Abusive head trauma

Abusive head trauma (AHT) is acknowledged as the most common cause of fatality and
long-term morbidity with approximately 1,500 fatalities and 18,000 seriously disabled infants
and children annually in the USA. Ninety-five percent of serious CNS injuries among infants less
than 1 year of age are attributed to Abusive Head Trauma.1
Children abuse cause most of the head injuries. Often referred as shaken baby or infant
syndrome. Intracranial hemorrhage mayor bleeding that occurs in any part of the brain or
between the brain and the skull damaging the brain tissue by swelling or brain compression. In
cases of severe bleeding the treatment will be limited by brain damage or save the childs life.
The initial impact of the head injury produced acceleration(coup) and deceleration
(countercoup)of the brain. A shearing force that produces bruising, tearing and bleeding moving
the brain forward and backward in the skull. Others causes including, vehicle collision, falls,
sport injuries producing concussions, contusions, lacerations, fractures, and hematomas. Minor
head injuries are presented with alteration of level consciousness, confusion, irritability,
vomiting, somnolence, and headache. Moderate or severe, manifested by increased ICP, retinal
hemorrhage, hemiparesis, papilledema, and the risk of seizures within the 7 days of injury. The
treatment is focus reduce the childs risk of having long-term brain (neurologic) problems.
Diagnostics tests are expected to find and treat as emergency intracranial hemorrhage as a
imminent emergency. Parents are advised to go to the near emergency department for evaluation
and treatment. A neurologist or neuro-surgeon to rule out the damage including:
MRI or CT scan of head. Provide detailed pictures of the brain to check for bleeding. During
the test, liquid contrast dye may be used to visualize blood vessels and brain such as intracranial
hemorrhage and hematomas. Providers must balance the risk of exposure to ionizing radiation
and missing a clinically important head injury.
Angiography. A thin catheter is guided into the blood vessels leading to the brain. Contrast dye
is sent through the tube to make the blood vessels easier to see. This test can also be done with
an MRI or CT scan. this test is often replaced or preceded with MRI (magnetic resonance
angiography) if available.
Transcranial Doppler (TCD) test that uses harmless sound waves to form pictures of the brain
and blood vessels. It is used to monitor ongoing conditions that may worsen the bleeding.
Lab testing. Blood tests are done to identify risk factors include platelet count and other tests to
measure blood clotting.
The focus of nursing interventions is to maintain vital functions, including adequate
oxygenation and perfusion, are provided until all injuries are determined. Applying (cool pack
wrapped in a towel or cool wet compresses) to the site for 20 minutes prevent or reduce swelling.
Clean any scrapes or cuts with soap and water. Encourage the child to rest. Assess the child
closely for the first 24 to 48 for slurred speech or blurred vision, blood or watery fluid coming
from the ear or nose (ICF), unequal pupils or crossed eyes, difficulty to walk, progressive arms
weakness that became hard to wake up are the main concerns. The childs outcome may vary
influenced by site, size, cause, and location of the bleeding. Some children do not have any
problems after treatment. Others, may have ongoing neurologic problems including trouble with
seizures, learning, speech, or movement. In these cases, regular follow-up with the provider is
needed. Supportive care, such as speech, physical, or occupational therapy to prevent child
sequela.

REFERENCE

Hedlund GL, Frasier LD. Neuroimaging of abusive head trauma. Forensic Science, Medicine
and Pathology, Springer. (2009) N.

McKinney, E. S., MSN, RN, C, James, S. R., PhD, MSN, RN, Murray, S. S., MSN, RN, C.
(032017). Maternal-Child Nursing, 5th Edition [Vital Source Bookshelf version].
Retrieved from https://bookshelf.vitalsource.com/books/9780323401708

Wong, D.L., Hockenberry, M.J., W. (2015) Wongs essentials of pediatric nursing.10th

Edition. St. Louis, Mo. Elsevier Mosby.