Abusive head trauma is a head or neck injury from physical child abuse. It happens when someone shakes a baby or hits the baby against something hard. Most cases happen when a parent or caregiver is angry, tired, or upset because a baby won't stop crying or the child can't do something they expect, like toilet train.
These injuries can cause permanent brain damage or death. People should never shake a baby for any reason.
Which Children Are at Risk for Abusive Head Trauma?
Most cases of abusive head trauma (also called shaken baby syndrome) happen to babies and toddlers younger than 2 years old. Rarely, it can happen in children up to 5 years old. It can happen to boys or girls in any family.
At special risk for abuse are children who have a lot of special needs or health problems that make them cry a lot, like colic and GER.
How Does Abusive Head Trauma Happen?
Things like gently bouncing a baby on a knee or riding in a bumpy car won't cause the problems seen in abusive head trauma.
Abusive head trauma happens when someone:
uses force to shake a child
uses force to throw or drop a child on purpose
hits the child's head or neck against an object, like the floor or furniture, or hits the child's head or neck with an object
Shaking a baby is so harmful because:
Infants have poor neck strength and their heads are large compared with the size of their bodies. This lets the head move around a lot when shaken.
When the head moves around, the baby or child's brain moves back and forth inside the skull. This can tear blood vessels and nerves inside or around the brain, causing bleeding and nerve damage.
The brain may hit against the inside of the skull, causing brain bruising and bleeding on the outside of the brain.
Brain swelling builds pressure in the skull. This pressure makes it hard for blood, carrying oxygen and nutrients, to reach the brain, further harming it.
What Are the Signs of Abusive Head Trauma?
In the most severe cases, babies and children may come to the ER, hospital, or doctor's office not awake, having seizures, or in shock.
have pupils (the dark spots in center of the eyes) that aren't the same size
be unable to lift their head
have trouble focusing their eyes or tracking movement
How Is Abusive Head Trauma Diagnosed?
Parents or caregivers often won't say that the child was shaken or hit, so doctors may not know to check for head injury. Many signs of abusive head trauma, like fussiness and throwing up, are common in routine childhood illnesses. So it can be hard for doctors to figure out that a baby was harmed.
If abusive head trauma is suspected, doctors will:
Do an eye exam to look for bleeding inside the eyes.
Order X-rays of all the bones to look for new or healing breaks, which happen most in the arms, legs, skull, and ribs.