Evaluation of a Temporal Association between Vaccination and Subdural Hematoma in Infants.

OBJECTIVE: To investigate a temporal association between vaccination and subdural hematoma, the main feature of abusive head trauma. STUDY DESIGN: From a prospective population-based survey carried out in 1 administrative district in France between January 2015 and April 2017, including all infants between 11 and 52 weeks old who underwent a first cerebral imaging (computerized tomography scan or magnetic resonance imaging), we conducted a nested case-control study. Vaccine exposure was compared between cases (infants with subdural hematoma) and 2-3 paired controls, without subdural hematoma or any other imaging findings compatible with abusive head trauma. Cases and controls were matched on chronological (±7 days) and gestational (≤33 vs >33 weeks) ages, respectively. Vaccination status was collected in the personal national pediatric health booklet. RESULTS: Among the 228 prospectively surveyed infants, 28 had subdural hematoma including 22 with abusive head trauma. The mean chronological age at imaging was 5.3 months among the 28 cases and the 62 controls, who did not differ significantly in median time since last vaccination (1.4 vs 1.3 months, P = .62) or frequency of at least 1 vaccination since birth (86% vs 89%; matched-pairs OR 0.77, 95% CI 0.17-3.86) or within 7 days (0.94, 0.08-6.96), 14 days (0.70, 0.12-2.92), or 21 days (0.48, 0.08-1.98) before cerebral imaging. CONCLUSIONS: We found no significant temporal association between vaccination and subdural hematoma diagnosis, which must continue to be considered a red flag for abusive head trauma and child abuse.

[How to detect and what to do with child abuse?]. / Repérage et conduite á tenir face à un enfant en danger.

Child abuse is a major public health problem. The consequences including death, but also physical injuries and psychological troubles. To know and recognize the possibility of child abuse is essential for all doctors. This diagnostic hypothesis must be considered alongside all pathologies in varied clinical presentations. The practitioner must keep in mind that an unusual location, incoherent mechanism, a health seeking delay, no painful expression are warning signs and particularly a traumatic injury unexplained in an infant who does not move. To overcome the denial that surrounds these situations, the health professional should emphasize teamwork and not hesitate in doubt to be hospitalized children or at least contact a specialized team.

[Recognizing clinical signs suggesting child abuse in young children]. / Repérage des signes cliniques evocateurs de maltraitance chez le petit enfant.

It is difficult to diagnose child abuse. Any injury to a child should raise the essential question as to its plausibility. Any incompatibility between the nature of the lesion and the child's age, or the explanations given, should suggest intentional injury. The presence of a bruise on an infant too young to move about is a serious warning sign. Any fractures before the infant is able to walk should raise the suspicion of intentional injury. Regardless of the type of abuse noted for an infant, it must be hospitalized. Supplementary examinations, in association with a psychosocial evaluation, will enable exploration for other lesions and the elimination of differential diagnoses. This allows the child to be protected, while including the family in the treatment process.