Abstract
In recent years, there has been a substantial increase in the number of published reports in the medical literature that specifically describe outcomes after inflicted traumatic brain injury (TBI) during the first years of life. Though much more work is needed, these early reports are soberinginflicted cranial injuries have been linked to devastating morbidity and mortality in infants and young children. In this article, we will analyze this emerging body of literature and discuss the implications of these early studies for early intervention specialists.
In the United States, inflicted head trauma is the leading cause of traumatic death and morbidity during infancy.1-3 Inflicted traumatic brain injury (TBI) occurs behind closed doors. The caregiver's explanation for an infant's traumatic cranial injuries is frequently absent, changing, or inadequate, and therefore unreliable. Although a single, compelling account of adult TBI induced by violent shaking has been published in the medical literature, presently there is no published account from an independent witness that directly links violent shaking to pediatric TBI in an infant or young child. Unfortunately, most of the published reports of perpetrator admissions of inflicted head trauma are second-hand accounts that are lacking in specific and detailed information regarding the injury events.
Nevertheless, these reports are compelling.5-13 Admitted perpetrators of inflicted pediatric head trauma have described violent shaking; blows to the head; and/or cranial impacts against walls, furniture, or the floor. Furthermore, their abusive actions have been linked specifically to their victims' rapid clinical deterioration and devastating intracranial injuries.14