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Abusive head trauma: two case reports
Ali Kanık1, Osman Tolga İnce1, Şehriban Yeşiloğlu1
1Clinic of Pediatrics, The Ministry of Health İzmir Tepecik Training and Research Hospital, İzmir, Turkey.
Insights
Abusive head trauma, a severe form of child abuse in infants, often presents with subtle signs. Suspecting abuse is crucial when parental accounts conflict with clinical findings, especially when examining for retinal hemorrhages.
Area of Science:
- Pediatrics
- Child Abuse Research
- Forensic Medicine
Background:
- Abusive head trauma (AHT) is a leading cause of death and disability in infants.
- It results from forceful shaking, often to quiet a crying infant, typically affecting those under two years old.
- AHT is frequently underdiagnosed due to the absence of external physical signs.
Observation:
- Characteristic injuries include subdural hematomas, encephalopathy, retinal hemorrhages, and long bone fractures.
- Clinical presentation may lack obvious external trauma.
- Discrepancies between parental history and the infant's clinical condition are key indicators.
Findings:
- Retinal hemorrhages are a critical sign that warrants thorough investigation in suspected AHT cases.
- Two pediatric cases of physical child abuse are presented, highlighting diagnostic challenges.
- One patient's history involved a minor fall, the other presented with respiratory distress and loss of consciousness.
Implications:
- Early recognition and diagnosis of AHT are vital for intervention and prevention of further harm.
- Considering AHT in the differential diagnosis is essential, especially with inconsistent historical information.
- Increased awareness among healthcare professionals can improve identification rates and outcomes for affected children.
Abstract:
Abusive head trauma is a serious form of child abuse and mostly seen in infants below the age of two years as a result of a strong shaking by the caregiver who aims to stop the infant's crying. Characteristic symptoms include subdural hematomas, encephalopathy, retinal hemorrhages and fractures of the long bones. When physically examined, there are generally no externally visible signs. For this reason, it can be underdiagnosed, if it is not considered in the differential diagnosis. When the information provided from the parents is inconsistent and contradictory with the clinical picture of the patient, this form of abuse must be suspected and retinal hemorrhages should be searched. In this article, two patients who were admitted to our emergency department and diagnosed with physical child abuse are reported. One of these patients had a history of minor head trauma after falling down from the sofa and the other one had a history of breathlessness and loss of consciousness as a result of excessive crying.
