Abusive head trauma (AHT), a medical diagnosis of infants
and young children who suffer from inflicted intracranial and associated spinal
injuries, is often misrepresented in legal proceedings of child abuse,
according to a consensus statement supported by nine paediatric and radiology
international organisations published in Pediatric Radiology. The statement outlines consensus of
evidence-based medical opinion on AHT to confirm the validity of the diagnosis
and serve as a tool for the legal system.
“When pivotal medical testimony on child abuse is
contradictory, the message to the courts, the news media, and the general
public about infant injuries and safe caregiving can be confusing and
inaccurate,” said Arabinda Choudhary, MD, chair of paediatric radiology at
Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware.
“Denialism of child abuse has become a significant medical, legal and
public health problem. This article will help re-establish the science of
abusive head trauma and will undoubtedly help children and their advocates
around the world.”
The authors of the paper utilised their collective and
extensive clinical experience, as well as an empirical review of the medical
literature in developing the consensus statement. AHT is the leading cause of
fatal head injuries in children younger than two years old and is responsible
for 53% of serious or fatal traumatic brain injury cases. The statement was supported
by the Society for Pediatric Radiology (SPR), European Society of Paediatric
Radiology (ESPR), American Society of Pediatric Neuroradiology (ASPNR),
American Academy of Pediatrics (AAP), European Society of Neuroradiology
(ESNR), American Professional Society on the Abuse of Children (APSAC), Swedish
Paediatric Society, Norwegian Paediatric Association and Japanese Paediatric
No single injury defines AHT, instead paediatricians and paediatric
subspecialists make diagnosis based on information collected through clinical
history, physical examination, and laboratory and imaging data. In many
children’s hospitals, an interdisciplinary team of specialists that includes
physicians, nurses, hospital social workers and others works together to evaluate
The consensus statement is intended to help the court system
recognize unsubstantiated medical expert testimony in child abuse judicial
cases. Key points include:
Abusive head trauma is the current most
appropriate and inclusive diagnostic term.
Relatively few infants with AHT have isolated
intracranial injury without retinal hemorrhages, fractures or other
manifestations of child abuse.
Each infant suspected of suffering AHT must be
further evaluated for other diseases that might present with similar findings.
There is no reliable medical evidence that other
medical causes could cause injuries mimicking abuse injuries.
There is no controversy about the methodology
used to diagnose AHT as a medical disease, unrelated to the legal determination
by a judge or jury.
“Abusive head trauma is a medical diagnosis, not a
legal determination. Even if medical evidence supports a finding of child
abuse, non-medical evidence is required to answer the legal questions,”
AK, et al. Consensus statement on abusive head trauma in infants and young
children. Pediatric Radiology.
Published online 23 May 2018.