Child's Nervous System

, Volume 23, Issue 5, pp 499–507

Nonaccidental head trauma in infants

Original Paper

DOI: 10.1007/s00381-006-0267-4

Cite this article as:
Gerber, P. & Coffman, K. Childs Nerv Syst (2007) 23: 499. doi:10.1007/s00381-006-0267-4

Abstract

Background

Nonaccidental head trauma in infants is the leading cause of infant death from injury.

Results and discussion

Clinical features that suggest inflicted head trauma include the triad of the so-called shaken baby syndrome, consisting of retinal hemorrhage, subdural, and/or subarachnoid hemorrhage in an infant with little signs of external trauma. Studies have shown that, in general, the average short fall in the home is extremely unlikely to produce either subdural or retinal hemorrhage, although focal injuries such as skull fractures and epidural hemorrhage may be seen. Acceleration/deceleration, especially of the rotational type, is believed to be the most probable mechanism of injury in cases of nonaccidental head trauma. Damage to the cervicomedullary junction and the respiratory centers, with subsequent hypoxia and intracerebral edema, has also been implicated. After the initial trauma and hemorrhage, loss of cerebral autoregulation, breakdown of the blood-brain barrier, and disruption of ionic homeostasis occur, leading to brain edema and cytotoxicity. Cellular damage can involve large volumes of tissue, without respecting vascular territories.

Conclusion

Overall, a satisfactory biomechanical model is lacking, and the criminal nature of abusive injury makes it difficult to perform systematic, controlled studies. Unfortunately, outcomes are poor, and the rate of repeated abusive episodes is high. Future research should focus on the development of a satisfactory research model and on prevention strategies.

Keywords

Abuse Children Shaken baby syndrome Nonaccidental trauma 

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  1. 1.Barrow Neurological InstitutePhoenixUSA
  2. 2.Child Abuse Assessment CenterSt. Joseph’s Hospital and Medical CenterPhoenixUSA

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