With investigations into early life having recently intensified, revealing how these initial experiences are vital for health and wellbeing across the life course, it is pertinent that further attention is afforded to pathological changes in these young individuals. Periosteal new bone formation (PNBF) in fetal-infant individuals has long been identified and recorded within both clinical and osteological investigations. Yet, understanding of these skeletal responses is insufficient. In particular, the interpretation of PNBF, and the macroscopic differentiation between normal and pathological PNBF, is a perpetual challenge. The homogeneity of physiological and pathological PNBF has meant that correctly recognising and interpreting PNBF in rapidly growing individuals is problematic.

This paper explores contemporary issues with identifying pathological PNBF in non-adults, and the importance of distinguishing between types of PNBF as well as the location, extent, and severity of lesions. Exploring patterns of PNBF needs to be undertaken more consistently to improve our understanding and interpretation of fetal-infant health in the past. It is only through standardised methods, of higher and more specific resolution, that we can fully understand pathological changes in fetal-infant individuals and consider patterns of the health and wellbeing over time.

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