Traumatic head injury due to child maltreatment (THI-CM), also known as abusive head trauma (AHT), is a significant public health problem due to the wide array of consequences affecting multiple domains of a child’s health and development. Several studies have evaluated its cost on healthcare systems, families, and societies. Many jurisdictions have implemented caregiver education programs to prevent THI-CM.
This paper aims to provide a brief overview of the epidemiology and cost analysis of THI-CM and discuss its prevention and the intergenerational transmission of child maltreatment.
Although not systematic, a literature search of original articles published from 2000 to 2022 in English and French was undertaken using the following databases: PubMed, EMBASE (Ovid), and PsycINFO (OVID). The search combined terms related to traumatic head injury and child maltreatment, with terms related to its cost and prevention. Studies of children aged 0–5 years old were included. The authors completed a screen of the titles and abstracts to determine relevance with respect to this article.
Globally, although THI-CM accounts for a small proportion of cases of child maltreatment, there is a high incidence of death and neurological sequelae compared to other causes of head trauma.The incidence of THI-CM is likely underestimated due to the lack of standardized definitions, differences in reporting, and challenges in identifying less severe cases. Cost analysis studies reveal the significant short- and long-term costs associated with THI-CM. Caregiver education programs have been studied and implemented in many centers and have shown varying but promising results.
A multi-pronged approach to prevention efforts should be considered to support families and help to prevent THI-CM and maltreatment throughout childhood.
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Choudhary AK, Servaes S, Slovis TL, Palusci VJ, Hedlund GL, Narang SK et al (2018) Consensus statement on abusive head trauma in infants and young children. Pediatr Radiol 48(8):1048–1065
Keenan HT, Runyan DK, Marshall SW, Nocera MA, Merten DF, Sinal SH (2003) A Population-Based Study of Inflicted Traumatic Brain Injury in Young Children. JAMA 290(5):621–626
Chevignard MP, Lind K (2014) Long-term outcome of abusive head trauma. Pediatr Radiol 44(Suppl 4):S548–S558
Canadian Paediatric Society Child and Youth Maltreatment Section (2008) Multidisciplinary guidelines on the identification, investigation and management of suspected abusive head trauma. Available from: https://cps.ca/documents/position/multidisciplinary-guidelines-abusive-head-trauma
Christian CW, Block R (2009) Abusive head trauma in infants and children. Pediatrics 123(5):1409–1411
Public Health Agency of Canada and the Canadian Paediatric Society (2020) Joint Statement on Traumatic Head Injury due to Child Maltreatment (THI-CM) - An update to the Joint Statement on Shaken Baby Syndrome. Ottawa: Public Health Agency of Canada
Narang S, Clarke J (2014) Abusive head trauma: past, present, and future. J Child Neurol 29(12):1747–1756
Parks S, Sugerman D, Xu L, Coronado V (2012) Characteristics of non-fatal abusive head trauma among children in the USA, 2003–2008: application of the CDC operational case definition to national hospital inpatient data. Inj Prev 18(6):392–398
Jenny C, Hymel KP, Ritzen A, Reinert SE, Hay TC (1999) Analysis of Missed Cases of Abusive Head Trauma. JAMA 281(7):621–626
Letson MM, Cooper JN, Deans KJ, Scribano PV, Makoroff KL, Feldman KW et al (2016) Prior opportunities to identify abuse in children with abusive head trauma. Child Abuse Negl 60:36–45
Laurent-Vannier A, De Agostini M, Chevignard M (2017) Fréquence des manifestations de violence antérieures au diagnostic de secouement 27ème Congrès de la Société française de neurologie pédiatrique
Institut de la Statistique du Québec (2004) Disciplining children in Québec: parenting norms and practices in 2004 Québec
Theodore AD, Chang JJ, Runyan DK, Hunter WM, Bangdiwala SI, Agans R (2005) Epidemiologic features of the physical and sexual maltreatment of children in the Carolinas. Pediatrics 115(3):e331–e337
Barlow KM, Minns RA (2000) Annual incidence of shaken impact syndrome in young children. Lancet 356(9241):1571–1572
Paget LM, Gilard-Pioc S, Quantin C, Cottenet J, Beltzer N (2019) Les enfants victimes de traumatismes crâniens infligés par secouement hospitalisés : analyse exploratoire des données du PMSI. Bulletin épidémiologique hebdomadaire 26–27:533–540
Tursz A, Cook JM (2014) Epidemiological data on shaken baby syndrome in France using judicial sources. Pediatr Radiol 44(Suppl 4):S641–S646
Vinchon M (2017) Shaken baby syndrome: what certainty do we have? Childs Nerv Syst 33:1727–1733
Parks SE, Kegler SR, Annest JL, Mercy JA (2012) Characteristics of fatal abusive head trauma among children in the USA: 2003–2007: an application of the CDC operational case definition to national vital statistics data. Inj Prev 18(3):193–199
Barr RG (2014) Crying as a trigger for abusive head trauma: a key to prevention. Pediatr Radiol 44(Suppl 4):S559–S564
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(1):7–16
Niederkrotenthaler T, Xu L, Parks SE, Sugerman DE (2013) Descriptive factors of abusive head trauma in young children–United States, 2000–2009. Child Abuse Negl 37(7):446–455
Libby AM, Sills MR, Thurston NK, Orton HD (2003) Costs of childhood physical abuse: comparing inflicted and unintentional traumatic brain injuries. Pediatrics 112(1 Pt 1):58–65
Albert DM, Blanchard JW, Knox BL (2012) Ensuring appropriate expert testimony for cases involving the “shaken baby.” JAMA 308(1):39–40
Miller TR, Steinbeigle R, Lawrence BA, Peterson C, Florence C, Barr M et al (2018) Lifetime Cost of Abusive Head Trauma at Ages 0–4, USA. Prev Sci 19(6):695–704
Wilson TA, Gospodarev V, Hendrix S, Minasian T (2021) Pediatric abusive head trauma: ThinkFirst national injury prevention foundation. Surg Neurol Int 12:526
Shahi N, Phillips R, Meier M, Smith D, Leopold D, Recicar J et al (2020) The true cost of child abuse at a level 1 pediatric trauma center. J Pediatr Surg 55(2):335–340
Peterson C, Xu L, Florence C, Parks SE, Miller TR, Barr RG et al (2014) The medical cost of abusive head trauma in the United States. Pediatrics 134(1):91–99
Peterson C, Xu L, Florence C, Parks SE (2015) Annual cost of U.S. hospital visits for pediatric abusive head trauma. Child Maltreat 20(3):162–9
Beaulieu E, Rajabali F, Zheng A, Pike I (2019) The lifetime costs of pediatric abusive head trauma and a cost-effectiveness analysis of the Period of Purple crying program in British Columbia. Canada Child Abuse Negl 97:104133
Friedman J, Reed P, Sharplin P, Kelly P (2012) Primary prevention of pediatric abusive head trauma: a cost audit and cost-utility analysis. Child Abuse Negl 36(11–12):760–770
Murray CJ, Atkinson C, Bhalla K, Birbeck G, Burstein R, Chou D et al (2013) The state of US health, 1990–2010: burden of diseases, injuries, and risk factors. JAMA 310(6):591–608
Miller TR, Steinbeigle R, Wicks A, Lawrence BA, Barr M, Barr RG (2014) Disability-adjusted life-year burden of abusive head trauma at ages 0–4. Pediatrics 134(6):e1545–e1550
Dias MS, Smith K, DeGuehery K, Mazur P, Li V, Shaffer ML (2005) Preventing abusive head trauma among infants and young children: a hospital-based, parent education program. Pediatrics 115(4):e470–e477
Barr RG, Barr M, Rajabali F, Humphreys C, Pike I, Brant R et al (2018) Eight-year outcome of implementation of abusive head trauma prevention. Child Abuse Negl 84:106–114
Zolotor AJ, Runyan DK, Shanahan M, Durrance CP, Nocera M, Sullivan K et al (2015) Effectiveness of a statewide abusive head trauma prevention program in North Carolina. JAMA Pediatr 169(12):1126–1131
Dias MS, Rottmund CM, Cappos KM, Reed ME, Wang M, Stetter C et al (2017) Association of a postnatal parent education program for abusive head trauma with subsequent pediatric abusive head trauma hospitalization rates. JAMA Pediatr 171(3):223–229
Goulet C, Frappier JY, Fortin S, Déziel L, Lampron A, Boulanger M (2009) Development and evaluation of a shaken baby syndrome prevention program. J Obstet Gynecol Neonatal Nurs 38(1):7–21
Frappier JY, Fortin S, L D editors (2016) Shaken baby syndrome (SBS) perinatal prevention program: implementation results [Poster presentation]. International Pediatric Association World Congress August 17–22; Vancouver, Canada
Scribano PV, Makoroff KL, Feldman KW, Berger RP (2013) Association of perpetrator relationship to abusive head trauma clinical outcomes. Child Abuse Negl 37(10):771–777
Leventhal JM, Asnes AG, Bechtel K (2017) Prevention of pediatric abusive head trauma: time to rethink interventions and reframe messages. JAMA Pediatr 171(3):218–220
Ertem IO, Leventhal JM, Dobbs S (2000) Intergenerational continuity of child physical abuse: how good is the evidence? The Lancet 356(9232):814–819
Thornberry TP, Knight KE, Lovegrove PJ (2012) Does maltreatment beget maltreatment? A systematic review of the intergenerational literature. Trauma Violence Abuse 13(3):135–152
Van Wert M, Anreiter I, Fallon B, Sokolowski M (2019) Intergenerational transmission of child abuse and neglect: a transdisciplinary analysis. Gend Genome 3:247028971982610
Assink M, Spruit A, Schuts M, Lindauer R, Put C, Stams G (2018) The intergenerational transmission of child maltreatment: a three-level meta-analysis. Child Abuse Negl 84:131–145
Langevin R, Marshall C, Kingsland E (2021) Intergenerational cycles of maltreatment: a scoping review of psychosocial risk and protective factors. Trauma Violence Abuse 22(4):672–688
Armfield JM, Gnanamanickam ES, Johnston DW, Preen DB, Brown DS, Nguyen H et al (2021) Intergenerational transmission of child maltreatment in South Australia, 1986–2017: a retrospective cohort study. The Lancet Public Health 6(7):e450–e461
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Raza, H.F., Archambault, É., Pépin, K. et al. Traumatic head injury due to child maltreatment: epidemiology, cost analysis, and impact of prevention. Childs Nerv Syst 38, 2281–2287 (2022). https://doi.org/10.1007/s00381-022-05560-1