Child-Abuse: Nonaccidental Trauma

Michelle Ge, Sean Barber, Lora Kahn, and Jaime Gasco

What is the most common cause of traumatic mortality in infants?

Inflicted injury

Is there a recognizable pattern of physical and behavioral signs and symptoms that warrant consideration of child abuse?

Yes; in the mid-1900s John Kempe proposed the battered-child syndrome and John Caffey came up with the shaken-baby syndrome.

Why are the terms inflicted injury and nonaccidental injury used instead of terms like shaken-baby syndrome?

Because the diverse injuries that children present with stem from a diverse range of mechanistic causes and usually not from a single specific cause (as the term shaken-baby syndrome implies)

What makes recognizing child abuse patients difficult upon presentation?

Withholding of the true history of present illness and nonspecific symptoms

What are some signs that can be associated with inflicted head injury?

• Single acute neurological events

• Acute or healing skeletal trauma

• Chronic subdural hemorrhages

• Retinal hemorrhages

• Bruising

• Signs of physical neglect

What findings indicate a more severe acute injury syndrome?

Apnea and hypoxia

What is the estimated risk of suffering inflicted neurotrauma?

1 in 4065 by age 1

True

True or false: Most inflicted neurotrauma cases occur in children >2 years of age.

False; the mean age of children inflicted with neurotrauma is <1 year of age.

What are the risk factors for inflicted injury?

• Young parents

• Low socioeconomic status

• Socially unstable households

• Single parents

• Infant prematurity

• Parents or caregivers were subjected to abuse when they were children

• Parents or caregivers have psychiatric or substance abuse histories

What are the most frequent perpetrators of inflicted child injury?

• Fathers (37%)

• Mothers’ boyfriends (20.5%)

• Female babysitters (17.3%)

• Mothers (12.6%)

What are the two most common histories given by caregivers when children present with nonaccidental head trauma?

History of trivial blunt trauma (usually a fall from a short height, like from a bed) and no history of trauma

What are some signs and symptoms to look for when there is no reported history of trauma?

• Difficulty with feeding or vomiting

• Lethargy

• Irritability

• Abnormal movements

• Seizures

• Apnea

• Unresponsiveness

How is the best and most helpful history acquired?