Abusive head trauma in infants and children - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

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.

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Bruising on the ear of a 10-month-old infant
Torn labial frenulum with associated bruising in a neonate
Retinal hemorrhages in abusive head trauma are usually widespread and multilayered, as seen in this image
CT scan revealing subdural hemorrhage extending over the right convexity and in the intrahemispheric region, as well as enlargement of the extra-axial fluid spaces
CT findings in fatal abusive head trauma often reveal significant brain edema with loss of gray-white differentiation and effacement of the ventricles. Subdural blood is often difficult to appreciate in such cases
MRI depicting subdural hygromas surrounding severe brain atrophy from abusive head trauma. This child was initially erroneously diagnosed with meningitis

Citations

Key Articles

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. [Abstract][Full Text]
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.[Abstract][Full Text]
National Institute for Health and Care Excellence (UK). Child maltreatment: when to suspect maltreatment in under 18s. October 2017 [internet publication].[Full Text]
Piteau SJ, Ward MG, Barrowman NJ, et al. Clinical and radiographic characteristics associated with abusive and nonabusive head trauma: a systematic review. Pediatrics. 2012 Aug;130(2):315-23.[Abstract]
Christian CW, Levin AV, Committee on Child Abuse and Neglect, et al. The eye examination in the evaluation of child abuse. Pediatrics. 2018 Aug;142(2):e20181411.[Abstract][Full Text]
American College of Radiology. Practice parameter for the performance and interpretation of skeletal surveys in children. 2021 [internet publication].[Full Text]

Other Online Resources

National Center on Shaken Baby Syndrome

Referenced Articles

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