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What are the distinguishing clinical features of abusive head trauma in children?

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.


Abusive head trauma (AHT) is the commonest cause of death in physical abuse. It may present in a variety of ways, from overt neurological symptoms to mild irritability or co-existent physical injuries 1,2. It is well documented that many children with AHT may be missed on initial presentation 2,3. We systematically reviewed the literature to identify key clinical indicators of AHT versus non-abusive head trauma.

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  1. Ichord RN, Naim M, Pollock AN, Nance ML, Margulies SS, Christian CW. Hypoxic-ischemic injury complicates inflicted and accidental traumatic brain injury in young children: the role of diffusion-weighted imaging. Journal of Neurotrauma. 2007;24(1):106-118. [Pubmed]
  2. Jenny C, Hymel KP, Ritzen A, Reinert SE, Hay TC. Analysis of missed cases of abusive head trauma. Journal of American Medical Association. 1999;281(7):621-626 [Pubmed]
  3. Gago LC, Wegner RK, Capone A Jr, Williams GA. Intraretinal hemorrhages and chronic subdural effusions: glutaric aciduria type 1 can be mistaken for shaken baby syndrome. Retina. 2003;23(5):724-726 [Pubmed citation only]

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   – Overall results
   – Age

   – Gender

   – Influence of ethnicity and socio-economic group

Analysis of included studies:

   – Apnoea

   – Retinal haemorrhage

   – Rib fracture
   – Long bone fracture
   – Seizure
   – Bruising to the head and/or neck
   – Skull fracture

Implications for practice

Research implications

Limitations of review findings

Other useful references


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