A review of social factors in the investigation and assessment of non-accidental head injury to children

Abstract

Investigation and assessment work in non-accidental head injury cases is complex and challenging. This article discusses briefly the professional systems involved and the conditions necessary for effective practice. It then reviews briefly the literature on social factors in serious and fatal child abuse in order to provide a context for discussion of recent UK studies of non-accidental head injuries/shaken baby syndrome. The findings on social factors are compared and areas for further research are suggested. The article then considers how best to use the existing knowledge base about these cases within assessment frameworks currently in use and considers issues in presenting assessment conclusions to decision-makers.

Non-accidental head injury: a consequence of deprivation?

“…The place of residence may affect many aspects of health and well-being, thereby influencing parenting. Moreover, given the existing social pressures and stresses on families in the most deprived areas of Scotland, it would not be surprising to find a higher incidence of NAHI cases in these areas 23. Our earlier report on the Lothian region alone found that cases of NAHI came from a strongly skewed profile representing the lowest socioeconomic groups in the community 18.…”

Temporal factors and the incidence of physical abuse in young children: decreased nonaccidental trauma during child abuse prevention month

“…A prior history of physical abuse and a history of violence in the home are also known to associate with infant abuse [12]. To date, no published studies have revealed significant associations between month, day, or weather, and an increase or decrease in child abuse cases.…”

Demographics of abusive head trauma in the Commonwealth of Pennsylvania

“…Recent studies from the United Kingdom also suggest that parents of children with AHT are younger and more frequently from laboring classes than the general population. 4,5,12 One must be very cautious in interpreting these data, as there are at least 2 different interpretations. One interpretation is that infants in these families are actually more likely to suffer AHT.…”