Recognition and Prevention of Pediatric Abusive Head Trauma: 
Kentucky Mandatory Training

Introduction

 




Pediatric abusive head trauma is a type of inflicted traumatic brain injury that happens when a baby or young child is violently shaken with or without traumatic blunt impact of the head.  It has been known by many terms over the years.  Beginning in the early 1970s, the term whiplash-shaken infant syndrome was used to identify the association of intracranial injuries, retinal hemorrhage and long bone fractures attributable to child abuse among infants (Dias, et al., 2005).  This severe form of child abuse (NIH, 2009) has also been called shaken baby syndrome or shaken infant syndrome, shaken impact syndrome, infant shaken impact syndrome, infant whiplash-shake injury syndrome, abusive head trauma and inflicted, non-accidental or intentional head injury (Dias, et al., 2005).  

Shaken infant syndrome has been the most widely used and recognized term, although shaking alone may not account for all injuries (Dias, et al., 2005).  In 2009, the American Academy of Pediatrics, in a policy statement (Christian, et al., 2009), stated:

“ Shaken baby syndrome is a term often used by physicians and the public to describe abusive head trauma inflicted on infants and young children. Although the term is well known and has been used for a number of decades, advances in the understanding of the mechanisms and clinical spectrum of injury associated with abusive head trauma compel us to modify our terminology to keep pace with our understanding of pathologic mechanisms. Although shaking an infant has the potential to cause neurologic injury, blunt impact or a combination of shaking and blunt impact cause injury as well. Spinal cord injury and secondary hypoxic ischemic injury can contribute to poor outcomes of victims. The use of broad medical terminology that is inclusive of all mechanisms of injury, including shaking, is required. The American Academy of Pediatrics recommends that pediatricians develop skills in the recognition of signs and symptoms of abusive head injury, including those caused by both shaking and blunt impact, consult with pediatric subspecialists when necessary, and embrace a less mechanistic term, abusive head trauma (AHT), when describing an inflicted injury to the head and its contents.”

Ken Hammond, USDA


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