Understanding Abusive Head Trauma-AHT
WHAT IS ABUSIVE HEAD TRAUMA (AHT)?
Abusive head trauma (AHT) is a well-recognized constellation of brain injuries caused by the directed application of force to an infant or young child, resulting in physical injury to the head and/or its contents.1 Approximately 20/100,000 children sustain AHT annually. 2, 3.
Physicians from distinct fields including pediatrics, neurology, neurosurgery, ophthalmology, critical care medicine, radiology, neuroradiology, and physiatry have contributed to the scientific data that support AHT as a firmly established medical diagnosis. 4, 5, 6, 7, 8, 9, 10, 11. The clinical diagnosis of AHT has been confirmed by pathologists, forensic pathologists, and neuropathologists through autopsies and postmortem research. 12, 13, 14, 15, 16.
Extensive peer-reviewed medical literature regarding AHT over the past 50 years 17 and clinical experience and reasoning by thousands of physicians leave no doubt that infants and young children sustain head and brain injury — sometimes severe, sometimes fatal — by caregivers.
In 2009, the AAP published a policy statement, “Abusive Head Trauma in Infants and Children,” that briefly reviewed the mechanisms and pathophysiology related to AHT and called for physicians “to use the term abusive head trauma rather than a term that implies a single injury mechanism, such as shaken baby syndrome (SBS), in their diagnosis and medical communications.” 18 The goal of the statement was “not to distract from shaking as a mechanism of AHT but to broaden the terminology to account for the multitude of primary and secondary injuries that result from AHT, some of which contribute to the often permanent and significant brain damage sustained by abused infants and children.” This policy statement has been mischaracterized in subsequent legal and medical literature and in court testimony to suggest that the AAP no longer recognizes shaken baby syndrome as a legitimate diagnosis. 19, 20.
On the contrary, the AAP reinforces the fact that shaking is an important contributor to abusive head injuries and that shaken baby syndrome is a subset of AHT. Additionally, since the release of this statement, peer-reviewed medical literature — including case reports in which adults have admitted shaking an infant or child — has been published and further underscores the significance of shaking as an important contributing mechanism of injury. 5
There is no legitimate medical debate among the majority of practicing physicians as to the existence or validity of AHT/SBS. The only real debate and controversy appear to be in the legal system and the media. Claims that shaking is not dangerous to infants or children are not factual and are not supported by AAP policy, despite being proffered by a few expert witnesses in the courtroom. Alternative hypotheses have been offered by a few physicians and others, but the evidence for these hypotheses is lacking. Several experts who have published and testified regarding alternative theories of AHT causation have conceded in recent medical publications that infants can be damaged or killed by violent shaking or abuse. 21, 22
It is unequivocally clear that inflicted head injury is a relatively common and clearly defined entity and that a differential diagnosis, including medical diseases that can mimic AHT/SBS, can be evaluated by physicians objectively.
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