Paediatric Abusive Head Trauma
Last updated: 26/06/2023
Overview
Paediatric abusive head trauma (AHT) or shaken baby syndrome describes injuries caused by shaking and direct head trauma to children and infants.
Excessive and forceful shaking of an infant can lead to injuries within seconds to minutes. There is no universally agreed degree of shaking that is safe. Crying is a common cause of infant shaking.
Mortality of abusive head trauma can be up to 30% and around 1/3 of survivors are left severely disabled.
Shaken baby syndrome
Shaken baby syndrome is another name for AHT and describes the triad of:
- Retinal haemorrhages
- Subdural haematoma
- Encephalopathy
Epidemiology
- AHT is the most common cause of death in children <1 year
Presentation
AHT must be considered as a potential cause in any young child with an unexplained apparent life-threatening event (ALTE)/brief resolved unexplained event (BRUE) or apnoea.
- An ALTE is a descriptive term that is frightening to the observer such as apnoea, colour changes, changes in muscle tone, gagging, or choking.
Features that are strongly associated with AHT compared to an accident are:
- <3 years old
- Bruising – especially to the head and neck
- Apnoea and/or irregular breathing – strongly associated with AHT
- Seizures
- Subdural haemorrhage – correlates strongly with AHT
- Retinal haemorrhage – reported in up to 80% of cases of AHT
Other features may include:
- General features of non-accidental injury:
- Examination findings that are inconsistent with the history
- Delays in seeking help
- Skull fractures
- Rib fractures, corner fractures
- Bites, cuts, abdominal injury and/or bruising, frenulum injury
- Long bone fractures
- Unexplained anogenital signs
- Apparent life-threatening events:
- Pallor/cyanosis
- Cardiorespiratory collapse or sudden death
- Other general features that may suggest encephalopathy:
