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Abused Children may have Hidden Head Injuries

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Updated March 13, 2006

Child abuse contributes to a number of mental health problems. It's important not to assume that these are the only effects of abuse. Research from The Children's Hospital of Philadelphia found that hidden head injuries may also cause problems. The researchers found that children with suspected high-risk child abuse injuries had a high incidence of head injuries. This was true even when their neurological examinations had appeared normal. The head injuries included scalp swelling, skull fractures and more serious intracranial injuries. The injuries were often missed by routine exams (including neurological exams) but were detected by brain scans - which are not universally used for screening in this population.

Researchers studied hospital records for 51 children under age two who presented to the hospital with suspected abuse injuries. All had normal neurological examination on admission and showed no overt signs of head injuries. Patients all had one of the following "high-risk" characteristics or injuries: age less than six months for any abusive injury, rib fractures, more than one fracture of any type, or facial injury. The children underwent routine neurological and ophthalmologic screening measures and also underwent a brain scan using computed tomography (CT) or magnetic resonance imaging (MRI) technology.

37% of the children showed signs of head injuries with more than half suffering from intracranial injuries. Skeletal survey alone missed 5 of the 19 children with an occult head injury. An ophthalmologic examination was performed on 14 patients to determine the presence of retinal hemorrhages, a sign of head trauma. No evidence of hemorrhage was present in any of the children. Children without head injury were also found to be older than children with head injury.

The study, published in the June 2003 issue of Pediatrics, was the first to estimate the prevalence of occult head injury in a high-risk cohort of abused children. A research press release from Children's Hospital of Philadelphia quotes lead author David M. Rubin, M.D. as stating that "Head injury is the leading cause of death among abused children under age two years. Because asymptomatic head injury can be difficult to diagnose, especially in young children, it is necessary to use additional measures to determine which children have sustained these injuries so we can intervene early."

The researchers recommend universal CT or MRI screening in all children under six months of age with any signs of abuse and children under one year of age with high-risk injuries, including rib fractures, multiple fractures and facial injuries. They also recommend further research into head injuries in child abuse.

Last updated 3/12/06

 Source - Children's Hospital of Philadelphia research press release, summarizing June 2003 study in Pediatrics

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