What is Abusive Head Trauma?

Social workers, like every profession, must earn continuing education credits in order to maintain their professional license. This past Friday I went to a new class our profession is required to take, “Pediatric Head Trauma.” To be quite honest, I was not excited to go. Usually required classes are boring and I was a little nervous about this one. In college I double majored in Psychology and Criminal Justice. I loved Criminal Justice but the photographs in the Child Abuse classes were disturbing and made me feel faint. Literally . . . faint.

In the workshop, I sat with my social work friends and prepared to doodle. The presenter, Dr. Melissa Currie, MD is Associate Professor and Director of Division of Forensic Medicine and Department of Pediatrics from University of Louisville School of Medicine. Luckily, her pictures were small (no fainting problems) and her information was outstanding. Dr. Currie made some frightening but insightful comments about foster children in Kentucky that I immediately connected to the children I see in my counseling practice.

In the workshop Dr. Currie stated, “Abusive head trauma is the most common cause of disability and death in physical child abuse” and “Abusive head trauma usually occurs in children younger than 1 year of age, but older children can be victims as well.”

What is Abusive Head Trauma?

Dr. Currie explained Abusive Head Trauma occurs when someone harshly shakes a child or when a child suffers an impact, such as being thrown onto a mattress or against a surface like a wall. She stated that head trauma is commonly triggered by a child’s crying, misbehavior, or during toilet training.

Infants and toddlers are more at risk because the infant’s brain has “fewer nooks and crannies” to keep the brain in place, and the toddlers’ large head to body ratio makes their neck muscles weak. Dr. Currie added, “Infants with abusive head injury may look completely normal and uninjured from the outside and the diagnosis is often missed and misdiagnosed by professionals.” At the time of an injury the symptoms may be vomiting, irritability, lethargy and sleepiness ranging to the more severe symptoms of seizures, breathing problems and cardiac arrest.

Dr. Currie stated when foster children are placed in the state of Kentucky their medical records do not follow them, and records are not made available to the foster family from the child’s pediatrician. The foster or adoptive parents often have no knowledge that the child suffered a past head trauma. Obviously, the same would be true for a child who has been internationally adopted.

Outcomes

For children who have a history of head injury, there is not a standard outcome but Dr. Currie named some possibilities including: “learning disabilities, emotional and behavioral issues, speed and language delays, vision and hearing problems and hormone or growth problems.” This information was thought provoking as many of the kids I see have these difficulties. In the past I had never considered Abusive Head Trauma as a cause, but I will now.

As soon as I left the workshop researched and found limited information about long term effects of early brain injury. One study did indicate Traumatic Brain Injury in young children is associated with later conduct problems and ADHD. Another article by Dr. Lopez-Duran, PhD states, “In fact, 21% of the children who experienced a TBI will continue to show somatic, cognitive, and emotional difficulties as long as 12 months after injury.” Clearly, more longitudinal studies are needed to show how Traumatic Brain Injury can effect a child over time. This pertinent information necessitates further thought for adoptive and foster parents and professionals.