Abusive Head Trauma in Infants and Children
Authors: Suzanne B Haney
Sandeep K Narang
Shalon Nienow
Bethany Mohr
Emalee G Flaherty
Stephen A Messner
Amanda Bird Hoffert Gilmartin
COUNCIL ON CHILD ABUSE AND NEGLECT
Rebecca L Moles
Antoinette Laskey
Vincent J Palusci
James Lukefahr
Amanda Fingarson
Sheila M Idzerda
Andrew P Sirotnak
Capt Amy R Gavril
Lori A Legano
Journal: PEDIATRICS (2020)
Discipline: CLINICAL MEDICINE
Keywords: Abusive head trauma; pediatric population; morbidity; mortality; infants
Affiliations: Division of Child Abuse Pediatrics, Feinberg School of Medicine, Northwestern University and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and ., Division of Child Abuse Pediatrics, Feinberg School of Medicine, Northwestern University and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and., Department of Pediatrics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas.

Abstract:  Abusive head trauma (AHT) remains a significant cause of morbidity and mortality in the pediatric population, especially in young infants. In the past decade, advancements in research have refined medical understanding of the epidemiological, clinical, biomechanical, and pathologic factors comprising the diagnosis, thereby enhancing clinical detection of a challenging diagnostic entity. Failure to recognize AHT and respond appropriately at any step in the process, from medical diagnosis to child protection and legal decision-making, can place children at risk. The American Academy of Pediatrics revises the 2009 policy statement on AHT to incorporate the growing body of knowledge on the topic. Although this statement incorporates some of that growing body of knowledge, it is not a comprehensive exposition of the science. This statement aims to provide pediatric practitioners with general guidance on a complex subject. The Academy recommends that pediatric practitioners remain vigilant for the signs and symptoms of AHT, conduct thorough medical evaluations, consult with pediatric medical subspecialists when necessary, and embrace the challenges and need for strong advocacy on the subject. 

Retracted: No

PubPeer comments:
 In this article Narang, Fingarson, and Lukefahr write: u201cIn a study examining 112 cases of perpetrator admissions to AHT in court, shaking was a commonly reported mechanism of injury, with the shaking being described as violent in 100% of cases and being separate, repetitive incidents in 55% of the cases (with a mean repetitive incidence of 10 times)(29)u201d Citing the following article: (29) Adamsbaum C, Grabar S, Mejean N, Rey-Salmon C. Abusive head trauma: judicial admissions highlight violent and repetitive shaking. Pediatrics. 2010;126(3):546u2013555 However, the cited article states the following: u201cIn this retrospective observational study we examined forensic evidence from 112 cases referred for AHT over a 7-year period. We compared 29 cases in which a perpetrator confessed to violence toward the child with 83 cases in which there was no confession.u201d This article goes on to state, referring to the 83 cases of non-confessions: u201cIn 19 of these cases, a perpetrator reported having shaken the child violently to revive him or her from an apparent life-threatening event; in 28 cases, a minor accident was reported (short-distance fall or impact); and in 36 cases, the child s entourage did not report any particular event during the observation period.u201d Not only do Narang , Fingarson, and Lukefahr get the numbers wrong, fabricating 83 confessions to child abuse that simply do not exist, they completely ignore the 83 eye-witness accounts challenging those diagnoses of child abuse, which include other explanations as to how the injuries may have occurred. Additionally, regarding the 29 cases that do included admissions, I think it would be worth examining just how unreliable confessions are. As is written in the cited article: u201cThe main limitation of the study is that perpetrator admissions are not scientific evidenceu201d Reading Narang, Fingarson, and Lukefahru2019s article, I get the impression that they believe they can definitively diagnose child abuse with such accuracy, that they are willing to simply ignore and or change data that may challenge their diagnoses. Are they suggesting that the people in those 83 non-admission cases are lying? If that is their opinion, then they should state that and back it up with supporting evidence, but fabricating data in order to support an opinion is absolutely wrong and should be removed from any scientific publication. ,