Academic journal article Child Welfare

The Child Welfare Response to Serious Nonaccidental Head Trauma

Academic journal article Child Welfare

The Child Welfare Response to Serious Nonaccidental Head Trauma

Article excerpt

Serious nonaccidental head trauma (NHT) can leave permanent neurological damage in children who survive abuse. This study reports on child welfare's handling of NHT cases compared with cases of physical abuse and head trauma due to neglect with regard to placement in foster care, reunification with family, and safety issues. The results show that workers placed children with NHT in foster care immediately after the abuse but treated them no differently than other physically abused children regarding reunification.

For more than half a century, physicians have been grappling with the diagnosis of shaken baby syndrome. In 1946, a radiologist, Dr. Caffey, described six infants with a combination of subdural hematomas and characteristic bone lesions. He later described and labelled the new syndrome as the whiplash shaken infant syndrome (Caffey, 1972, 1974). Kempe, Silverman, Steele, Droegulueller, and Silver's (1962) landmark paper, which put a name to child maltreatment, included subdural hematomas as part of battered child syndrome.

With the advent of craniocerebral computed tomography in the mid-1970s, identifying bleeding in the brain became significantly more accurate and easy (Ellison, Tsai, & Largent, 1978; Zimmerman, Bilanluk, & Bruce, 1979). Over the last 25 years, a growing body of knowledge has described battered child syndrome, which is now called nonaccidental head trauma (NHT). The literature has concentrated on the physical findings, incidence, presenting symptoms, biomechanics, timing of the injury, and autopsy findings based on case reports. Several excellent articles (Brown & Minns, 1993; Conway, 1998; Duhaime, Christian, Rorke, & Zimmerman, 1998) review the current knowledge about the medical aspects of NHT.

NHT is the leading cause of death in infancy (Billmire & Myers, 1985; Centers for Disease Control and Prevention, 1990; Duhaime et al., 1992). Most children who survive suffer permanent neurological damage (Benzel & Hadden, 1989; Bonner, Nassogne, & Evrard, 1995; Duhaime, Chrisian, Moss, & Seidl, 1996). What happens to these children in the child welfare system?

The authors undertook this study to understand the child welfare system's actions in cases of serious NHT. The authors believe this is especially important because NHT is increasingly easier to diagnose and because of the long-term health consequences of this type of severe abuse. NHT is an important form of abuse to study, given that it raises issues of the caregiver's intent to harm the infant. It is important that child welfare practitioners recognize shaking as potentially having more devastating consequences for a child than beating him or her.

This study uses administrative data to describe the demographics, case characteristics, and case outcomes for children with indicated NHT between 1994 and 1998. The authors categorized these findings by the seriousness of the injury and compared them with infants suffering from other forms of physical abuse. Because it uses administrative data, the study is unable to explore the dynamics of the relationship between the perpetrator and the victim. These types of data are essential to understanding the intent of caregivers to commit abuse as well as to recommending appropriate treatment interventions for practitioners, however, understanding the response of the child welfare system reveals critical information about reunification and reabuse of these children.


To determine the response of the child welfare system to children with serious NHT, the authors analyzed all children from birth to age 3 with an indicated report of head trauma by the Illinois Department of Children and Family Services (DCFS). The head trauma was due either to abuse or neglect between January 1, 1994, and December 31, 1998. The group included 625 children. As a comparison, the researchers identified 3,116 children during the same time period who had other forms of physical abuse, including internal injuries; burns or scalding; poisoning; bone fractures; cuts, bruises, and welts; human bites; sprains or dislocations; tying or close confinement; substance abuse; and torture. …

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