Abusive Head Injury and Shaken Baby Syndrome (From Child Abuse and Neglect: Guidelines for Identification, Assessment, and Case Management, P 34-40, 2003, Marilyn Strachan Peterson and Michael Durfee, eds. -- See NCJ-200932)

• NCJ Number: 200935
• Author(s): Stephen C. Boos M.D.
• Date Published: 2003
• Length: 7 pages
• Sale Source: Volcano Press, Inc
• Publication Format: Book (Softbound)
• Publication Type: Instructional Material
• Language: English
• Country: United States of America

Annotation

This chapter discusses medical practitioners' screening for and recognition of abusive head trauma in infants that may be indicative of shaken baby syndrome.

Abstract

The chapter advises that once threatening conditions are addressed and patients are stabilized, the health-care provider's first responsibility in pediatric head injury is to identify the possibility of abuse. Recognizable patterns in the patient's history and physical findings can alert medical providers to most cases of child abuse. Once alerted, careful consideration should be given to the epidemiology, biomechanics, pathophysiology, and differential diagnosis of head trauma. A section in the chapter on the child's patterns of trauma considers medical history related to trauma, syndromes (groups of individual findings that have special meaning when they co-occur), and individual physical findings. The section of the chapter on epidemiology notes that during infancy (under 1 year of age), 50 percent to 95 percent of children's serious head injuries may be due to abuse. Thirty to 50 percent of children with abusive head injury have evidence of earlier head injury. A section on the biomechanics of head injury notes that a shaking mechanism can cause brain injury without any indication of external impact. This mechanism has led to the postulation of what is called "shaken baby syndrome" by many experts in child abuse. Biomechanical studies done on primates and human volunteers have established that head acceleration, without impact, is adequate to cause all of the injuries observed in shaken baby syndrome. A section of the chapter on pathophysiology considers what happens to the brain and surrounding tissue during and after head trauma. In a discussion of differential diagnosis, the chapter advises that the most important diagnosis to exclude is accidental injury. Also discussed in the chapter are the medical reporting of suspicions of head injury due to abuse, the poor prognosis for inflicted head injuries, and the implementation of prevention programs that educate parents about shaking their babies and instruct health-care providers in the early detection of abuse. Three relevant case vignettes are presented, followed by related questions that must be answered by medical practitioners in the cases. 52 references