Inflicted traumatic brain injury (TBI) is a frequent consequence of physical child abuse in infants and children. Twenty-eight children who were 2–42 months of age when hospitalized for moderate to severe TBI were enrolled in a prospective, longitudinal study of neurobehavioral outcome following acquired brain injury. Relative to a comparison group, the children with inflicted TBI had significant deficits in cognitive, motor and behavioral domains when assessed with the Bayley Scales of Infant Development-II 1 and 3 months after the injury. Nearly half of the injured children showed persisting deficits in attention/arousal, emotional regulation and motor coordination. Greater injury severity, as indicated by lower coma scale scores, longer periods of unconsciousness and the presence of edema/cerebral infarctions was associated with poorer outcomes in all domains.

Keywords:
Brain injury, Cerebral infarction, Child abuse, Cognition, Outcome, Infants, Children, Shaken baby syndrome
1.
Hahn YS, Raimondi AJ, McLone DG, Yamanouchi Y: Traumatic mechanisms of head injury in child abuse. Childs Brain 1983;10:229–241.
2.
Duhaime AC, Alario AJ, Lewander WJ, et al: Head injury in very young children: Mechanisms, injury types, and ophthalmologic findings in 100 hospitalized patients younger than two years of age. Pediatrics 1992;90:179–185.
3.
Levin HS, Aldrich EF, Saydjari C, et al: Severe head injury in children: Experience of the traumatic coma data bank. Neurosurgery 1992;31:435–444.
4.
Kraus JF, Rock A, Hemyari P: Brain injuries among infants. Am J Dis Child 1990;144:684–691.
5.
Caffey J: On the theory and practice of shaking infants: Its potential residual effects of permanent brain damage and mental retardation. Am J Dis Child 1972;124:161–169.
6.
Bruce DA, Zimmerman RA: Shaken impact syndrome. Pediatr Ann 1989;18:482–489.
7.
Bonnier C, Nassogne MEP: Outcome and prognosis of whiplash shaken infant syndrome; late consequences after a symptom-free interval. Dev Med Child Neurol 1995;37:943–956.
8.
Cohen RA, Kaufman RA, Myers PA, Towbin RB: Cranial computed tomography in the abused child with head injury. AJNR 1986;146:97–102.
9.
Fischer H, Allasio D: Permanently damaged: Long-term follow-up of shaken babies. Clin Pediatr 1994;33:696–698.
10.
Goldstein B, Kelly MM, Bruton D, Cox C: Inflicted versus accidental head injury in critically injured children. Crit Care Med 1993;21:1328–1332.
11.
Ludwig S, Warman M: Shaken baby syndrome: A review of 20 cases. Ann Emerg Med 1984;13:104–107.
12.
Sinal SH, Ball MR: Head trauma due to child abuse: Serial computerized tomography in diagnosis and management. South Med J 1987;80:1505–1512.
13.
Jaspan T, Narborough G, Punt JAG, Lowe J: Cerebral contusional tears as a marker of child abuse – detection by cranial sonography. Pediatr Radiol 1992;22:237–245.
14.
Duhaime AC, Christian C, Moss E, Seidl T: Long-term outcome in infants with the shaking-impact syndrome. Pediatr Neurosurg 1996;24:292–298.
15.
Ewing-Cobbs L, Kramer L, Prasad M, et al: Neuroimaging, physical, and developmental findings after inflicted and noninflicted traumatic brain injury in young children. Pediatrics 1998;102:300–307.
16.
Jennett B, Bond M: Assessment of outcome after severe brain damage. Lancet 1975;1:480–487.
17.
Teasdale G, Jennett B: Assessment of coma and impaired consciousness: A practical scale. Lancet 1974;ii:81–84.
18.
Bayley N: Bayley Scales of Infant Development, ed 2. San Antonio, Psychological Corporation, 1993.
19.
Hollingshead A: Four factor index of social status (unpublished). 1975.
20.
Dunst KJ, Leet HE: Measuring the adequacy of resources in households with young children. Childcare Health Hum Dev 1987;13:111–129.
21.
Ewing-Cobbs L, Thompson NM, Miner ME, Fletcher JM: Gunshot wounds to the brain in children and adolescents: Age and neurobehavioral development. Neurosurgery 1994;35:225–233.
22.
Ewing-Cobbs L, Fletcher JM, Levin HS, Francis DJ, Davidson K, Miner ME: Longitudinal neuropsychological outcome in infants and preschoolers with traumatic brain injury. J Int Neuropsychol Soc 1997;3:581–591.
23.
Ewing-Cobbs L, Prasad M, Kramer L, et al: Acute neuroradiologic findings in young children with inflicted or noninflicted traumatic brain injury. Childs Nerv Syst, in press.
24.
Chadwick O, Rutter M, Brown G, Shaffer D, Traub M: A prospective study of children with head injuries. II. Cognitive sequelae. Psychol Med 1981;11:49–61.
25.
Jaffe KM, Gayle CF, Polissar NL, et al: Severity of pediatric traumatic brain injury and early neurobehavioral outcome: A cohort study. Arch Phys Med Rehabil 1992;73:540–547.
26.
Thompson NM, Francis DJ, Stuebing KK, et al: Motor, visual-spatial, and somatosensory skills after closed head injury in children and adolescents: A study of change. Neuropsychology 1994;8:333–342.
27.
Hoffman-Plotkin D, Twentyman CT: A multimodal assessment of behavioral and cognitive deficits in abused and neglected preschoolers. Child Dev 1984;55:794–802.
28.
Shields A, Cicchetti D: Reactive aggression among maltreated children: The contributions of attention and emotion dysregulation. J Clin Child Psychol 1998;4:381–395.
29.
Trickett P, Aber J, Carlson V, Ciccchetti D: Relationship of socioeconomic status to the etiology and developmental sequelae of physical child abuse. Dev Psychol 1991;27:148–158.
30.
Gilles EE, Nelson MD: Cerebral complications of nonaccidental head injury in childhood. Pediatr Neurol 1998;19:119–128.
31.
Adelson P, Clyde B, Kochanek P, Wisniewski S, Marion D, Yonas H: Cerebrovascular response in infants and young children following severe traumatic brain injury: A preliminary report. Pediatr Neurosurg 1997;26:200–207.
32.
Famularo R, Fenton T, Kenscherff R: Medical and developmental histories of maltreated children. Clin Pediatr 1992;31:536–541.
33.
Goldson E, Fitch MJ, Wendell T, Knapp G: Child abuse: Its relationship to birthweight, apgar score, and developmental testing. Am J Dis Child 1978;132:790–793.
34.
Morse CW, Sahler OJZ, Friedman SB: A three-year follow-up study of abused and neglected children. Am J Dis Child 1970;120:439–447.
35.
Applebaum AS: Developmental retardation in infants as a concomitant of physical child abuse. J Abnorm Child Psychol 1977;5:417–423.
36.
Green AH, Voeller K, Gaines R, Kubie J: Neurological impairment in maltreated children. Child Abuse Neglect 1981;5:129–134.
37.
Okun A, Parker J, Levendosdy A: Distinct and interactive contributions of physical abuse, socioeconomic disadvantage, and negative life events to children’s social, cognitive, and affective adjustment. Dev Psychopathol 1994;6:77–98.
38.
Elmer E: A follow-up study of traumatized children. Pediatrics 1977;59:273–279.
39.
Fitch MJ, Cadol RV, Goldson E, Wendell T, Swartz D, Jackson E: Cognitive development of abused and failure-to-thrive children. J Pediatr Psychol 1976;1:32–37.
40.
Elmer E, Gregg GS: Developmental characteristics of abused children. Pediatrics 1967;40:596–602.
© 2000 S. Karger AG, Basel
2000
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.