Abusive Head Trauma

Condition Basics

What is abusive head trauma?

Abusive head trauma is a brain injury that occurs when someone shakes a baby or throws a baby against an object. It is a form of child abuse. It may happen to children up to 5 years of age, but it's most common in babies younger than 1 year old.

It is never okay to shake or throw a young child. It may not leave any obvious sign of injury, but it can cause serious long-term problems or even death.

Abusive head trauma often occurs when a baby won't stop crying and a caregiver loses control of their emotions. Parents can help prevent this problem by learning healthy ways to relieve stress and anger. It's also important to choose child care providers carefully.

Abusive head trauma may also be called shaken baby syndrome. Some doctors may use the term "intentional head injury" to describe how it happened.

What causes the brain injury?

When a baby is shaken or thrown, the head twists or whips back and forth. This can cause tears in brain tissue, blood vessels, and nerves. The child's brain slams against the skull. This can cause bleeding and swelling in the brain.

Young children are at high risk for brain injury when they are shaken or thrown. That's because they have:

• Heavy, large heads for their body size.
• Weak neck muscles that don't hold up the head well.
• Delicate blood vessels in their brains.

Possible problems from brain injury

A child may have brain damage that causes one or more serious problems, such as:

• Seizures. A baby may have uncontrolled muscle movement and be unable to speak, see, or interact normally.
• Blindness or trouble seeing or hearing.
• Cerebral palsy, with muscle stiffness (spasticity) that results in awkward movements.
• Intellectual disabilities that can affect every area of a child's life. For example, a child may have trouble learning to talk or may not be able to care for themself in the future.
• Learning disabilities that may not appear until the child starts school.
• Emotional or behavior problems.

Some children die from their injuries.

What are the symptoms of abusive head trauma?

Symptoms vary among children based on how old they are, how often they've been abused, how long they were abused each time, and how much force was used.

Mild injuries may cause subtle symptoms. For example, a child may:

• Be fussy, grouchy, or sluggish.
• Vomit.
• Not be hungry.

A child with more severe injuries may have symptoms such as:

• Seizures.
• A slow heartbeat.
• Trouble hearing.
• Bleeding inside one or both eyes.

A child who has been shaken or thrown may also have other signs of abuse, such as broken bones, bruises, or burns.

Symptoms can start quickly, especially in a badly injured child. Other times, it may take a few days for brain swelling to cause symptoms.

Sometimes caregivers who harm a child will put the child to bed. They may hope that symptoms will get better with rest. By the time the child gets to a doctor, the child may need urgent care. In some cases, the child may be in a coma before a caregiver seeks help.

How is it diagnosed?

Abusive head trauma can be hard to detect because often there aren't clear signs of abuse. Instead, a baby may have vague symptoms, such as vomiting or a poor appetite. At first these symptoms may seem related to an infection, such as the flu or a kidney infection. Sadly, abusive head trauma may not be discovered until repeated abuse or more severe harm occurs.

To confirm a diagnosis of abusive head trauma, a doctor will:

• Ask about the child's medical history, including when changes in behavior began.
• Do a physical exam to look for signs of injury and increased blood pressure.
• Do imaging tests such as a CT scan or an MRI to look for bleeding or other injury in the brain.
• Take X-rays to check for broken bones.

A doctor may also do tests to rule out other possible causes of the child's symptoms. For example, a lumbar puncture checks the spinal fluid for signs of meningitis. Blood tests may be done to check for internal injuries or to rule out other conditions, such as rare blood disorders.

A doctor who suspects abusive head trauma must report it to the local child welfare office and police.

How is abusive head trauma treated?

A child with abusive head trauma needs to be in the hospital, sometimes in an intensive care unit (ICU). Oxygen therapy may be used to help the child breathe. Doctors may give the child medicine to help ease brain swelling. Sometimes a cooling mattress will help lower the child's body temperature and reduce brain swelling.

Depending on the symptoms, doctors may try seizure medicine, physical therapy, or other treatments. A child who has severe bleeding in the brain may need surgery.

How can you prevent it?

Never shake or harm a baby. Even a few seconds of shaking can cause lifelong problems. Find healthy ways to relieve stress and anger. If you're afraid you may harm your baby, put your baby in a safe place, like a crib. Then calm yourself in another room, or call someone for help.

What should you do if you suspect abusive head trauma?

It is important to get help if something doesn't seem right with your baby. Abusive head trauma may cause only mild symptoms at first, but any head injury in a young child can be dangerous.

Young children can't defend themselves, so it is up to adults who care to protect them. If you suspect abuse and the child is not in immediate danger:

• Call local child protective services or the police.
• Do not confront the person who may have abused the child. This may cause more harm to the child.