age assessment practices in infants and older children among Society for Pediatric Radiology members. Pediatr Radiol (2016) 46: 1269.
Tsai A, Stamoulis C, Bixby SD, et al. Infant bone age estimation based on fibular shaft length: model development and clinical validation. Pediatr Radiol (2016) 46: 342–356.