Patterns of structural head injury in children younger than 3 years: a ten-year review of 519 patients

J Trauma Acute Care Surg. 2013 Jan;74(1):276-81. doi: 10.1097/TA.0b013e318270d82e.


Background: Abusive head injury is a major contributor to morbidity and mortality in infants and toddlers, but data comparing patterns of injury in corroborated accidental trauma and confessed child abuse are scarce.

Methods: This is a retrospective review of head injuries with abnormal neuroimaging in children younger than 3 years during a 10-year period in Auckland, New Zealand. Histories were assumed to be true. Results were analyzed for incongruity then compared with data on confessed abuse and corroborated accidental injury.

Results: Five hundred nineteen cases were analyzed. Most cases were congruent with the history, and their pattern was consistent with the literature on accidental head trauma in childhood. However, a spike of subdural hemorrhage was seen in the first 6 months of life, explained neither by mechanism nor by published data on birth trauma. The age distribution of retinal hemorrhage was also inconsistent with published data on birth trauma. In infants younger than 6 months, retinal and subdural hemorrhages were associated with the absence of a history of trauma. In older children (6 months-3 years), subdural hemorrhage was more common after minor falls (<1 m, 49%) than major falls (>2 m, 20%) (p = 0.002).

Conclusion: We conclude that when a young child (particularly an infant younger than 6 months) presents with traumatic intracranial pathology and either no history of trauma or a history of a minor fall, it must be seriously considered that the history is false.

Level of evidence: Epidemiologic study, level III.

MeSH terms

  • Accidental Falls
  • Child Abuse / diagnosis
  • Child, Preschool
  • Craniocerebral Trauma / diagnostic imaging*
  • Craniocerebral Trauma / etiology
  • Female
  • Humans
  • Infant
  • Male
  • Radiography
  • Skull Fractures / diagnostic imaging
  • Skull Fractures / etiology