JAMA Network Open published two studies yesterday on child abuse in France and domestic violence in Japan early in the COVID-19 pandemic, the former finding that the rate of abusive head trauma (AHT) in infants nearly doubled and the latter showing that calls to domestic-violence help centers rose significantly.Trauma more severe, deadlyIn the first study, researchers in Paris compared rates of AHT in infants younger than 1 year referred to Necker Hospital for Sick Children, the only pediatric neurosurgery center for the Paris metropolitan area, from Jan 1, 2017, to Dec 31, 2021.The team defined AHT as one or more subdural hemorrhages (brain bleeds) and determination of abuse after multidisciplinary review of a social, clinical, biologic, and radiologic examination.
Pediatric AHT, often called "shaken baby syndrome," is the one of most severe forms of child abuse."AHT is the most frequent cause of traumatic death in infants in high-income countries, and nonlethal forms are associated with severe long-term morbidity, such as neurodevelopmental impairment (microcephaly [small head size], epilepsy, motor and visual deficiencies, language disorders, intellectual disability, and behavioral abnormalities) leading to severe lifelong disabilities," the researchers wrote.Of 99 infants diagnosed as having AHT, the median age was 4 months, 65% were boys, 87% had bridging vein thrombosis, 75% had retinal hemorrhages (82% in both eyes), 32% had fractures, 26% had status epilepticus [long-lasting or seizures occurring close together], 24% had refractory status epilepticus, 30% had ischemic lesions [white-matter changes and brain microbleeds] on magnetic resonance imaging (MIR0=), 20% had skin injuries, 54% underwent neurosurgery, 29%