WHAT'S KNOWN ON THIS SUBJECT:Abusive head trauma (AHT) is the leading cause of death from child abuse. Poverty and stress are recognized risk factors for abuse. No studies to date have evaluated whether there is a relationship between the economy and rates of AHT. WHAT THIS STUDY ADDS:Results of this study demonstrate a relationship between an economic recession and the rate of AHT. Given the high morbidity and mortality rates for children with AHT, these results are highly concerning. abstract OBJECTIVE: To evaluate the rate of abusive head trauma (AHT) in 3 regions of the United States before and during an economic recession and assess whether there is a relationship between the rate of AHT and county-level unemployment rates. RESULTS: During the 5 1 ⁄ 2-year study period, a total of 422 children were diagnosed with AHT in a 74-county region. The overall rate of AHT increased from 8.9 in 100 000 (95% confidence interval [CI]: 7.8 -10.0) before the recession to 14.7 in 100 000 (95% CI: 12.5-16.9) during the recession (P Ͻ .001). There was no difference in the clinical characteristics of subjects in the prerecession versus recession period. There was no relationship between the rate of AHT and county-level unemployment rates. METHODS: CONCLUSIONS:The rate of AHT increased significantly in 3 distinct geographic regions during the 19 months of an economic recession compared with the 47 months before the recession. This finding is consistent with our understanding of the effect of stress on violence. Given the high morbidity and mortality rates for children with AHT, these results are concerning and suggest that prevention efforts might need to be increased significantly during times of economic hardship.