Abusive head trauma in infants and young children

Abusive head trauma refers to the constellation of cranial, spinal cord, and brain injuries that result from inflicted injury in infants and young children.

Diagnosis generally rests on the finding of unexplained injury to the skull, brain, and/or spinal cord in an infant who has no other medical explanation for their clinical presentation.

Frequently, there are other associated findings such as widespread retinal hemorrhaging, unexplained bruising, fractures and/or abdominal trauma. These additional findings are not necessary to make the diagnosis of abusive head trauma.

The clinical presentation and degree of injury occur on a spectrum from mild to severe. Management is supportive, with intervention to stop seizures and reduce intracranial pressure if needed.

Around 10% of victims die from their injuries.

Most surviving victims are at high risk of permanent neurologic damage, vision loss, and pervasive cognitive deficits and behavioral issues ranging from moderate to severe.

Children with inflicted brain injury have worse neurocognitive outcome than those with accidental head trauma.

In many cases repeated injury has occurred, as documented by the finding of old injuries such as fractures and previous head injury.

Abusive head trauma describes head injuries that are deliberately inflicted on infants and children.[1]Narang SK, Fingarson A, Lukefahr J; Council on Child Abuse and Neglect. Abusive head trauma in infants and children. Pediatrics. 2020 Apr;145(4):e20200203. https://pediatrics.aappublications.org/content/145/4/e20200203.long http://www.ncbi.nlm.nih.gov/pubmed/32205464?tool=bestpractice.com The term includes injuries caused by shaking and by direct trauma to the head.

Abusive head trauma may be associated with other forms of physical abuse that may result in bruising, fractures, or abdominal injury in addition to brain injury.[1]Narang SK, Fingarson A, Lukefahr J; Council on Child Abuse and Neglect. Abusive head trauma in infants and children. Pediatrics. 2020 Apr;145(4):e20200203. https://pediatrics.aappublications.org/content/145/4/e20200203.long http://www.ncbi.nlm.nih.gov/pubmed/32205464?tool=bestpractice.com [2]Sieswerda-Hoogendoorn T, Bilo RA, van Duurling LL, et al. Abusive head trauma in young children in the Netherlands: evidence for multiple incidents of abuse. Acta Paediatr. 2013 Nov;102(11):e497-501. http://www.ncbi.nlm.nih.gov/pubmed/23909838?tool=bestpractice.com