ABSTRACT
El maltrato infantil es definido por la Organización Mundial de la Salud (OMS) como "el abuso y la desatención que sufren los niños menores de 18 años. Incluye todo tipo de maltrato físico y/o emocional [ ] que resulte en un daño real o potencial para la salud, la supervivencia, el desarrollo o la dignidad del niño". Al examinar los rastros corporales del maltrato físico, siguiendo los mecanismos de lesión más frecuentemente implicados, es posible detectar patrones radiológicos típicos. La evaluación imagenológica del hueso en reparación permite inferir cronologías para correlacionar con los datos obtenidos en la anamnesis. Los profesionales de la salud deben detectar oportunamente lesiones radiológicas sospechosas y activar de forma temprana el resguardo del menor. Nuestro propósito es realizar una revisión sobre las publicaciones recientes referidas al estudio imagenológico en niños de quienes se sospeche que puedan ser víctimas de violencia física.
The World Health Organization (WHO) defines child maltreatment as "the abuse and neglect that occurs to children under 18 years of age. It includes all types of physical and/or emotional ill-treatment [...], which results in actual or potential harm to the child's health, survival, development or dignity." By examining the bodily traces of physical abuse, following the most frequently involved mechanisms of injury, it is possible to identify typical radiological patterns. The imaging studies of the bone under repair allows inferring a timeline that may be correlated to the data obtained during history taking. Health care providers should detect suspicious radiological lesions in a timely manner and promptly activate the safeguarding of the child. Our objective was to review recent publications on the imaging studies of children suspected of being victims of physical violence.
Subject(s)
Humans , Child, Preschool , Child , Adolescent , Child Abuse/psychology , Violence , RadiologistsABSTRACT
The World Health Organization (WHO) defines child maltreatment as "the abuse and neglect that occurs to children under 18 years of age. It includes all types of physical and/or emotional ill-treatment [...], which results in actual or potential harm to the child's health, survival, development or dignity." By examining the bodily traces of physical abuse, following the most frequently involved mechanisms of injury, it is possible to identify typical radiological patterns. The imaging studies of the bone under repair allows inferring a timeline that may be correlated to the data obtained during history taking. Health care providers should detect suspicious radiological lesions in a timely manner and promptly activate the safeguarding of the child. Our objective was to review recent publications on the imaging studies of children suspected of being victims of physical violence.
El maltrato infantil es definido por la Organización Mundial de la Salud (OMS) como "el abuso y la desatención que sufren los niños menores de 18 años. Incluye todo tipo de maltrato físico y/o emocional [ ] que resulte en un daño real o potencial para la salud, la supervivencia, el desarrollo o la dignidad del niño". Al examinar los rastros corporales del maltrato físico, siguiendo los mecanismos de lesión más frecuentemente implicados, es posible detectar patrones radiológicos típicos. La evaluación imagenológica del hueso en reparación permite inferir cronologías para correlacionar con los datos obtenidos en la anamnesis. Los profesionales de la salud deben detectar oportunamente lesiones radiológicas sospechosas y activar de forma temprana el resguardo del menor. Nuestro propósito es realizar una revisión sobre las publicaciones recientes referidas al estudio imagenológico en niños de quienes se sospeche que puedan ser víctimas de violencia física.
Subject(s)
Child Abuse , Child , Humans , Adolescent , Child Abuse/psychology , Violence , RadiologistsABSTRACT
BACKGROUND: Abusive head trauma (AHT) is the most serious injury inflicted to the nervous system of neonate an infant with a high incidence of disabilities. The authors present two cases in which the initial manifestations and neurologic status were misinterpreted and stress that clinical presentation and imaging can be variable and confuse the examiner. DISCUSSION: Subdural hemorrhage (SDH) in this age group raises high suspicion of non-accidental trauma but have been reported in other situations such as several bleeding disorders. Although rare, hematological diseases should be considered when other data of maltreatment are lacking. CONCLUSION: Differential diagnosis is important to avoid underdiagnosing AHT and to prevent morbidity if a pre-existing hematological disease is misdiagnosed.
Subject(s)
Child Abuse , Craniocerebral Trauma , Infant , Child , Infant, Newborn , Humans , Child Abuse/diagnosis , Craniocerebral Trauma/diagnostic imaging , Craniocerebral Trauma/etiology , Hematoma, Subdural/diagnostic imaging , Hematoma, Subdural/etiology , Tomography, X-Ray Computed/methods , IncidenceABSTRACT
Abusive head trauma (AHT) is one of the most severe forms of child abuse due to its morbidity and mortality. However, AHT is still misdiagnosed in developing countries because of its nonspecific clinical picture and limited knowledge of it on the part of physicians. The aim of this study was to describe some characteristics of children with AHT, their families, and caregivers, as well as the clinical data that could serve as signs for its suspicion and the medical-legal resolution of the cases. Children suspect with AHT in emergency rooms in three Mexican hospitals were included after obtaining informed consent from the parents. All information was obtained from the parents by means of a questionnaire and from different clinical and radiological evaluations of the clinical records of the patients. 15 children, with a median age of 5 months and predominantly males (73.33%), were included in the study. 66% reported a history of irritability periods, and most of the patients (73.33%) had more than one habitual caregiver. The diagnosis of AHT was suspected in only 33.33% on admission in the Emergency Services. Acute symptomatology was present in 53.33%, while less severe symptoms were reported in the rest. Special attention should be paid on babies with history of irritable periods. When a child who is previously healthy and suddenly presents with a seizure or cardiorespiratory dysfunction or brought to the hospital dead, the diagnosis of AHT should be considered as a priority.
Subject(s)
Child Abuse , Craniocerebral Trauma , Caregivers , Child , Child Abuse/diagnosis , Craniocerebral Trauma/diagnosis , Craniocerebral Trauma/epidemiology , Humans , Infant , Male , Mexico/epidemiology , ParentsABSTRACT
INTRODUCTION: Abusive head trauma (AHT) is an extreme form of physical abuse that is produced by abruptly shaking an infant or toddler. OBJECTIVE: To describe the direct economic cost of care during hospitalization of 14 children with confirmed diagnosis of AHT in a pediatric hospital. METHOD: Analysis of the cost of disease in patients with AHT attended to between 2001 and 2010. Partial direct economic cost of medical care (days of hospital stay, laboratory tests and imaging studies, surgical procedures and subspecialist consultations) was calculated adjusting for inflation, with year 2001 taken as base year. Patients were classified in three groups (moderate, severe and fatal AHT). Descriptive and sensitivity analysis was carried out. RESULTS: Patients with severe AHT generated higher medical care costs ($105,794.88 ± 33,201.91) in comparison with the group of moderate ($37,012.95, ± 7,154.87) and fatal AHT ($18,595.04 ± 6424.47) (p <0.05). Total cost was $665,467.98 Mexican pesos ($71,249.25 international dollars). CONCLUSIONS: Total cost for the 14 patients was an elevated figure, as in other parts of the world. The direct economic cost is closely related to the severity of the clinical presentation.
INTRODUCCIÓN: El trauma craneal no accidental (TCNA) es una forma extrema de abuso físico que se produce por la sacudida brusca de un lactante o preescolar. OBJETIVO: Describir el costo económico directo de la atención durante la hospitalización de 14 niños con diagnóstico confirmado de TCNA en un hospital pediátrico. MÉTODO: Análisis del costo de la enfermedad en pacientes con TCNA, atendidos entre 2001 y 2010. Se realizó análisis descriptivo y de sensibilidad. Se calculó costo económico directo parcial de la atención médica (días de estancia hospitalaria, exámenes de laboratorio y gabinete, procedimientos quirúrgicos y consultas por subespecialista), ajustado por la inflación, se tomó como año base 2001. Los pacientes se clasificaron en tres grupos: TCNA moderado, severo y fatal. RESULTADOS: Los pacientes con TCNA severo generaron mayor costo en la atención médica ($105 794.88 ± 33 201.91), en comparación con el grupo con TCNA moderado ($37 012.95 ± 7154.87) y fatal ($18 595.04 ± 6424.47) (p < 0.05). El costo total fue de 665 467.98 pesos mexicanos (71 249.25 dólares internacionales). CONCLUSIONES: El costo total de los 14 pacientes fue una cifra elevada como en otras partes del mundo. El costo económico directo se relaciona estrechamente con la gravedad del cuadro clínico.
Subject(s)
Child Abuse/economics , Craniocerebral Trauma/therapy , Hospitalization/economics , Shaken Baby Syndrome/therapy , Craniocerebral Trauma/economics , Craniocerebral Trauma/physiopathology , Female , Hospital Costs/statistics & numerical data , Hospitals, Pediatric , Humans , Infant , Length of Stay , Male , Mexico , Retrospective Studies , Severity of Illness Index , Shaken Baby Syndrome/economics , Shaken Baby Syndrome/physiopathologyABSTRACT
OBJECTIVE: To assess the current general acceptance within the medical community of shaken baby syndrome (SBS), abusive head trauma (AHT), and several alternative explanations for findings commonly seen in abused children. STUDY DESIGN: This was a survey of physicians frequently involved in the evaluation of injured children at 10 leading children's hospitals. Physicians were asked to estimate the likelihood that subdural hematoma, severe retinal hemorrhages, and coma or death would result from several proposed mechanisms. RESULTS: Of the 1378 physicians surveyed, 682 (49.5%) responded, and 628 were included in the final sample. A large majority of respondents felt that shaking with or without impact would be likely or highly likely to result in subdural hematoma, severe retinal hemorrhages, and coma or death, and that none of the alternative theories except motor vehicle collision would result in these 3 findings. SBS and AHT were comsidered valid diagnoses by 88% and 93% of the respondents, respectively. CONCLUSIONS: Our empirical data confirm that SBS and AHT are still generally accepted by physicians who frequently encounter suspected child abuse cases, and are considered likely sources of subdural hematoma, severe retinal hemorrhages, and coma or death in young children. Other than a high-velocity motor vehicle collision, no alternative theories of causation for these findings are generally accepted.
Subject(s)
Attitude of Health Personnel , Child Abuse/diagnosis , Craniocerebral Trauma/diagnosis , Shaken Baby Syndrome/diagnosis , Adult , Cause of Death , Child , Child Abuse/mortality , Coma/etiology , Craniocerebral Trauma/complications , Craniocerebral Trauma/mortality , Hematoma, Subdural/etiology , Humans , Middle Aged , Retinal Hemorrhage/etiology , Shaken Baby Syndrome/complications , Shaken Baby Syndrome/mortality , Young AdultABSTRACT
RESUMO A ocorrência do trauma craniano violento (TCV) pode estar associada à falta de conhecimento de pais e cuidadores sobre o desenvolvimento infantil. Neste sentido, o presente estudo pretendeu investigar o conhecimento de pais sobre o choro do bebê, as estratégias para lidar com o choro e as consequências de sacudi-lo. Participaram da pesquisa 83 mães e 7 pais de recém-nascidos, que responderam ao instrumento Questionário sobre o Choro do Bebê. Os resultados do estudo sugerem um desconhecimento por parte dos pais sobre o TCV, principalmente no que se refere à sua gravidade. Além disso, 34,4% dos participantes relataram que sacudiriam seus bebês para fazê-los parar de chorar. Tais resultados parecem indicar a necessidade de desenvolver intervenções de educação parental sobre o TCV, especialmente durante o pré-natal, de modo a contribuir para o aumento do conhecimento dos pais, prevenindo assim tal forma de maus-tratos.
ABSTRACT Abusive head trauma (AHT) may be associated to a lack of knowledge of parents and caregivers concerning child development. This study intended to investigate parental knowledge regarding the crying of babies, how parents deal with a crying baby and the consequences of shaking a baby to make it stop crying. Participants were 83 mothers and 7 fathers of newborns who responded to the Crying Baby Questionnaire. Results suggest a lack of knowledge of AHT, especially regarding its severity. Furthermore, 34.4% of participants reported that they would shake their babies to make them stop crying. These results highlight the need to develop interventions for parent training on AHT, particularly during the prenatal period in order to increase parental knowledge and to contribute to the prevention of this form of child maltreatment.
ABSTRACT
Objective Abusive head trauma (AHT) is defined as a severe, non-accidental traumatic brain injury. Early recognition and treatment are instrumental in limiting the immediate complications and long-term disabilities. The goal of this study was to describe our experience with traumatic head injuries in children younger than 2 years of age. Methods We reviewed the medical records of 195 children aged under 2 years with suspected AHTwho presented with a head injury without witnessed accidental trauma, between January 2008 and June 2013. Results AHT was considered in 145 children. Familial problems (ρ » 0.008), cutaneous hematoma/bruising (ρ < 0.001), retinal hemorrhages (ρ < 0.001), and bone fractures (ρ » 0.04), were significantly more frequent in the AHT group. Conclusions The association between the subdural hematoma and retinal hemorrhage, resulting from an unwitnessed and incoherent history of trauma, is a strong argument for AHT, particularly when associated lesions and socioeconomic risk factors are evident.
Objetivo O traumatismo craniano por abuso (AHT) é definido como uma grave lesão cerebral traumática não acidental. O reconhecimento e tratamento precoce são fundamentais para limitar as complicações imediatas e sequelas tardias. O objetivo deste estudo foi descrever a nossa experiência em crianças menores de 2 anos de idade, vítimas de trauma craniano. Métodos Foram revisados os prontuários de 195 crianças com idade inferior a 2 anos com suspeita de AHT, sem trauma acidental testemunhado e com diagnostico de hematoma subdural, entre janeiro de 2008 e junho de 2013. Resultados AHT foi considerado em 145 crianças. Problemas socioeconômicos familiares (ρ » 0,008), hematomas e lesões cutâneas (ρ <0,001), hemorragias retinianas (ρ <0,001), e fraturas em ossos longos (ρ » 0,04), foram significativamente mais frequentes no grupo de crianças com suspeita de AHT. Conclusões A associação entre hematomas subdurais e hemorragia retiniana, resultante de uma história incoerente de trauma sem testemunhas, é um forte argumento para a AHT, particularmente quando lesões cutâneas e fatores de risco socioeconômicos forem identificados.
Subject(s)
Child Abuse/statistics & numerical data , Shaken Baby Syndrome/diagnostic imaging , Craniocerebral Trauma/complications , Craniocerebral Trauma/epidemiology , Hematoma, Subdural/diagnostic imaging , Socioeconomic Factors , Accidental Falls , Chi-Square Distribution , Data Interpretation, Statistical , Craniocerebral Trauma/diagnostic imaging , InfantABSTRACT
Introducción: el síndrome del niño sacudido se incluye en la clasificación del maltrato físico. Las lesiones oculares se deben a la tracción producida sobre la retina a partir del vítreo del niño, fuertemente unido a ella, con desgarro de las capas retinales y colección de sangre en la cavidad resultante (retinosquisis hemorrágica). Objetivo: describir las manifestaciones oftalmológicas iniciales y la evolución del síndrome del bebé sacudido. Materiales y métodos: se realiza un estudio descriptivo y retrospectivo de cuatro pacientes con el síndrome del niño sacudido. Las variables analizadas son: sexo, edad, fondo de ojos, ecografía ocular, tratamiento y evolución visual. Resultados: los casos 1 y 2 eran gemelos, uno de ellos presentó manifestaciones a nivel del fondo de ojos y el segundo no, ambos requirieron intervención neuroquirúrgica. El tercero presentaba lesiones a nivel ocular con opacidad de medios por lo cual se le realizó en ambos ojos vitrectomía exploradora. El cuarto caso se trataba de una paciente de 6 meses con hemovítreo en ojo derecho y retinosquisis hemorrágica en ojo izquierdo, y requirió vitrectomía para la resolución del hemovítreo, aunque el resultado visual fue desfavorable. Conclusión: el examen oftalmológico contribuye al diagnóstico del síndrome del bebé sacudido por lo que es necesario en la evaluación de los niños pequeños que presenten lesiones sospechosas de abuso (AU)
Introduction: Shaken baby syndrome is included in the classification of physical abuse. Ocular lesions in the infant are due to traction to the retina from the adjacent vitreous causing with tears of the retinal layers and blood collection in the resulting cavity (hemorrhagic retinoschisis). Objective: To describe early ocular manifestations and outcome of shaken baby syndrome. Material and methods: A retrospective, descriptive study was conducted in four patients with shaken baby syndrome. Sex, age, ocular fundus, ultrasonography, treatment, and visual outcome were analyzed. Results: Cases 1 and 2 were twins, one of them presented with fundus manifestations, the other did not; both required neurosurgical intervention. The third infant had eye lesions with media opacities and therefore exploratory vitrectomy was performed in both eyes. The fourth was a 6-month-old baby girl with hemovitreous in the right and hemorrhagic retinoschisis in the left eye. She required vitrectomy to resolve the hemovitreous, but the result was poor. Conclusion: Ophthalmological examination was useful in the diagnosis of shaken baby syndrome and should therefore be performed in little children in whom child abuse is suspected (AU)
Subject(s)
Humans , Infant , Battered Child Syndrome/diagnosis , Eye Manifestations , Retinal Hemorrhage/diagnosis , Retinal Hemorrhage/etiology , Shaken Baby Syndrome/diagnosis , Vitreous Hemorrhage/diagnosis , Vitreous Hemorrhage/etiologyABSTRACT
En este artículo se presentan las características "visibles" e "invisibles" de las diferentes modalidades del maltrato Infantil (MI) con base en la experiencia de la Clínica de Atención Integral al Niño Maltratado del Instituto Nacional de Pediatría (CAINM-INP). Se presenta y se enfatiza el cuadro clínico de las víctimas del "síndrome del niño sacudido" y se insiste en la necesidad de prevenirlo y diagnosticarlo a tiempo. También se exponen los problemas médicos que generan las manifestaciones clínicas desencadenantes de este síndrome como son: crisis de llanto inconsolable, irritabilidad y rechazo al alimento.
A presentation is made of the "visible" and "invisible" characteristics of the different forms of Child abuse (ChA) based on the experience of the Comprehensive Care Clinic of Abused Children of the National Institute of Pediatrics (CAINM-INP). We present and emphasize the clinical picture of the child victim of "shaken baby syndrome" and insist in the need to prevent and diagnose it in time. We also expose the medical conditions that generate the clinical manifestations that trigger the problem such as: inconsolable crying spells, irritability and refusal to eat.
ABSTRACT
OBJETIVO: Fornecer uma revisão de literatura científica sobre trauma craniano violento pediátrico enquanto forma de maus-tratos físicos contra bebês e crianças, ressaltando prevalência, sinais e sintomas, consequências, fatores de risco para sua ocorrência e, principalmente, estratégias de prevenção. FONTES DOS DADOS: Revisão nas bases de dados MEDLINE, SciELO, LILACS e Web of Science no período de 2001 a 2012 utilizando os termos "síndrome do bebê sacudido" e "trauma craniano violento" em inglês, espanhol e português. SÍNTESE DOS DADOS: O trauma craniano violento é definido como a lesão ao crânio ou ao conteúdo intracraniano de um bebê ou criança menor de cinco anos devido a um impacto brusco intencional e/ou a uma sacudida violenta. Ocorre principalmente com bebês e crianças menores de um ano de idade, e pode resultar em consequências graves, desde deficiências físicas ou mentais até a morte. Apesar de haver sinais específicos para esta forma de maus-tratos, eles podem se confundir com doenças comuns em crianças ou traumas cranianos acidentais, sendo imprescindível o preparo clínico dos profissionais envolvidos na avaliação dos casos para o diagnóstico correto. As estratégias de prevenção devem incluir tanto a identificação precoce dos casos, como a educação parental sobre o desenvolvimento infantil, especialmente sobre o padrão de choro do bebê. CONCLUSÕES: Considerando a gravidade do trauma craniano violento pediátrico, é fundamental que estratégias de prevenção sejam implementadas e avaliadas no contexto brasileiro. Sugere-se que indicadores de sua incidência sejam pesquisados nacionalmente.
OBJECTIVE: To review the scientific literature on pediatric abusive head trauma as a form of physical abuse against infants and young children, highlighting the prevalence, signs and symptoms, consequences, risk factors for its occurrence, and prevention strategies. DATA SOURCE: The MEDLINE, SciELO, LILACS, and Web of Science databases from 2001 to 2012 were reviewed, using the terms "shaken baby syndrome" and "abusive head trauma" in English, Spanish, and Portuguese. DATA SYNTHESIS: Pediatric abusive head trauma is defined as injury to the skull or intracranial contents of a infant or child younger than 5 years due to intentional abrupt impact and/or violent shaking. It occurs mainly in infants and children under 1 year of age, and may result in severe consequences, from physical or mental disabilities to death. Although there are specific signs for this form of abuse, they can be mistaken for common illnesses in children or accidental head injury; thus, clinical training of professionals involved in the assessment of cases to attain the correct diagnosis is crucial. Prevention strategies should include early identification of cases, as well as parental education on child development, especially on the infant's crying pattern. CONCLUSIONS: Considering the severity of abusive head trauma in children, it is critical that prevention strategies be implemented and evaluated in the Brazilian context. It is suggested that its incidence indicators be assessed at the national level.
Subject(s)
Child , Humans , Child Abuse/prevention & control , Craniocerebral Trauma/prevention & control , Shaken Baby Syndrome/prevention & control , Crying , Incidence , Risk Factors , Shaken Baby Syndrome/epidemiology , Violence/prevention & controlABSTRACT
OBJECTIVE: To review the scientific literature on pediatric abusive head trauma as a form of physical abuse against infants and young children, highlighting the prevalence, signs and symptoms, consequences, risk factors for its occurrence, and prevention strategies. DATA SOURCE: The MEDLINE, SciELO, LILACS, and Web of Science databases from 2001 to 2012 were reviewed, using the terms "shaken baby syndrome" and "abusive head trauma" in English, Spanish, and Portuguese. DATA SYNTHESIS: Pediatric abusive head trauma is defined as injury to the skull or intracranial contents of a infant or child younger than 5 years due to intentional abrupt impact and/or violent shaking. It occurs mainly in infants and children under 1 year of age, and may result in severe consequences, from physical or mental disabilities to death. Although there are specific signs for this form of abuse, they can be mistaken for common illnesses in children or accidental head injury; thus, clinical training of professionals involved in the assessment of cases to attain the correct diagnosis is crucial. Prevention strategies should include early identification of cases, as well as parental education on child development, especially on the infant's crying pattern. CONCLUSIONS: Considering the severity of abusive head trauma in children, it is critical that prevention strategies be implemented and evaluated in the Brazilian context. It is suggested that its incidence indicators be assessed at the national level.
Subject(s)
Child Abuse/prevention & control , Craniocerebral Trauma/prevention & control , Shaken Baby Syndrome/prevention & control , Child , Crying , Humans , Incidence , Risk Factors , Shaken Baby Syndrome/epidemiology , Violence/prevention & controlABSTRACT
El abuso infantil es la causa más común de lesión cefálica grave en los niños de corta edad. A pesar de ello, el traumatismo cefálico abusivo con frecuencia es subdiagnosticado y subinformado. Esto se relaciona parcialmente con el entrenamiento inadecuado que los profesionales de la salud reciben en el reconocimiento y enfoque del abuso infantil. Actualmente, está disponible el contenido curricular para las universidades médicas y programas de residencia. Dadas las altas tasas de muerte y deterioro neurológico grave asociado con el traumatismo cefálico abusivo, la prevención se ha convertido en el centro de atención. Algunas estrategias de prevención mostraron resultados promisorios en mejorar la educación de los padres y en reducir la incidencia de lesiones. Este artículo revisa la epidemiología, las características clínicas y el desenlace del traumatismo cefálico abusivo en los niños de corta edad. También analiza las estrategias de prevención, como la educación y el contenido curricular para los profesionales de la salud.(AU)
Child abuse is the most common cause of serious head injury in young children. Despite this, abusive headtrauma is often under-recognized and under-reported. This is partly related to the inadequate trainingthat health professionals receive in child abuse recognition and management. Published curricula are nowavailable for medical school and residency education. Given the high rates of death and serious neurolo-gical impairment associated with abusive head trauma, prevention has become a focus. Some preventionstrategies show promising results in improving parent education and reducing the incidence of injury. Thisarticle reviews the epidemiology, clinical characteristics, and outcomes of abusive head trauma in youngchildren. It also discusses prevention strategies, including education and curricula for health professionals.(AU)
Subject(s)
Female , Infant , Child, Preschool , Child , Child Abuse/diagnosis , Child Abuse/trends , Child Abuse/therapy , Brain Injuries, Traumatic/diagnosis , Brain Injuries, Traumatic/prevention & control , Shaken Baby Syndrome/diagnosis , Shaken Baby Syndrome/prevention & controlABSTRACT
El abuso infantil es la causa más común de lesión cefálica grave en los niños de corta edad. A pesar de ello, el traumatismo cefálico abusivo con frecuencia es subdiagnosticado y subinformado. Esto se relaciona parcialmente con el entrenamiento inadecuado que los profesionales de la salud reciben en el reconocimiento y enfoque del abuso infantil. Actualmente, está disponible el contenido curricular para las universidades médicas y programas de residencia. Dadas las altas tasas de muerte y deterioro neurológico grave asociado con el traumatismo cefálico abusivo, la prevención se ha convertido en el centro de atención. Algunas estrategias de prevención mostraron resultados promisorios en mejorar la educación de los padres y en reducir la incidencia de lesiones. Este artículo revisa la epidemiología, las características clínicas y el desenlace del traumatismo cefálico abusivo en los niños de corta edad. También analiza las estrategias de prevención, como la educación y el contenido curricular para los profesionales de la salud.
Child abuse is the most common cause of serious head injury in young children. Despite this, abusive headtrauma is often under-recognized and under-reported. This is partly related to the inadequate trainingthat health professionals receive in child abuse recognition and management. Published curricula are nowavailable for medical school and residency education. Given the high rates of death and serious neurolo-gical impairment associated with abusive head trauma, prevention has become a focus. Some preventionstrategies show promising results in improving parent education and reducing the incidence of injury. Thisarticle reviews the epidemiology, clinical characteristics, and outcomes of abusive head trauma in youngchildren. It also discusses prevention strategies, including education and curricula for health professionals.
Subject(s)
Female , Infant , Child, Preschool , Child , Child Abuse/diagnosis , Child Abuse/trends , Child Abuse/therapy , Shaken Baby Syndrome/diagnosis , Shaken Baby Syndrome/prevention & control , Brain Injuries, Traumatic/diagnosis , Brain Injuries, Traumatic/prevention & controlABSTRACT
El síndrome del niño sacudido hace parte de la clasificación del maltrato físico. Este afecta, en su mayoría, a niños menores de dos años de edad y sucede cuando el cuidador sujeta al menor y ejerce fuerzas sobre él que le producen aceleración y desaceleración de la cabeza, lo cual ocasiona lesiones cerebrales, óseas, auditivas, oculares, entre otras. Por lo tanto, se pretende determinar el efecto de una intervención educativa encaminada a evitar que los cuidadores de niños menores de dos años ejerzan el sacudimiento, ya sea como mecanismo para calmar el llanto o como demostración de afecto a través del juego. El presente estudio es de tipo evaluativo-cuantitativo realizado a 60 cuidadores de niños menores de dos años, a los cuales se les aplicó un instrumento diseñado a partir de la revisión literaria sobre el síndrome del niño sacudido, el cual indaga acerca de las características sociodemográficas de los participantes y los conocimientos y comportamientos que pueden influir en el síndrome del niño sacudido antes de la intervención educativa y después de esta. Los resultados del estudio demostraron que gracias a la intervención educativa los cuidadores de niños menores de dos años tuvieron un cambio en conocimientos del 84,5%, y en comportamientos, de un 26%. Ello permite concluir que las estrategias educativas dirigidas a cuidadores aumentan sus habilidades y conocimientos en relación con el cuidado...
The Shaken Baby Syndrome is part of the classification of physic abuse. It affects mostly children under two years old and occurs when the caregiver holds the minor and exerts pressure that produces acceleration and deceleration of the childs head generating an impact that causes brain, osseous, hearing, ocular injuries. Therefore is intended to determine the effect of an educational intervention in order to avoid the shaking, no matter if it is used as a mechanism to calm the babies crying or as a demonstration of affection through playing. The present investigation is an evaluative-quantitative study conducted at 60 caregivers who were given a tool designed from existing literature on Shaken Baby Syndrome which inquires about sociodemographic characteristics of the participants and the knowledge and behaviour that can influence the Shaken Baby Syndrome before and after the educational intervention. The result of the investigation showed that thanks to the educational intervention, the caregivers had an improvement in knowledge in 84.5% and in behaviour in 26%. This leads to the conclusion that the educational strategies aimed at caregivers increased their skills and knowledge in relation to the care...
O síndrome do bebê sacudido faz parte da classificação de maus-tratos infantis. Afeta principalmente crianças menores de dois anos de idade e acontece quando o cuidador segura a criança e faz forças que produzem a aceleração e desaceleração da cabeça do bebê e que causam danos ao cérebro, ossos, ouvidos, olhos e outros. Assim, pretende-se determinar o efeito de uma intervenção educativa destinada a impedir que os cuidadores de crianças menores de dois anos exerçam a sacudida como mecanismo para a detenção do choro ou como uma demonstração de carinho através do jogo. Este é um estudo de avaliação e quantitativo realizado com 60 cuidadores de crianças menores de dois anos, no qual foi aplicado um instrumento concebido a partir da literatura existente sobre o síndrome do bebê sacudido que pergunta sobre as características sociodemográficas dos participantes e dos conhecimentos e comportamentos que podem influenciar no síndrome do bebê sacudido antes e depois da intervenção educativa. Os resultados do estudo mostraram que através da intervenção educativa para cuidadores de crianças com menos de dois anos se obteve uma mudança no conhecimento do 84,5% e 26% no comportamento; fato com o que pode-se concluir que as estratégias educativas dirigidas aos cuidadores incrementam as habilidades deles e os conhecimentos em relação com o cuidado...
Subject(s)
Models, Educational , Caregivers , Child AbuseABSTRACT
Dentro de las múltiples manifestaciones de la violencia intrafamiliar, una de las que más atención atrae es aquella dirigida hacia los niños y uno de los cuadros mas estudiados ampliamente es el Síndrome del Niño Sacudido, causado cuando un niño pequeño es tomado por un adulto del tórax y sacudido hacia atrás y adelante. El mismo es una entidad clínica reconocida por la medicina actual, con factores predisponentes y cuadro clínico identificable por el personal medico y de salud en contacto con pacientes pediátricos de corta edad. La importancia de la difusión de las características del Síndrome del Niño Sacudido es fundamental para su identificación así como también la concientización en la población de la gravedad de las consecuencias que esto conlleva para su prevención.
Among the multiple manifestations of intrafamiliar violence, one of the most alarming is the used against children; and of this one of the most studied cases are of the Shaken Baby Síndrome, caused when an adult grabs a little child from the thorax and shakes him backs and forth. It is reconized as a clinical identity by today´s medicine, with predisponent factors and identifiable clinics by the physicians and health care workers in contact with pediatric patients at early ages. The importante of the information of the characteristics of the Shaken Baby Syndrome is fundamental for its identification also the concientization of the citizenship about the serious consequences derived to enhance its prevention.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Battered Child Syndrome , Domestic Violence , Violence , Wounds and InjuriesABSTRACT
El síndrome del niño sacudido es una de las formas más severas de maltrato infantil que ocurre principalmente en niños menores de un año. Por la vulnerabilidad de las víctimas y por las secuelas que puede producir, incluyendo la muerte, es necesario, en el abordaje clínico, tener presente la sospecha diagnóstica ante lesiones de explicación insatisfactoria por parte de los encargados del menor. Asimismo si se trata de un abordaje médico legal deben tenerse las consideraciones necesarias para documentar las lesiones, tanto en el paciente vivo, como en los casos de homicidio, para colaborar con la administración de justicia. Para ello se debe tratar de implementar una metodología homogénea para la realización de dichas pericias, tanto en la parte clínica como patológico forense. En este artículo se describe la forma habitual de presentación clínica del síndrome del niño sacudido y se expone una guía básica para la realización de autopsias medico legales en casos de muertes por esta causa.
The shaken baby syndrome is one of the most severe presentations of child abuse that is seen in children especially under the first year of age. The great vulnerability of this group of patients and the serious consequences that they may encounter in the future, including death, are enough reason to inquire, during the clinical approach, about the possibility that the patient being attended may be a victim of physical abuse. From a medico-legal evaluation, it is pertinent to document and describe thoroughly the physical lesions in the living patient and in cases of homicide, in order to contribute scientifically in the administration of justice. For that reason it is essential to follow a uniform methodology in the management of both the clinical and the forensic assessment. This article reviews the usual clinical presentation of the shaken baby syndrome and proposes a basic guide to evaluate the autopsies in cases of deaths originated by this cause.