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Abusive head trauma: Canadian and global perspectives


Canada has come a long way since Dr. C. Henry Kempe first described battered-child syndrome in 1962. The year 1999 was crucial in Canada’s battle against shaken baby syndrome/abusive head trauma (SBS/AHT), when the first national conference on the topic was held in Saskatoon. This was followed by the issuance of a national statement and multidisciplinary guidelines, recently updated in 2020. Incidence of AHT in Canada is similar to that found in population-based studies from Switzerland and New Zealand. The mainstay of prevention of AHT in Canada is education of parents and caregivers with respect to their response to infant crying. Population-based data for global incidence of AHT are lacking, largely because of social and cultural differences contributing to poor understanding of AHT as a medico-legal entity. India faces a distinct challenge in the battle against female feticide and infanticide.

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  1. Canadian Paediatric Society, Child and Youth Maltreatment Section (2008) Multidisciplinary guidelines on the identification, investigation and management of suspected abusive head trauma. Paediatr Child Health 13. Accessed 18 September 2020

  2. Canadian Paediatric Society, Child and Youth Maltreatment Section (2001) Joint statement on shaken baby syndrome. Paediatr Child Health 6:663–667

    Article  Google Scholar 

  3. Christian CW, Block R, Committee on Child Abuse and Neglect, American Academy of Pediatrics (2009) Abusive head trauma in infants and children. Pediatrics 123:1409–1411

    Article  Google Scholar 

  4. Ward M, Shouldice M (2020) Joint statement on traumatic head injury due to child maltreatment — an update to the joint statement on shaken baby syndrome. Government of Canada website. Accessed 28 July 2020

  5. Brain Injury Australia (2010) Policy papers: inflicted traumatic brain injury in children. Brain Injury Australia website. Accessed 28 July 2020

  6. King WJ, Mackay M, Sirnick A, Canadian Shaken Baby Study Group (2003) Shaken baby syndrome in Canada: clinical characteristics and outcomes of hospital cases. CMAJ 168:155–159

    PubMed  PubMed Central  Google Scholar 

  7. Bennett S, Ward M, Moreau K et al (2011) Head injury secondary to suspected child maltreatment: results of a prospective Canadian national surveillance program. Child Abuse Negl 35:930–936

    Article  Google Scholar 

  8. Barlow KM, Minns RA (2000) Annual incidence of shaken impact syndrome in young children. Lancet 356:1571–1572

    CAS  Article  Google Scholar 

  9. Sibert JR, Payne EH, Kemp AM et al (2002) The incidence of severe physical child abuse in Wales. Child Abuse Negl 26:267–276

    CAS  Article  Google Scholar 

  10. Keenan HT, Runyan DK, Marshall SW et al (2004) A population-based comparison of clinical and outcome characteristics of young children with serious inflicted and noninflicted traumatic brain injury. Pediatrics 114:633–639

    Article  Google Scholar 

  11. Kelly P, Farrant B (2008) Shaken baby syndrome in New Zealand, 2000–2002. J Paediatr Child Health 44:99–107

    Article  Google Scholar 

  12. Fanconi M, Lips U (2010) Shaken baby syndrome in Switzerland: results of a prospective follow-up study, 2002–2007. Eur J Pediatr 169:1023–1028

    Article  Google Scholar 

  13. Iacobucci F, Hamilton G (2010) The Goudge inquiry and the role of medical expert witnesses. CMAJ 182:53–56

    Article  Google Scholar 

  14. Goudge ST (2008) Inquiry into pediatric forensic pathology in Ontario. Online report. Accessed 28 July 2020

  15. Barr RG, Barr M, Fujiwara T et al (2009) Do educational materials change knowledge and behaviour about crying and shaken baby syndrome? A randomized controlled trial. CMAJ 180:727–733

    Article  Google Scholar 

  16. Barr RG, Rivara FP, Barr M et al (2009) Effectiveness of educational materials designed to change knowledge and behaviors regarding crying and shaken-baby syndrome in mothers of newborns: a randomized, controlled trial. Pediatrics 123:972–980

    Article  Google Scholar 

  17. Kempe CH (1971) Paediatric implications of the battered baby syndrome. Arch Dis Child 46:28–37

    CAS  Article  Google Scholar 

  18. Brewster AL, Nelson JP, Hymel KP et al (1998) Victim, perpetrator, family, and incident characteristics of 32 infant maltreatment deaths in the United States Air Force. Child Abuse Negl 22:91–101

  19. Barr RG, Trent RB, Cross J (2006) Age-related incidence curve of hospitalized shaken baby syndrome cases: convergent evidence for crying as a trigger to shaking. Child Abuse Negl 30:7–16

    Article  Google Scholar 

  20. Barr RG, Barr M, Rajabali F et al (2018) Eight-year outcome of implementation of abusive head trauma prevention. Child Abuse Negl 84:106–114

    Article  Google Scholar 

  21. Shanahan ME, Zolotor AJ, Parrish JW et al (2013) National, regional, and state abusive head trauma: application of the CDC algorithm. Pediatrics 132:e1546–e1553

    Article  Google Scholar 

  22. Kaltner M (2010) Abusive head trauma: incidence and associated factors in Queensland. University of Queensland. PhD thesis in UQ eSpace. Accessed 28 July 2020

  23. Kempe CH, Silverman FN, Steele BF et al (1962) The battered-child syndrome. JAMA 181:17–24

    CAS  Article  Google Scholar 

  24. Caffey J (1974) The whiplash shaken infant syndrome: manual shaking by the extremities with whiplash-induced intracranial and intraocular bleedings, linked with residual permanent brain damage and mental retardation. Pediatrics 54:396–403

    CAS  PubMed  Google Scholar 

  25. Duhaime AC, Gennarelli TA, Thibault LE et al (1987) The shaken baby syndrome. A clinical, pathological, and biomechanical study. J Neurosurg 66:409–415

    CAS  Article  Google Scholar 

  26. Choudhary AK, Servaes S, Slovis TL et al (2018) Consensus statement on abusive head trauma in infants and young children. Pediatr Radiol 48:1048–1065

    Article  Google Scholar 

  27. Choudhary AK, Dies Suarez P, Binenbaum G et al (2019) Consensus statement on abusive head trauma: additional endorsements. Pediatr Radiol 49:421

    Article  Google Scholar 

  28. Watts P (2013) Abusive head trauma and the eye in infancy. Eye 27:1227–1229

    CAS  Article  Google Scholar 

  29. Crown Prosecution Service (2018) Non accidental head injury cases (NAHI, formerly referred to as shaken baby syndrome [SBS]) — prosecution approach. CPS website. Accessed 25 March 2020

  30. United Nations Department of Economic and Social Affairs (2019) World population prospects 2019: highlights. UN website. Accessed 25 March 2020

  31. Aggarwal K, Dalwai S, Galagali P et al (2010) Recommendations on recognition and response to child abuse and neglect in the Indian setting. Indian Pediatr 47:493–504

    Article  Google Scholar 

  32. Pooniya S, Lalwani S, Madaan N et al (2017) Battered baby syndrome. Trauma 19:216–218

    Article  Google Scholar 

  33. Sriram K, Rathnavel S, Papakumari M, Somasundaram O (1981) Battered baby syndrome: a review of eight cases. Ann Acad Med Singap 10:466–471

    CAS  PubMed  Google Scholar 

  34. Subba SH, Pant S, Senthilkumaran S, Menezes RG (2011) Battered child syndrome: is India in dire straits? Egyptian J Forensic Sci 1:111–113

    Article  Google Scholar 

  35. Holla RG, Gupta A (2005) Child abuse where [sic] do we stand today? Indian Pediatr 42:1251

    CAS  PubMed  Google Scholar 

  36. Seth R (2015) Child abuse and neglect in India. Indian J Pediatr 82:707–714

    Article  Google Scholar 

  37. Garg S, Nath A (2008) Female feticide in India: issues and concerns. J Postgrad Med 54:276–279

    CAS  Article  Google Scholar 

  38. Bardia A, Paul E, Kapoor SK, Anand K (2004) Declining sex ratio: role of society, technology and government regulation in Faridabad district, Haryana. Natl Med J India 17:207–211

    CAS  PubMed  Google Scholar 

  39. Bhaktwani A (2012) The PC-PNDT act in a nutshell. Indian J Radiol Imaging 22:133–134

    Article  Google Scholar 

  40. Singh JP (2010) Socio-cultural aspects of the high masculinity ratio in India. J Asian Afr Stud 45:628–644

    CAS  Article  Google Scholar 

  41. Guilmoto CZ, Saikia N, Tamrakar V, Bora JK (2018) Excess under-5 female mortality across India: a spatial analysis using 2011 census data. Lancet Glob Health 6:e650–e658

    Article  Google Scholar 

  42. PMINDIA (n.d.) Beti Bachao, Beti Padhao: caring for the girl child. Prime Minister of India website. Accessed 26 March 2020

  43. Transforming India (n.d.) Sukanya Samriddhi Yojana. Transforming India website. Accessed 26 March 2020

  44. Sadh A, Kapoor PS (2012) Save the volume 4 issue 3 girl child initiatives in India — a social marketing perspective. IMJ 4:17–34

    Google Scholar 

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A.B. is partially funded by Ontasian Imaging Laboratory (OIL), Toronto, Canada. The authors would like to thank Drs. Michelle Shouldice and Emma Cory, Division of Paediatric Medicine and Suspected Child Abuse and Neglect (SCAN) team at The Hospital for Sick Children, Toronto, for their valuable input.

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Correspondence to Manohar M. Shroff.

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Biswas, A., Shroff, M.M. Abusive head trauma: Canadian and global perspectives. Pediatr Radiol 51, 876–882 (2021).

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  • Abusive head trauma
  • Canada
  • Child abuse
  • Children
  • Female feticide
  • Global
  • Incidence
  • Prevention
  • Radiology