Pediatric Abusive Head Trauma CE for Kentucky Nurses
Prevent and Report Shaken Baby Syndrome
CONTACT HOURS: 1.5
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LEARNING OUTCOME AND OBJECTIVES: Upon completion of this course, you will be better prepared to recognize and help prevent pediatric abusive head trauma (AHT) and understand reporting requirements for instances of AHT in Kentucky. Specific learning objectives to address potential knowledge gaps include:
- Define “pediatric abusive head trauma.”
- Recognize the risk factors for head injuries resulting from abuse.
- Describe the mechanisms of injury, clinical presentation, history gathering, physical assessment, and diagnosis of pediatric AHT.
- Distinguish between accidental and abusive head trauma in the pediatric population.
- Discuss resources for prevention of pediatric AHT.
- Summarize Kentucky reporting requirements for suspected child abuse and neglect.
TABLE OF CONTENTS
- Introduction
- Risk Factors for Abusive Head Trauma
- Assessment and Diagnosis of Pediatric Abusive Head Trauma
- Prevention Strategies for Abusive Head Trauma
- Reporting Child Abuse and Neglect in Kentucky
- Conclusion
- Resources
- References
INTRODUCTION
According to the CDC (2021), pediatric abusive head trauma (AHT) is a preventable and severe form of physical child abuse that results in an injury to the head or brain of a child. It is caused by violent shaking (often referred to as shaken baby syndrome) and/or blunt impact. AHT includes a range of injury mechanisms and clinical outcomes, from subtle presentations to infants with severe and life-threatening injuries.
The diagnosis of AHT should be made by a multidisciplinary team based on an aggregate of physical, radiographic, and laboratory evidence that cannot be explained by the provided history or is incongruent with the developmental stage of the child (Choudhary et al., 2018; O’Meara et al., 2020). Subspecialists in radiology, ophthalmology, neurosurgery, neurology, general pediatric surgery, and other fields should also be consulted when necessary to ensure a complete and accurate diagnostic evaluation (AAP, 2020).
AHT continues to be leading cause of physical abuse–related death in children and the leading cause of death from injury in infants. The fatality rate is significant for AHT and has been estimated to exceed 20%, with significant disability for nearly two thirds of the survivors. Deaths due to abusive head trauma peak at 1 to 2 months of age, most likely due to higher physiologic vulnerability (see also “Risk Factors” below) (CDC, 2022, 2021).
For children in the first year of life, the majority of serious head injuries result from abuse, and this peak incidence and rapid decrease with age are thought to be related to episodes of prolonged, inconsolable, and unpredictable crying. Such crying can be both a developmentally typical way for infants to communicate their basic needs, but it also can be related to a variety of other health and/or developmental causes that can be identified through medical examination. Regardless of the etiology, it is important to aim prevention strategies toward supporting parents and caregivers in dealing with crying.
TERMINOLOGY
Pediatric Abusive Head Trauma (PAHT or AHT): KRS 620.020 defines pediatric abusive head trauma as the various injuries or conditions that may result following the vigorous shaking, slamming, or impacting the head of an infant or young child. These injuries or conditions, also known as pediatric acquired abusive head trauma, have in the past been called Shaken Baby Syndrome or Shaken Infant Syndrome. Pediatric abusive head trauma injuries or conditions have included but are not limited to the following:>
- Irreversible brain damage
- Blindness
- Retinal hemorrhage
- Eye damage
- Cerebral palsy
- Hearing loss
- Spinal cord injury
- Paralysis
- Seizures
- Learning disability
- Death
- Central nervous system injury as evidenced by central nervous system hemorrhaging
- Closed head injury
- Rib fracture
- Subdural hematoma
Pediatric Acquired/Traumatic Brain Injury (PA/TBI): This term includes traumatic causes such as those sustained as a result of motor vehicle accidents, sports-related injuries, blast injuries from war, assaults/child abuse, gunshot wounds, and falls.
Shaken Baby Syndrome (SBS): SBS refers to a form of abusive head trauma caused by shaking and with a characteristic pattern of injuries that may include retinal hemorrhages, certain fractures (in particular, ribs and the ends of long bones), and recognizable patterns of brain injury, often including thin subdural hemorrhages and sometimes diffuse axonal injury.
The change in terminology (from “shaken baby syndrome” to “abusive head trauma”) was misinterpreted by some in the legal and medical communities as an invalidation of the diagnosis and the mechanism of shaking as a cause of injury. However, the AAP continues to affirm the dangers and harms of shaking infants and embraces the “shaken baby syndrome” diagnosis as a valid subset of an AHT diagnosis and for parental education and community preventative efforts to caution against the detrimental effects of infant shaking (AAP, 2020).