Child abuse: Epidemiology, mechanisms, and types of abusive head trauma in infants and children
- Cindy Christian, MD
Cindy Christian, MD
- Professor of Pediatrics
- Perelman School of Medicine at the University of Pennsylvania
- V Jordan Greenbaum, MD
V Jordan Greenbaum, MD
- Clinical Assistant Professor
- Emory University School of Medicine
- Section Editors
- Daniel M Lindberg, MD
Daniel M Lindberg, MD
- Section Editor — Pediatric Psychosocial Emergencies
- Associate Professor of Emergency Medicine and Pediatrics
- University of Colorado Kempe Center
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
- Douglas R Nordli, Jr, MD
Douglas R Nordli, Jr, MD
- Section Editor — Pediatric Neurology
- Chief of Neurology
- Children’s Hospital Los Angeles
- Vice Chair of Neurology
- USC Keck School of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The epidemiology, mechanisms, and types of head injury found in abused children are reviewed here.
The clinical features, evaluation, and diagnosis of abusive head trauma in infants and children, including ophthalmologic aspects, and the management of suspected child abuse are discussed separately. (See "Child abuse: Evaluation and diagnosis of abusive head trauma in infants and children" and "Child abuse: Eye findings in children with abusive head trauma (AHT)" and "Physical child abuse: Diagnostic evaluation and management".)
Abusive head trauma includes inflicted cranial, cerebral, and spinal injuries resulting from blunt force trauma, shaking, or a combination of forces [1,2]. The injuries themselves may be primary or secondary. The classic injury pattern that is associated with shaking includes diffuse unilateral or bilateral subdural hemorrhage, diffuse multilayered retinal hemorrhages, and diffuse brain injury. This pattern has been referred to as the "shaken baby syndrome" and "shaken/impact syndrome" [3,4]. The absence of a history of trauma and a paucity of external manifestations of injury can make recognition of the inflicted nature of these injuries difficult. The AAP has recommended that the term "shaken baby syndrome" be replaced in medical records with the broader term "abusive head trauma", which allows for consideration of multiple mechanisms of injury in any child . Generic terms, such as "head injury", also serve to distinguish the diagnosis of injury from the investigation of how the injury occurred [2,5].
The mechanism of brain injury is only one factor that must be considered in making the diagnosis of abusive injury. The significance of the diagnosis (with regard to child protection and criminal prosecution) may be similar, regardless of whether injury resulted from direct blows or from shaking . In addition, much of the evidence to support the mechanism of injuries that result from shaking is retrospective and indirect. (See 'Mechanisms of injury' below and "Child abuse: Evaluation and diagnosis of abusive head trauma in infants and children", section on 'Diagnosis'.)
Child abuse occurs most often among children less than four years of age . In one population based study, the most common mechanism of injury for infants three to five months of age was battering . Among young children, head injury, in particular, is often inflicted. This is illustrated in the following reports:
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- Prior history of abuse
- Risk factors
- MECHANISMS OF INJURY
- Primary injury
- Secondary injury
- TYPES OF INJURY
- Retinal hemorrhages
- Intracranial bleeding
- - Subdural hemorrhage
- - Epidural hemorrhage
- - Subarachnoid hemorrhage
- - Parenchymal injuries
- Spinal and paraspinal injuries
- Skull fractures
- Skeletal fractures