Severe Head Trauma May Signal Abuse in Young Children. (under Age 5 Years)

Article excerpt

CHICAGO -- Accidental falls rarely produce significant head injuries, Dr. Karl Johnson said at the annual meeting of the Radiological Society of North America.

"In our experience, if it's an accident, most children will fall over, they may cry a bit, they may have some swelling on the head, but the majority of times they'll actually just walk away from it," said Dr. Johnson, lead investigator and consultant pediatric radiologist at Birmingham (England) Children's Hospital.

Therefore, be suspicious of child abuse when caretakers blame a severe head injury in children under the age of 5 years on a household accident, he said.

He and his colleagues studied the severity of head injuries in 94 children between the ages of 4 months and 5 years who were seen in a radiology practice after normal domestic falls and accidents. While an "accident" is often offered as the cause of nonaccidental injuries, in these cases each fall was witnessed by a responsible adult and corroborated by a second party.

To be included in the study, the children had to be brought in within a few hours after the event, and the stories had to be compatible with a normal domestic situation. The height of the falls ranged from 20 cm to more than 3 m, or one to four times the patient's height.

Dr. Johnson found that in 89 (95%) of the children, there were no significant long-term problems from accidents, including falls from beds and couches. Of the remaining five children, three had linear parietal skull fractures, one had a fractured wrist, and one child suffered a fracture at the base of the skull after falling from a first-story window onto a concrete driveway. …


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