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Updated: Jul 16, 2026
Assessing Changes in Synaptic Plasticity Using an Awake Closed-Head Injury Model of Mild Traumatic Brain Injury
Published on: January 20, 2023
Nonaccidental head trauma in infants
Paula Gerber1, Kathryn Coffman
1Barrow Neurological Institute, Phoenix, AZ 85013, USA. paula.gerber@chw.edu
Insights
Nonaccidental head trauma is a leading cause of infant death. Key indicators include retinal and subdural hemorrhages, often without external signs, suggesting severe acceleration/deceleration injuries.
Area of Science:
- Pediatric Traumatology
- Forensic Pathology
- Neurology
Background:
- Nonaccidental head trauma represents the primary cause of injury-related infant mortality.
- Inflicted head injuries in infants often present with subtle external signs.
Purpose of the Study:
- To elucidate the clinical features and biomechanical mechanisms of nonaccidental head trauma in infants.
- To highlight the diagnostic challenges and poor outcomes associated with abusive head injuries.
Main Methods:
- Review of clinical presentations and proposed injury mechanisms.
- Discussion of pathological findings including hemorrhage and edema.
- Analysis of limitations in current biomechanical modeling.
Main Results:
- The triad of retinal, subdural, and/or subarachnoid hemorrhage suggests inflicted trauma, distinct from accidental falls.
- Rotational acceleration/deceleration is the likely mechanism, causing widespread cellular damage.
- Pathophysiology involves hypoxia, edema, and disruption of cerebral autoregulation.
Conclusions:
- A definitive biomechanical model for abusive head trauma is currently lacking.
- The criminal nature of abuse hinders systematic research, leading to poor outcomes and high recurrence rates.
- Future research priorities include developing robust research models and effective prevention strategies.
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.
