Position Paper on Fatal Abusive Head Injuries in Infants and Young Children

Citation:

Case ME, Graham MA, Handy TC, Jentzen JM, Monteleone JA: Position paper on fatal abusive head injuries in infants and young children. American Journal of Forensic Medicine and Pathology 22(2):112-122, February 2001.

Abstract

Notes:

• Abusive head injury often occurs in response to prolonged crying and is usually inflicted by a caregiver with limited patience or experience with children.
• The baby's body should be carefully searched to identify any injury.
• Rotational movements of the brain result in diffuse axonal injury.
• Tearing of bridging veins produces subdural and subarachnoid hemorrhages.
• The pathogenesis of retinal hemorrhages is not precisely understood. If a child is older than 30 days, these are a marker for abuse.
• Nontraumatic causes of retinal hemorrhages include bleeding disorders, sepsis, meningitis, vasculopathies, increased intracranial pressure and rarely, cardiopulmonary resuscitation.
• Many children die too soon after injury for the pathologic changes that prove diffuse axonal injury to be established.
• In accidental head injury, children with diffuse axonal injury show an immediate decrease in the level of consciousness (lethargy or unconsciousness), respiratory problems, and seizures.
• "Proof of rebleeding of a chronic subdural membrane should be based on the demonstration of a chronic subdural membrane that is grossly evident at autopsy." (p. 120)

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