When head injury occurs with children, sometimes it is caused by accident and sometimes it is caused by other medical ailments. However, in some cases abuse can be involved in child head injuries. In this post, we explore indicators of abuse in head injuries during the reporting and diagnosis of the injury, as outlined in our Abusive Head Trauma Quick Reference.
Adults who are guilty of abuse and who report on how an injury occurred often fabricate explanations to keep themselves out of trouble. Infants are often reported to have fallen from couches or beds, and adults may describe shaking infants while playing. Although this can be the case in some circumstances, these stories often do not support a severe injury. Fabrication can be identified when stories do not match up between different caregivers and/or over time in different recollections of the event.
Explanations that do not match up should be a red flag to investigators. If another child is blamed for the incident or if an explanation does not align with the developmental capability of the child, abuse can be suspected.
Additionally, if a child experiences trauma and the adult’s report of the events would not warrant a traumatic experience, this can be a sign that abusive action occurred.
In cases of head injury in children, injuries in other areas of the body are also usually present. If there is an explanation for the head injury without an explanation for coexisting injuries, this can also be a sign of abuse.
During diagnosis and treatment, inconsistencies may also be found in biomechanics, epidemiology, and temporal issues discovered by first responders, physicians, and other people involved in the treatment. This can also support suspicion of abuse.
Delayed action to seek medical attention for a child is a sign that abuse may have been involved in the injury. Adults guilty of abuse typically minimize the severity of the injury during the report of the incident which is not revealed or explained until inconsistencies are noticed in the history. Adults who minimize the severity of the injury as a way to feel less guilty about the events or to underscore that abuse took place can lead to delayed action.
Physicians involved in the diagnosis and treatment of child head injury have several factors to consider before deciding if the caregiver abused the child. We have several publications to help physicians make that decision, including our Abusive Head Trauma Pocket Atlases and the third volume of our Child Abuse Pocket Atlas which focuses specifically on head injuries.
If you are someone who helps children who have experienced abuse, maltreatment, or neglect, our books can offer valuable information to you in your work. For more information on what we do, check out our website or subscribe to our newsletter.