A study in which perpetrators confessed to shaking the child showed that violent shaking, on average about 10 times until the baby stopped crying, could cause all these symptoms, even when three-quarters of them involved nothing more than shaking. Yet a strong body of research shows that shaking can injure infants and toddlers and cause these symptoms. In 2009, the AAP reclassified 'shaken baby syndrome' as abusive head trauma to be more inclusive of all the ways a child's head can be injured through abuse, including but not limited to violent shaking. They are among the 1,500 children who die each year from abuse or neglect in the U.S. Each year about 80 children die from abusive head trauma. children suffer abuse each year, including approximately 30 cases of abusive head trauma among every 100,000 infants, according to the American Academy of Pediatrics. There are certain injuries that are much more highly correlated with abuse, and there aren't very many things that cause these together.' A subdural hemorrhage is a subdural hemorrhage. 'It's always going to be a clinical diagnosis with social investigation.

'Part of the challenge is that there is no gold standard for making a diagnosis of child abuse - you can't do a blood test,' said Cindy Christian, chair of both Child Abuse and Neglect Prevention at The Children's Hospital of Philadelphia and the American Academy of Pediatrics' Committee on Child Abuse and Neglect. Twelve cases mistaken for abuse involved substantial injuries from a car accident or other situations in which a pediatrician would probably not use this tool. It also correctly found that two-thirds of the other 66 children had suffered abusive head trauma, though it missed 13 cases of abuse in which the child had few of the physical symptoms used by the tool. Extensive investigations, often including confessions or independent witnesses, had already established whether these children, mostly under 1 year old, had been abused.īy using a standard that at least three of the six symptoms were needed to presume abuse, the method correctly identified 82 percent of 133 cases as not abusive.

The researchers used medical records and child protection files of 198 babies with head trauma to see how well the tool identified child abuse. The more of those a child suffers, the more likely the case resulted from abuse.

The tool itself is simple: listing rib fracture, seizures, long-bone fractures, bruises on the head or neck, periods of not breathing called apnea and bleeding in the retina of the eyes. 'However, it is also important that accidental head injury cases are not wrongly diagnosed as abusive,' she continues, 'because this can have devastating consequences for the families involved.' 'It is vitally important that abuse head trauma is diagnosed accurately so that the team looking after the child can ensure that they receive appropriate support and are protected from further harm,' lead study author Laura Elizabeth Cowley, a doctoral student at the Cardiff University School of Medicine in the U.K., said in an email. The method, described in the journal Pediatrics on Monday, asks doctors to check for six other injuries, each of which increases the likelihood that a head injury resulted from severe shaking, blunt force or both. So researchers have developed and validated a tool doctors can use to distinguish between head injuries resulting from abuse and those from accidents or medical conditions.

Signs of abusive head trauma