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Abusive head trauma is importantly a serious form of abuse and it can happen at any time in the family.It also remains as the potential one to cause severe together with life threatening injury to the child.Abnormal and violent shaking with forceful strikes of the child can raise certain health issues to the child as they remain prone not to tolerate such incidents.

As the neck musculature is weak in comparison with large head size may make them more susceptible to acquire head trauma.That is why it is very essential for you to know the causes,risk factors,warning signs and some effective preventive measures in order to tackle such incidents.That’s why it is mandatory for us to ensure a safe environment for the guardians and care givers of the child.

In this article,we try to cover all the important aspects of abusive head trauma that help make you knowledgeable about the causes,risk factors and preventive measures of abusive head trauma in children.

What is the usual understanding of an abusive head trauma to your child?

Abusive head trauma refers to head, neck or brain injury that happens when someone shakes or hits a baby on their own purpose and it can easily hurt a baby. It only takes 1 or 2 hard shakes to seriously hurt a baby’s brain that result in development of shaken baby syndrome,a type of abusive head trauma.

Babies have large and heavy heads in comparison with their bodies, and their necks remain vulnerable to getting injured easily.They can’t have the full control over their head movement as easily as older children or adults do.If you shake a baby,it can vigorously move their head backward and forward in a very quick succession.

This action can shake the baby’s brain and can be very dangerous simultaneously.Rough play like tossing your baby in the air or onto a soft bed are  just as dangerous as you throwing them in air with anger or frustration.No parent or other caregiver should ever shake a baby in order to ensure their brain’s safety or to prevent any abusive head trauma in children.

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What things escalate the occurrence of abusive head trauma 

Various risk factors for AHT have been identified by experts that corelates with peculiarities of the child, the caregiver as well as the broader social environment.Though it is very challenging to understand these variables in order to guide the prevention, screening, and early intervention efforts of the abusive head trauma in children.

Child-related risk factors include the following:

• Persistent crying is difficult to soothe and it is more prominent in children who are 6 to 8 weeks of age.
• Infantile colic which means frequent episodes of prolonged crying without medical cause.
• Delayed growth along with poor learning and abnormal movement. 
• Ongoing health issues requiring medical attention.
• History of prematurity or low birth weight
• Multiple births like tweens,triplets births.
• Unplanned pregnancy together with social and emotional difficulties.

The general contribution of Caregiver and family characteristics augment AHT risk

Caregiver and family-related factors may also augment the risk of happening of abusive head trauma in children who are still very young.These comprise young parents with limited social support, low socioeconomic status, low self-confidence, limited education, or lack of prenatal care with additional risks that may arise from limited childcare experience, difficulty managing stress or frustration.

Mental health challenges, substance use, single-caregiver situations, or previous involvement with child protective services also assist in the happening of abusive head trauma. Certain community-level factors that have the close association for further increased vulnerability are:

• Social isolation with restrictive access to amusing spaces.
• Poverty along with Unemployment. 
• Exposure to domestic violence that comprise partner violence
• Lack of adequate community support services. 

Incidence rate of abusive trauma to the child

The accurate proven rate of determination of abusive head trauma in children remains challenging and this is due to the absence of a centralized reporting system.It also accumulates the variability of clinical presentations.That is why there is frequent underrecognition of abuse in the family. Abusive head trauma often results from uninterrupted maltreatment rather than it generally having the association of a single acute event. 

In the United States (US), the approximate evidence based incidence of acute head trauma in children who are younger than 1 year generally calculates from 25 to 35 per 100,000 in each year.Abusive head trauma (AHT) is the most common cause of fatal physical abuse in children and the infants are the most vulnerable group who account for the majority of related deaths.

Age Variation who possess acute head trauma

The incidence of abusive head trauma in children actually has a peak age between 6 and 8 weeks and it lines up with the period of excessive infant crying, namely “purple crying period.” The report of mortality rates due to abusive head trauma in families ranges from 10% to 20% and it has a significant drop rate after 1 year of age.Thereby it makes the overall count approximately 3.8 per 100,000 annually.

Geographical distinction of abusive head trauma

Geographic distinction of abusive head trauma in children has been perceived within the entire US.The experts counted the highest incidence based on evidence in the Midwest and the lowest in the Northeast of the country. There is no clear or conclusive explanation that has been notified for these regional variations across the country. 

Sentinel Injuries of the child to cause abusive head trauma

Sentinel injuries frequently antecede a formal diagnosis of child ill-treatment.Consequently it almost counts nearly 25% of children who are later diagnosed with abuse present with previously unacknowledged injuries.Among the findings,bruising and intraoral trauma are the  common ones and it is more particularly in children younger than 3 years of age.As many as 20% of these cases may go unrecognized during initial medical evaluations.  

Variation in Clinical Practice

Clinical practice variation further has the effects on diagnosis of abusive head trauma in children and this is due to biases on caregiver demographics and socioeconomic status.Moreover ethnicity may also affect assessment verdicts.Standardized screening protocols can enhance the identification of abusive head trauma (AHT) and thereby help ensure more consistent evaluation and treatment when ultimately reduce variations and disparities in patient care. 

How abusive head trauma affects a child’s brain and bodily systems 

The factors like biomechanical forces are closely involved in AHT typically include combinations of rotational along with translational, and impact forces. These injury processes may be the outcome of violent shaking, blunt impact, or both simultaneously. Experimental studies comprising computational models, human surrogates together with animal research, and postmortem analyses have emerged the concept of how such forces injure your child’s brain. 

Infants are particularly more susceptible due to close associations of several anatomical and physiological features that favours the occurrence of head trauma.Thereby this also includes a relatively large head-to-body ratio, immature neck musculature,excessive ligamentous laxity, partially ossified skull, and higher intracranial fluid content. These characteristics help amplify the impacts of acceleration-deceleration and rotational forces and thus end up with increasing the risk for diffuse brain injury as well as making them prone to get abusive head trauma in children.

Possible outcomes of abusive head trauma to the child 

Constant shaking can cause the head and neck to move rapidly back and forth which thereby can help stretch and damage your child’s brain blood vessels.After that this may lead to bleeding such as subdural hematoma, subarachnoid hemorrhage, and brain swelling inside your baby’s skull. As pressure inside the skull increases, blood flow to the brain may fall than normal level and also cause injury. Similar to traumatic brain injury, diffuse axonal damage can also affect a baby’s brain function and result in fluctuation in coordination. Direct impact may also cause fractures or concussions. 

Why does abusive head trauma happen?

Many parents and caregivers experience exhaustion and frustration and there may be at times, you might have a temptation to shake your crying baby in order to stop them to cry.It’s important to remember or keep in mind that vigorous shaking can cause serious brain issues and causes abusive head trauma in children.In order to avoid these episodes of exhaustions,you can try try these tips.

• Place the baby safely: Set them in their cot or crib.
• Step away: Move out of hearing range for a short break.
• Collect yourself: Take deep breaths to regain your calm.
• Phone a friend: Call someone you trust for immediate support.

What are the best ways to comfort your baby who is crying non-stop? 

There are a few things you can try if there is no end in sight of your baby’s crying.

First,you need to check if the crying is due to something straightforward conditions.For instance:

• Does their tummy need to fill up?
• Are they uncomfortable because they need a change?
• Are they feeling a bit under the uncomfortable weather or flushed?
• Are there any painful gums that make them fussy?
• Do they struggle to settle down because of exhaustion?

Some important tips to calm down your baby

If there is no clear cause of their continuous crying,then you can try these tricks that can help calm your baby.These are: 

• Give them a warm hug.
• Gently rub their back or tummy.
• Push them back and forth in the stroller.
• Softly sing a lullaby or talk to them while cradling them.

How can you ensure if your baby has got hurt by abusive head trauma?

It can be very hard to know or tell confidently that a baby has a head injury and it is due to abusive head trauma in children.Some important signs may indicate if there any kind of abusive head trauma or not.These comprise:

• The baby may feel drowsiness than normal.

• The baby may experience tremors sometimes with some episodes of vomitings.
• There is also difficulty in breathing or facing problems in feeding.
• The kin of the baby may be pale or blue coloured.

The injury can be life-threatening as well as there is risk of getting permanent brain damage.If you think a baby has been shaken vigorously with unsafe manners,you need to seek medical attention from the nearest emergency department as soon as possible.

What actually happens if you shake your baby?

It would be very fortunate for your babies if they experience several rough shakes or any kind of abusive head trauma in children that can make your baby’s brain and meninges hit the hard bone inside their skull.It then causes blood loss from the brain and it is likely due to continuous injury to the brain against the skull bone.

Shaken babies can have brain-related problems that comprise blindness,deafness,several seizures along with facing difficulty to eat or swallow something.Moreover they face leaning,behavioural together with space difficulties.

The Bottom Line

Abusive head trauma in children is actually a preventable but a very critical condition which can eventually mark lifelong health impacts on the child and thereby hamper their normal development.If the parent and care givers become able to recognise the causes,risk factors,early features,they can then be able to protect the vulnerable children as they handle the situation cautiously.

When we ensure a caring and secure environment, we can help assure every child receives the protection and care they fully deserve.Thus proper support along with safe caregiving practice ultimately bring goods to the family and also ensure your child does not get the abusive head trauma.