Abusive head trauma in infants and young children

Visão geral 
Teoria 
Diagnóstico 
Tratamento 
ACOMPANHAMENTO 
Recursos 

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Última revisão das evidências: 17 Feb 2026

Última atualização do tópico: 10 Nov 2025

Abusive head trauma in infants and young children is diagnosed when there is unexplained injury to the skull, brain, and/or spinal cord with 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.

Definição

Abusive head trauma refers to the constellation of cranial, spinal cord, and brain injuries that result from deliberately inflicted injury in infants and children.[1] 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][2]

História e exame físico

Principais fatores diagnósticos

age <3 years
altered mental status: irritability/lethargy/coma
clinical findings inconsistent with carer history
retinal/vitreal hemorrhages or retinoschisis
apnea

Detalhes completos

Outros fatores diagnósticos

no known history of trauma
seizure
vomiting
loss of muscle tone
brisk or asymmetric reflexes
unexplained bruising
increasing head circumference
bulging fontanelle
long-bone fractures
mucosal injury or torn labial/lingual frenulum
anogenital signs and symptoms

Detalhes completos

Fatores de risco

age <1 year
peak of normal crying curve
male caregiver
unrelated adult household member
male sex
socioeconomic stressors

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

cranial CT scan
CBC
liver function tests
toxicology screen
prothrombin time (PT)/activated PTT/fibrinogen/von Willebrand testing
urinalysis
cerebrospinal fluid analysis
cranial MRI

Detalhes completos

Investigações a serem consideradas

spinal MRI
cranial ultrasound
skeletal survey
complementary imaging
blood culture
serum calcium
serum 1,25-dihydroxy vitamin D levels (calcidiol)
serum inorganic phosphorus
serum parathyroid hormone (PTH)
serum alkaline phosphatase
skin biopsy/fibroblast culture
postmortem exam

Detalhes completos

Algoritmo de tratamento

AGUDA

all patients

Colaboradores

Autores

Barney Scholefield, MBBS, BSc, MSc, MRCPCH, PhD

Consultant in Paediatric Intensive Care

NIHR Clinician Scientist

Birmingham Women’s and Children’s NHS Foundation Trust

Birmingham

Declarações

BS receives grant funding from the UK NIHR Clinician Scientist Fellowship programme.

Agradecimentos

Dr Barney Scholefield would like to gratefully acknowledge Dr Joe Brierley, Dr Gavin Wooldridge, and Dr Alice Newton, previous contributors to this topic.

Declarações

JB, GW, and AN declare that they have no competing interests.

Revisores

Amy Goldberg, MD

Attending Physician

Child Protection Team

Hasboro Children's Hospital

Assistant Professor of Pediatrics

Alpert Medical School

Brown University

Providence

Declarações

AG declares that she has no competing interests.

Rebecca Moles, MD

Division Chief

Child Protection Program

UMass Memorial Medical Center

Worcester

Declarações

RM declares that she has no competing interests.

Créditos aos pareceristas

Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.

Declarações

As afiliações e declarações dos pareceristas referem--se ao momento da revisão.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Narang SK, Haney S, Duhaime AC, et al. Abusive head trauma in infants and children: technical report. Pediatrics. 2025 Mar 1;155(3):e2024070457.Texto completo

Nuño M, Pelissier L, Varshneya K, et al. Outcomes and factors associated with infant abusive head trauma in the US. J Neurosurg Pediatr. 2015 Nov;16(5):515-22.Texto completo Resumo

National Institute for Health and Care Excellence (UK). Child maltreatment: when to suspect maltreatment in under 18s. October 2017 [internet publication].Texto completo

American College of Radiology. ACR appropriateness criteria: suspected physical abuse - child. 2016 [internet publication].Texto completo

American College of Radiology. Practice parameter for the performance and interpretation of skeletal surveys in children. 2021 [internet publication].Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Accidental head trauma
- Birth trauma
- Central nervous system infection: meningitis and encephalitis
Mais Diagnósticos diferenciais
Diretrizes
- Abusive head trauma in infants and children: technical report
- 2024 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations: summary from the basic life support; advanced life support; pediatric life support; neonatal life support; education, implementation, and teams; and first aid task forces
Mais Diretrizes
Conectar-se ou assinar para acessar todo o BMJ Best Practice

O uso deste conteúdo está sujeito ao nosso aviso legal

Abusive head trauma in infants and young children

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

all patients

Colaboradores

Autores

Barney Scholefield, MBBS, BSc, MSc, MRCPCH, PhD

Declarações

Agradecimentos

Declarações

Revisores

Amy Goldberg, MD

Declarações

Rebecca Moles, MD

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice