PEDIATRICS Vol. 90 No. 2 August 1992, pp. 179-185
This Article
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Duhaime, A. C.
Right arrow Articles by Loporchio, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Duhaime, A. C.
Right arrow Articles by Loporchio, S.

Head Injury in Very Young Children: Mechanisms, Injury Types, and Ophthalmologic Findings in 100 Hospitalized Patients Younger Than 2 Years of Age

A. C. Duhaime MD1, A. J. Alario MD2, W. J. Lewander MD2, L. Schut MD1, L. N. Sutton MD1, T. S. Seidl MSW3, S. Nudelman RN4, D. Budenz MD5, R. Hertle MD5, W. Tsiaras MD6, and S. Loporchio MD6

1 From the Department of Neurosurgery, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine
2 From the Department of Pediatrics, Rhode Island Hospital, Brown University School of Medicine, Providence
3 From the Department of C1inica1 Social Work, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine
4 From the Department of Nursing, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine
5 From the Department of Ophthalmology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine
6 From the Department of Ophthalmology, Rhode Island Hospital, Brown University School of Medicine, Providence

Head injury in the youngest age group is distinct from that occurring in older children or adults because of differences in mechanisms, injury thresholds, and the frequency with which the question of child abuse is encountered. To analyze some of these characteristics in very young children, the authors prospectively studied 100 consecutively admitted head-injured patients 24 months of age or younger who were drawn from three institutions. Mechanism of injury, injury type, and associated injuries were recorded. All patients underwent ophthalmologic examination to document the presence of retinal hemorrhages. An algorithm incorporating injury type, best history, and associated findings was used to classify each injury as inflicted or accidental. The results confirmed that most head injuries in children younger than 2 years of age occurred from falls, and while different fall heights were associated with different injury types, most household falls were neurologically benign. Using strict criteria, 24% of injuries were presumed inflicted, and an additional 32% were suspicious for abuse, neglect, or social or family problems. Intradural hemorrhage was much more likely to occur from motor vehicle accidents and inflicted injury than from any other mechanism, with the latter being the most common cause of mortality. Retinal hemorrhages were seen in serious accidental head injury but were most commonly encountered in inflicted injury. The presence of more serious injuries associated with particular mechanisms may be related to a predominance of rotational rather than translational forces acting on the head.

Key Words: head injury • infants • child abuse • retinal hemorrhage

Submitted on August 26, 1991
Accepted on January 21, 1992




This article has been cited by other articles:


Home page
 PediatricsHome page
T. Fujiwara, M. Okuyama, and M. Miyasaka
Characteristics That Distinguish Abusive From Nonabusive Head Trauma Among Young Children Who Underwent Head Computed Tomography in Japan
Pediatrics, October 1, 2008; 122(4): e841 - e847.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
S. A. Monson, E. Henry, D. K. Lambert, N. Schmutz, and R. D. Christensen
In-Hospital Falls of Newborn Infants: Data From a Multihospital Health Care System
Pediatrics, August 1, 2008; 122(2): e277 - e280.
[Abstract] [Full Text] [PDF]

Home page
 Arch OphthalmolHome page
J. D. Kivlin, M. L. Currie, V. J. Greenbaum, K. B. Simons, and J. Jentzen
Retinal Hemorrhages in Children Following Fatal Motor Vehicle Crashes: A Case Series
Arch Ophthalmol, June 1, 2008; 126(6): 800 - 804.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
D. L. Chadwick, G. Bertocci, E. Castillo, L. Frasier, E. Guenther, K. Hansen, B. Herman, and H. F. Krous
Annual Risk of Death Resulting From Short Falls Among Young Children: Less Than 1 in 1 Million
Pediatrics, June 1, 2008; 121(6): 1213 - 1224.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
D. M. Lindberg, C. J. Lindsell, and R. A. Shapiro
Variability in Expert Assessments of Child Physical Abuse Likelihood
Pediatrics, April 1, 2008; 121(4): e945 - e953.
[Abstract] [Full Text] [PDF]

Home page
 J Child NeurolHome page
C. Bonnier, P. Marique, A. Van Hout, and D. Potelle
Neurodevelopmental Outcome After Severe Traumatic Brain Injury in Very Young Children: Role for Subcortical Lesions
J Child Neurol, May 1, 2007; 22(5): 519 - 529.
[Abstract] [PDF]

Home page
 PediatricsHome page
K. P. Hymel, K. L. Makoroff, A. L. Laskey, M. R. Conaway, and J. A. Blackman
Mechanisms, Clinical Presentations, Injuries, and Outcomes From Inflicted Versus Noninflicted Head Trauma During Infancy: Results of a Prospective, Multicentered, Comparative Study
Pediatrics, May 1, 2007; 119(5): 922 - 929.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Neuroradiol.Home page
P.D. McNeely, J.D. Atkinson, G. Saigal, A.M. O'Gorman, and J.-P. Farmer
Subdural hematomas in infants with benign enlargement of the subarachnoid spaces are not pathognomonic for child abuse.
AJNR Am. J. Neuroradiol., September 1, 2006; 27(8): 1725 - 1728.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
H. Salehi-Had, J. D. Brandt, A. J. Rosas, and K. K. Rogers
Findings in Older Children With Abusive Head Injury: Does Shaken-Child Syndrome Exist?
Pediatrics, May 1, 2006; 117(5): e1039 - e1044.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
K. M. Barlow, E. Thomson, D. Johnson, and R. A. Minns
Late Neurologic and Cognitive Sequelae of Inflicted Traumatic Brain Injury in Infancy
Pediatrics, August 1, 2005; 116(2): e174 - e185.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Roentgenol.Home page
I. Prosser, S. Maguire, S. K. Harrison, M. Mann, J. R. Sibert, A. M. Kemp, and Welsh Child Protection Systematic Review Group
How Old Is This Fracture? Radiologic Dating of Fractures in Children: A Systematic Review
Am. J. Roentgenol., April 1, 2005; 184(4): 1282 - 1286.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
K. Bechtel, K. Stoessel, J. M. Leventhal, E. Ogle, B. Teague, S. Lavietes, B. Banyas, K. Allen, J. Dziura, and C. Duncan
Characteristics That Distinguish Accidental From Abusive Injury in Hospitalized Young Children With Head Trauma
Pediatrics, July 1, 2004; 114(1): 165 - 168.
[Abstract] [Full Text] [PDF]

Home page
 BMJHome page
R. M Reece
The evidence base for shaken baby syndrome: Response to editorial from 106 doctors
BMJ, May 29, 2004; 328(7451): 1316 - 1317.
[Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
S. P. Starling, S. Patel, B. L. Burke, A. P. Sirotnak, S. Stronks, and P. Rosquist
Analysis of Perpetrator Admissions to Inflicted Traumatic Brain Injury in Children
Arch Pediatr Adolesc Med, May 1, 2004; 158(5): 454 - 458.
[Abstract] [Full Text] [PDF]

Home page
 BMJHome page
B. Harding, R A. Risdon, and H. F Krous
Shaken baby syndrome
BMJ, March 27, 2004; 328(7442): 720 - 721.
[Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
R. G. Wells and J. R. Sty
Traumatic Low Attenuation Subdural Fluid Collections in Children Younger Than 3 Years
Arch Pediatr Adolesc Med, October 1, 2003; 157(10): 1005 - 1010.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
A. M. Libby, M. R. Sills, N. K. Thurston, and H. D. Orton
Costs of Childhood Physical Abuse: Comparing Inflicted and Unintentional Traumatic Brain Injuries
Pediatrics, July 1, 2003; 112(1): 58 - 65.
[Abstract] [Full Text] [PDF]

Home page
 RadioGraphicsHome page
G. J. Lonergan, A. M. Baker, M. K. Morey, and S. C. Boos
From the Archives of the AFIP: Child Abuse: Radiologic-Pathologic Correlation
RadioGraphics, July 1, 2003; 23(4): 811 - 845.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
W. Pickett, S. Streight, K. Simpson, and R. J. Brison
Injuries Experienced by Infant Children: A Population-Based Epidemiological Analysis
Pediatrics, April 1, 2003; 111(4): e365 - 370.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
J. Hettler and D. S. Greenes
Can the Initial History Predict Whether a Child With a Head Injury Has Been Abused?
Pediatrics, March 1, 2003; 111(3): 602 - 607.
[Abstract] [Full Text] [PDF]

Home page
 CMAJHome page
W. J. King, M. MacKay, A. Sirnick, and The Canadian Shaken Baby Study Group
Shaken baby syndrome in Canada: clinical characteristics and outcomes of hospital cases
Can. Med. Assoc. J., January 21, 2003; 168(2): 155 - 159.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
R. D. Pitetti, F. Maffei, K. Chang, R. Hickey, R. Berger, and M. C. Pierce
Prevalence of Retinal Hemorrhages and Child Abuse in Children Who Present With an Apparent Life-Threatening Event
Pediatrics, September 1, 2002; 110(3): 557 - 562.
[Abstract] [Full Text] [PDF]

Home page
 Arch. Dis. Child.Home page
M Mei-Zahav, Y Uziel, J Raz, N Ginot, B Wolach, and P Fainmesser
Convulsions and retinal haemorrhage: should we look further?
Arch. Dis. Child., May 1, 2002; 86(5): 334 - 335.
[Abstract] [Full Text] [PDF]

Home page
 BrainHome page
M. V. Parulekar and J. S. Elston
Neuropathology of inflicted head injury in children
Brain, March 1, 2002; 125(3): 676 - 677.
[Full Text] [PDF]

Home page
 PediatricsHome page
K. W. Feldman, R. Bethel, R. P. Shugerman, D. C. Grossman, M. S. Grady, and R. G. Ellenbogen
The Cause of Infant and Toddler Subdural Hemorrhage: A Prospective Study
Pediatrics, September 1, 2001; 108(3): 636 - 646.
[Abstract] [Full Text] [PDF]

Home page
 BrainHome page
D. I. Graham
Paediatric head injury
Brain, July 1, 2001; 124(7): 1261 - 1262.
[Full Text] [PDF]

Home page
 PediatricsHome page
S. A. Schutzman, P. Barnes, A.-C. Duhaime, D. Greenes, C. Homer, D. Jaffe, R. J. Lewis, T. G. Luerssen, and J. Schunk
Evaluation and Management of Children Younger Than Two Years Old With Apparently Minor Head Trauma: Proposed Guidelines
Pediatrics, May 1, 2001; 107(5): 983 - 993.
[Abstract] [Full Text]

Home page
 Am. J. Neuroradiol.Home page
L. S. Medina, K. Frawley, D. Zurakowski, D. Buttros, A. J.C. DeGrauw, and K. R. Crone
Children with Macrocrania: Clinical and Imaging Predictors of Disorders Requiring Surgery
AJNR Am. J. Neuroradiol., March 1, 2001; 22(3): 564 - 570.
[Abstract] [Full Text]

Home page
 Emerg. Med. J.Home page
C. A Graham, S. J O'Toole, and G. Haddock
Neonatal head injuries
Emerg. Med. J., September 1, 2000; 17(5): 334 - 336.
[Abstract] [Full Text]

Home page
 PediatricsHome page
M. W. Morris, S. Smith, J. Cressman, and J. Ancheta
Evaluation of Infants With Subdural Hematoma Who Lack External Evidence of Abuse
Pediatrics, March 1, 2000; 105(3): 549 - 553.
[Abstract] [Full Text]

Home page
 JAMAHome page
J. M. Leventhal
The Challenges of Recognizing Child Abuse: Seeing Is Believing
JAMA, February 17, 1999; 281(7): 657 - 659.
[Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
K. D. Gruskin and S. A. Schutzman
Head Trauma in Children Younger Than 2 Years: Are There Predictors for Complications?
Arch Pediatr Adolesc Med, January 1, 1999; 153(1): 15 - 20.
[Abstract] [Full Text] [PDF]

Home page
 BMJHome page
B. Lloyd
Subdural haemorrhages in infants
BMJ, December 5, 1998; 317(7172): 1538 - 1539.
[Full Text]

Home page
 PediatricsHome page
L. Ewing-Cobbs, L. Kramer, M. Prasad, D. N. Canales, P. T. Louis, J. M. Fletcher, H. Vollero, S. H. Landry, and K. Cheung
Neuroimaging, Physical, and Developmental Findings After Inflicted and Noninflicted Traumatic Brain Injury in Young Children
Pediatrics, August 1, 1998; 102(2): 300 - 307.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
A.-C. Duhaime, C. W. Christian, L. B. Rorke, and R. A. Zimmerman
Nonaccidental Head Injury in Infants -- The "Shaken-Baby Syndrome"
N. Engl. J. Med., June 18, 1998; 338(25): 1822 - 1829.
[Full Text] [PDF]

Home page
 Child MaltreatHome page
K. P. Hymel, F. A. Bandak, M. D. Partington, and K. R. Winston
Abusive Head Trauma? A Biomechanics-Based Approach
Child Maltreat, May 1, 1998; 3(2): 116 - 128.
[Abstract]

Home page
 J Child NeurolHome page
P. D. Adelson and P. M. Kochanek
Topical Review: Head Injury in Children
J Child Neurol, January 1, 1998; 13(1): 2 - 15.
[Abstract] [PDF]

Home page
 Arch. Dis. Child.Home page
J Haviland and R I R. Russell
Outcome after severe non-accidental head injury
Arch. Dis. Child., December 1, 1997; 77(6): 504 - 507.
[Abstract] [Full Text]

Home page
 PediatricsHome page
D. S. Wheeler and T. R. Shope
Depressed Skull Fracture in a 7-Month-Old Who Fell From Bed
Pediatrics, December 1, 1997; 100(6): 1033 - 1034.
[Full Text] [PDF]

Home page
 PediatricsHome page
A. Odom, E. Christ, N. Kerr, K. Byrd, J. Cochran, F. Barr, M. Bugnitz, J. C. Ring, S. Storgion, R. Walling, et al.
Prevalence of Retinal Hemorrhages in Pediatric Patients After In-hospital Cardiopulmonary Resuscitation: A Prospective Study
Pediatrics, June 1, 1997; 99(6): e3 - e3.
[Abstract] [Full Text] [PDF]

Home page
 Arch. Dis. Child.Home page
B. WILKINS; and R. SUNDERLAND
Head injury---abuse or accident? • Commentary
Arch. Dis. Child., May 1, 1997; 76(5): 393 - 397.
[Full Text]

Home page
 NEJMHome page
L. S. Wissow
Child Abuse and Neglect
N. Engl. J. Med., May 25, 1995; 332(21): 1425 - 1431.
[Full Text] [PDF]

Home page
 CLIN PEDIATRHome page
R. S. B. Clark, R. A. Orr, C. S. Atkinson, R. B. Towbin, and D. Pang
Retinal Hemorrhages Associated With Spinal Cord Arteriovenous Malformation
Clinical Pediatrics, May 1, 1995; 34(5): 281 - 283.
[PDF]