Recognition and nursing management of abusive head trauma in children

Abusive head trauma (AHT) describes an injury to the head caused by a deliberate impact or shaking by a parent or carer. It can cause significant morbidity and mortality in infants, and is most commonly seen in those aged under 2 years. The initial presentation of AHT can include vague symptoms and the correct diagnosis may be missed by health professionals. Subdural haematoma, brain oedema and retinal haemorrhages are well-known features associated with AHT. However, other conditions such as birth trauma, accidental falls in infants and bleeding disorders can all mimic AHT, thus making its recognition difficult. Suspicion of AHT should lead to initiation of safeguarding procedures alongside organising neurological imaging to identify skull fracture and/or intracranial lesions. This article highlights different aspects of the clinical presentation of AHT and its management. Safeguarding and recognising child abuse is vital and requires every member of the multidisciplinary team to remain vigilant. An illustrative case study is included to highlight some of the challenges that health professionals working in different clinical set-ups are likely to come across while managing an infant with AHT.