The Specifics of Abusive Head Trauma

The American Academy of Pediatrics officially now calls it, "Abusive Head Trauma." It really is the same thing as Shaken Baby Syndrome, except that it's a little bit more broad. There are a lot of injuries, for example, where you can have an impact injury. If a child gets hit over the head with a baseball bat by an adult, that's clearly an abusive head trauma, but it's not a shaken baby. So, there are other ways to hurt a child that don't involve shaking, and I think as time has gone on, we've realized that what we thought was Shaken Baby Syndrome--a lot of these children may be shaken, but a lot of other things happen, and so the word, "Abusive Head Trauma" gets away from this idea that we know exactly what the mechanism is, and tries to focus on the fact that an adult--another person--hurt the child, rather than exactly how that injury occurred. In terms of what happens in an abusive head trauma, we don't usually know, except with the rare cases where people have been caught on nanny-cam--you know, abusing their children. Most of these are based on a clinical understand. Some are based on confession, but what we think happens is an adult gets frustrated with a child and either shakes them and throws them, shakes them and impacts their head in some way, but usually what also happens is the children stop breathing. And so what we often see as one of the biggest problems is these children have a lack of oxygen to their brain, and so their injury is very diffuse. We're talking about the local injury and the diffuse injury. These are almost all diffuse injuries. And so outcome from abusive head trauma tends to be very poor, and if you match these children for their severity of injury, their age, some match of socioeconomic status--they do much worse than children with non-inflicted injuries of the same--when all those issues are matched. And it's probably because of the severity of the injury--the diffuseness of the injury, and perhaps because once this has happened, caretakers don't always call for help right away.

Abusive head trauma includes Shaken Baby Syndrome but also includes other injuries inflicted by an adult on a child. The main issue can be that children stop breathing and the lack of oxygen to the brain causes diffuse injury, and thus poor outcome.

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Rachel Berger

Rachel Berger MD, MPH is part of the Child Advocacy Center at Children’s Hospital of Pittsburgh and a member of the hospital’s Child Protection Team. She has been involved in the evaluation of thousands of children with suspected child abuse and neglect.

Posted on BrainLine January 9, 2013.

Produced by Victoria Tilney McDonough and Jared Schaubert, BrainLine, and Dan Edblom.