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Depressed skull fractures: a pattern of abusive head injury in three older children
Anselm C W Lee1, Yvonne Ou, Dawson Fong
1Department of Pediatrics, Tuen Mun Hospital, New Territories, Hong Kong.
Insights
This study describes abusive head injuries in children over 4 years old, noting that the perpetrators were mentally disturbed parents. The abusive acts were severe, resembling attempted child homicide.
Area of Science:
- Pediatrics
- Forensic Pathology
- Child Abuse Research
Background:
- Abusive head injury (AHI) is a significant cause of morbidity and mortality in children.
- Previous research has primarily focused on infants and younger children.
Observation:
- A case series of three children older than 4 years presenting with abusive head injury and skull fractures.
- The injuries involved blunt force trauma, specifically depressed skull fractures, inflicted by severely mentally disturbed parents.
Findings:
- One 11-year-old girl sustained multiple depressed fractures, intracranial bleeding, and brain contusion from an assault with a hammer.
- Two brothers, aged 7 and 9, suffered occipital fractures from a hammer attack by their father, who had undiagnosed schizophrenia.
Implications:
- This research highlights a pattern of AHI in older children, challenging the notion that such injuries are exclusive to younger age groups.
- The findings underscore the critical need for recognizing severe mental disturbance in caregivers as a risk factor for extreme child abuse, including acts resembling homicide.
Objective:
To describe a pattern of abusive head injury in a series of children older than 4 years of age.
Methods:
A hospital chart review of abused children with skull fractures from 1999 to 2001 was carried out. The clinical features, social background, and subsequent outcome and management are described.
Results:
An 11-year-old girl and a pair of brothers of ages 7 and 9 were identified. The girl was attacked with a hammer during sleep by her stepmother, who committed suicide shortly afterwards. After craniotomy and intensive care, the child survived her multiple depressed fractures, intracranial bleeding, and brain contusion. Two brothers from a second family were attacked from behind with a hammer by their biological father, who was subsequently found to have undiagnosed schizophrenia. A depressed occipital fracture, without intracranial injury, was found in each child. The elder brother also had metacarpal fractures. Both children recovered without surgical intervention.
Conclusion:
A pattern of abusive head injury was described in older children with depressed skull fractures from blunt injury. The abusing parents were seriously mentally disturbed, and the abusive acts closely resembled child homicide.
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