The Child and Youth Maltreatment Section of the Canadian Paediatric Society (CPS) has released a new Practice Point for the assessment of children with suspected traumatic head injury related to child maltreatment (THI-CM).
This type of injury "is not rare and frequently results in significant morbidity for the child and family," the CPS told Medscape Medical News in email correspondence.
"Healthcare providers have important roles to play," according to the new guidance. These include "identifying and treating these children, reporting concerns of child maltreatment to child welfare authorities, assessing for associated injuries and medical conditions, supporting children and their families, and communicating medical information clearly to families and other medical, child welfare, and legal professionals."
The Practice Point was published online in Paediatrics & Child Health.
Although no single injury is pathognomonic for CM, there are several "red flags" that should prompt a healthcare provider to consider THI-CM, the CPS said. "These include elements of the history, clinical presentation, and radiographic findings."
CPS also noted that the term THI-CM "was chosen through an iterative process to reflect the current language (traumatic head injury) used by health professionals, separated from the opinion on the cause of the injury (level of concern for child maltreatment)."
The terms "shaken baby syndrome," "abusive head trauma," "non-accidental head injury," and "inflicted traumatic brain injury" are no longer recommended for use in Canada, they added.
If clinicians are concerned that CM may have occurred, they should approach the case with an open mind, be aware of possible bias, and have compassion for the child and family, according to the Practice Point. Other recommendations include:
Provincial and territorial laws require that clinicians report any concerns of possible CM to their local child welfare agency.
The Practice Point also stated that a pediatrician specialized in CM "can help guide clinical assessment and communication with families, healthcare professionals, child welfare, and law enforcement." Consultation with other specialists, including critical care, ophthalmology, neurosurgery, neurology, orthopedics, endocrinology, hematology, genetics, and rehabilitation, "can assist as needed."
Notably, the American Academy of Pediatrics' (AAP's) guidance mirrors that of the CPS, Suzanne Haney, MD, professor of child abuse pediatrics at the University of Nebraska Medical Center and Nebraska Children's Hospital, Omaha, Nebraska, told Medscape Medical News.
Like the CPS, the AAP does not use the term "shaken baby syndrome" to describe suspected head trauma due to abuse, she said. "Instead, we use the term 'abusive head trauma.' Sometimes these kids are shaken, sometimes they're slammed, sometimes shaken and slammed, we don't necessarily know exactly what the forces are, but we do know that it's abusive and was done by someone."
Similar to the new Canadian guidance, Haney suggested advocating for the involvement of a child abuse expert when faced with a situation that suggests CM.
"Studies have shown that when you involve somebody with expertise, you are more likely to get the right diagnosis," she said. "Most major medical centers have a child abuse pediatrician, although unfortunately our numbers are far too small. We do have a number of colleagues who may not be board-certified but have a special interest or expertise in this area. So if clinicians can identify somebody in their area who has a special interest in child maltreatment, they can be very helpful."