4/2/2024 0 Comments Signs of trauma in 4 year old![]() Another study from Scotland reported the incidence as 24.6/100,000 children younger than 1 year of age. The first population-based study in the United States reported 29.7/100,000 person-years in children less than one year. The morbidity and mortality from AHT are noticeable. This is due to the absent centralized reporting system, no obvious signs of abuse, various presentations, and acute head trauma not being a single isolated event rather a result of chronic maltreatment. The diagnosis of pediatric AHT should only be made following careful history taking, detailed physical examinations, and relevant testings.ĪHT is difficult for accurate diagnosis, therefore, the incidence is uncertain. It is often difficult for health professionals to recognize AHT due to often lack of external signs of AHT or abuse. ![]() Early diagnosis is essential but may be challenging. Brain injuries are the most common cause of traumatic death in children less than 2 years. The outcome ranges from complete recovery to significant brain damage and even death. ĪHT typically involves injury to the intracranial structures or skull of an infant or child younger than 5 years old as a result of violent shaking and/or blunt impact. Although shaking alone has the potential to cause neurologic damage, blunt impact or a combination of shaking and blunt impact cause significant neurologic injuries. Finally, the American Academy of Pediatrics and consecutively the Centers for Disease Control and Prevention (CDC) recommend the term abusive head trauma (AHT) based on the understanding of the mechanisms and clinical spectrum of injury associated with abusive head injury. Other terminologies involving SBS included nonaccidental head injury or trauma, inflicted traumatic brain injury or more inclusively, “shaken impact syndrome”. For many decades, “shaken baby syndrome” (SBS) has been a common term used by many physicians to describe abusive head trauma or inflicted traumatic brain injury on infants and young children. In 1974, Caffey used another term “the whiplash shaken infant syndrome” to describe those injures in infants from shaking the extremities with whiplash-induced intracranial and intraocular bleedings. In 1962, Henry Kempe named the victim as “the battered child”. John Caffey reported a group of children with chronic subdural hematoma and long bone fractures in 1946 and then described the association between traumatic shaking, subdural hematoma and retinal hemorrhage, the recognition of various forms of child abuse substantially increased, but with different terminologies. AHT is a potentially preventable disease, therefore, prevention should be stressed in all encounters within the family, the society and all the healthcare providers. The outcome is associated with the clinical staging, the extent of increased intracranial pressure and the existence of neurological complications such as acquired hydrocephalus or microcephalus, cortical blindness, convulsive disorder, and developmental delay. The prognosis of patients with AHT correlates with the extent of injury identified on CT and MRI imaging. There are potential morbidity and mortality associated with AHT, ranging from mild learning disabilities to severe handicaps and death. Intracranial pressure, if necessary, should be monitored and controlled to ensure adequate cerebral perfusion pressure. As for the treatment, most of the care of AHT is supportive. The differential diagnosis must exclude those medical or surgical diseases that can mimic AHT such as traumatic brain injury, cerebral sinovenous thrombosis, and hypoxic-ischemic injury. The diagnosis of AHT should be based on the existence of multiple components including subdural hematoma, intracranial pathology, retinal hemorrhages as well as rib and other fractures consistent with the mechanism of trauma. The mechanism of AHT includes shaking as well as impact, crushing or their various combinations through acceleration, deceleration and rotational force. It is a worldwide leading cause of fatal head injuries in children under 2 years. Abusive head trauma (AHT), used to be named shaken baby syndrome, is an injury to the skull and intracranial components of a baby or child younger than 5 years due to violent shaking and/or abrupt impact.
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