Technical report is first extensive compilation of decades of research supporting diagnosis of abusive head trauma in children
ITASCA, IL--The American Academy of Pediatrics provides a comprehensive literature review in support of evidence-based medical evaluations to diagnose abusive head trauma in children within a new technical report written by a multidisciplinary team of experts and published in the March 2025 Pediatrics.
Abusive head trauma, defined as an injury to the skull or intracranial contents of an infant or child under age 5 due to inflicted blunt impact and/or violent shaking, is the third leading cause of death in children younger than 5. There are about 1,300 cases reported annually, and survivors may face lifelong physical challenges and brain damage. The diagnosis is complex and carries clinical, social, and legal implications that add to the emotional distress experienced by families.
“There is a wide breadth of evidence supporting a diagnosis of abusive head trauma,” said Sandeep K. Narang, MD, JD, FAAP, lead author of the report. “When presented with a case of suspected abuse, a team of medical professionals works together and follows a methodical, evidence-based approach. Child abuse pediatricians receive three years of additional training to identify the signs and symptoms of maltreatment—and many times pediatricians rule out child abuse.”
The technical report, “Abusive Head Trauma in Infants and Children,” published online Feb. 24, was written and reviewed by specialists from the fields of ophthalmology, radiology, neurosurgery, and pathology. These experts specialize in evaluating and treating children with traumatic brain injury.
Technical reports created by AAP are written by medical experts, reflect the latest evidence in the field, and go through several rounds of peer review before being approved by the AAP Board of Directors and published in Pediatrics. The process is described here.
“When child abuse is suspected, we make a medical diagnosis the same way we diagnose any other medical condition: based on the history provided by the family, the physical examination, medical testing and proven medical science,” said a co-author of the report, Suzanne Haney, MD, MS, FAAP, with Children’s Nebraska and University of Nebraska Medical Center.
“For instance, it is incredibly rare for an infant who can’t even crawl to have bruising or broken bones. Such a presentation should raise concern for possible abuse and prompt a pediatrician to do a thorough evaluation.”
The AAP breaks down the evidence by fields of medical expertise and disciplines to reflect the broad scope of research. It observes misunderstandings about the diagnosis that are perpetuated in court cases. It also notes geographic variances where abusive head trauma cases are reported, with the highest incidences reported in the Midwest and the lowest in the Northeast.
Differential diagnoses are discussed, such as accidental trauma, bleeding disorders and birth trauma, as well as alternative medical hypotheses that are not supported by research.
“This AAP technical report provides comprehensive, practical information to pediatricians, family practitioners, and other healthcare professionals caring for children,” said Ann-Christine Duhaime, MD, FAAP, a pediatric neurosurgeon at Mass General for Children and and co-author of the report.
“Drawing on up-to-date evidence, the report includes clear and detailed guidance on virtually every aspect of head trauma in which abuse may be a consideration, including diagnosis, management, outcomes, and prevention. By providing the rationale, context, and evolution of the science behind its recommendations, the report will serve as a valuable resource for any healthcare provider who interacts with pediatric patients and their families.”
The report also reviews the efficacy of prevention programs that seek to improve caregiver knowledge and behavior about abusive head trauma and emotional-behavioral responses to infant crying.
“Preventing abuse is really about building relationships and supporting others who are struggling. For instance, any of us can relate to how quickly a crying baby can easily frustrate the best-intentioned among us,” said Dr. Narang, a physician with the Medical College of Wisconsin Child Advocacy and Protection Services, Children’s Wisconsin.
“Family members, friends and neighbors can make a difference by extending a hand to new parents or anyone who is overextended. We all share a goal of creating happy, safe and loving environments for children and families.”
The technical report was authored by the AAP Council on Child Abuse and Neglect, Section on Ophthalmology, Section on Radiology and Section on Neurological Surgery; Society for Pediatric Radiology; American Association of Certified Orthoptists; American Association for Pediatric Ophthalmology and Strabismus; and American Academy of Ophthalmology.
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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.