The “New Science” of Abusive Head Trauma

Abstract

Claims that new science is changing accepted medical opinion about abusive head injury have been made frequently in the media, legal publications, and in legal cases involving abusive head trauma (AHT). This review analyzes recently published scientific articles about AHT to determine whether this new information has led to significant changes in the understanding, evaluation, and management of children with suspected AHT. Several specific topics are examined as follows: serious or fatal injuries from short falls, specificity of subdural hematoma for severe trauma, biomechanical explanations for findings, the specificity of retinal hemorrhages, the possibility of cerebral sinus thrombosis presenting with signs similar to AHT, and whether vaccines can produce such findings. We conclude (a) that the overwhelming weight of recent data does not change the fundamental consensus, (b) that abusive head trauma is a significant source of morbidity and mortality in children, (c) that subdural hematomas and severe retinal hemorrhages are commonly the results of severe trauma, (d) that these injuries should prompt an evaluation for abuse when identified in young children without a history of such severe trauma, and (e) that short falls, cerebral sinus thrombosis, and vaccinations are not plausible explanations for findings that raise concern for abusive head trauma.

Legal Outcomes of Suspected Maltreatment Cases Evaluated by a Child Abuse Pediatrician as Part of a Multidisciplinary Team Investigation

“…These perceptions are further inflated by a form of child abuse denialism. With this denialism has come both controversy and the sharing of information in the courtroom that is not supported by scientific evidence (7). Many of these disputes are centered on alternative explanations of injuries that have been either debunked, or are not supported in the medical field (7–9).…”

“…With this denialism has come both controversy and the sharing of information in the courtroom that is not supported by scientific evidence (7). Many of these disputes are centered on alternative explanations of injuries that have been either debunked, or are not supported in the medical field (7–9). For example, abusive head trauma (AHT) has been shrouded by such significant misrepresentations that a consensus statement was recently published to reaffirm the validity of the diagnosis as well as clinical evidence supporting it (10).…”

“…For example, abusive head trauma (AHT) has been shrouded by such significant misrepresentations that a consensus statement was recently published to reaffirm the validity of the diagnosis as well as clinical evidence supporting it (10). In fact, Lindberg et al’s recent review of literature purporting to offer alternative explanations for AHT concluded with Lindberg et al pointing to fundamental flaws in the research and the erroneous conclusions drawn (7). Ultimately, the only influence these publications have is in the courtroom (7).…”

“…In fact, Lindberg et al’s recent review of literature purporting to offer alternative explanations for AHT concluded with Lindberg et al pointing to fundamental flaws in the research and the erroneous conclusions drawn (7). Ultimately, the only influence these publications have is in the courtroom (7). Narang points to several contributing factors that have caused these fringe beliefs including, “emotional bias forged in relationships with caregivers, philosophical denialism of the entity of abuse, political dissatisfaction and mistrust of child welfare systems, and plain old pecuniary interests” (11).…”

Denying the abusive head trauma denialists their day in court, one step at a time

“…How very pleasing it is to see this unproven theory so directly confronted by compelling clinical research. For more information, interested readers are encouraged to read two recently published manuscripts that explore the denialists' unproven theories in much greater detail [3][4][5].…”