child abuse and head injuries

This summarises the Core-info leaflet on head and spinal injuries in children. Full details are available at


Inflicted head injuries

  • can arise from shaking and/or impact
  • occurs most commonly in the under 2’s
  • are the leading cause of death among children who have been abused
  • survivors may have significant long term disabilities
  • must be treated promptly to minimise long term consequences
  • victims often have been subject to previous physical abuse

Signs of inflicted head injury

  • may be obvious eg. loss of consciousness, fitting, paralysis, irritability
  • can be more subtle eg. poor feeding, excessive crying, increasing OFC
  • particular features include retinal haemorrhages, rib fractures, bruising to the head and/or neck and apnoeas
  • also look for other injuries including bites, fractures, oral injuries

If inflicted head injury is suspected

  • a CT head, skull X-ray and/or MRI brain should be performed
  • neuro-imaging findings include subdural haemorrhages +/- subarachnoid haemorrhages (extradural haemorrhages are
    more common in non-inflicted injuries)
  • needs thorough examination including ophthalmology and skeletal survey
  • co-existing spinal injuries should be considered
  • any child with an unexplained brain injury need a full investigation eg. for metabolic and haematological conditions, before a diagnosis of abuse can be made

The following diagram comes from



These CT images are from


EXTRADURAL (or epidural) haematoma



SUBDURAL haemorrhages in a 4 month old

SUBARACHNOID haemorrhage in a 14 month old

Neuro-imaging for inflicted brain injury should be performed in

  • any infant with abusive injuries
  • any child with abusive injuries and signs and symptoms of brain injury

Inflicted spinal injuries

  • come in 2 categories : neck injuries, and chest or lower back injuries
  • neck injuries are most common under 4 months
  • neck injuries are often associated with brain injury and/or retinal haemorrhages
  • chest or lower back injuries are most common in older toddlers over 9 months
  • if a spinal fracture is seen on X-ray or a spinal cord injury is suspected, an MRI should be performed


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