A fractured skull. Broken ribs. Bleeding in the brain. The injuries suffered by abused children can be devastating.
The youngest and smallest are especially vulnerable. Too small to defend themselves, too young to speak up for themselves, they depend on physicians, among many others in the community, to be their voice and serve as their protectors.
The weight of determining whether a child’s injuries are accidental or inflicted falls on the shoulders of dedicated pediatricians across the country, often working with multidisciplinary teams of physicians and other professionals. It’s a gut-wrenching responsibility. Much is at stake — for parents, families and, especially, children.
The subspecialty of child abuse pediatricians was established a decade ago. These pediatricians have special training and expertise in identifying, diagnosing and treating injuries. They work diligently to understand whether those injuries are the result of abuse or an accident or disease. Evidence-based research and policies guide these pediatricians in this life-saving work.
The American Academy of Pediatrics recently updated its policy on abusive head trauma, once referred to as shaken baby syndrome, to incorporate a growing body of science on how to diagnose this type of abuse — and when to rule it out.
However, diagnosing abusive head trauma places child abuse pediatricians in the crosshairs of defense attorneys who have increasingly pushed pseudo-scientific theories that have no basis in medical research. Medical science, itself, is now on trial.
Pseudo-experts have falsely claimed that a debate is raging in the medical community about whether abusive head trauma is a real diagnosis. Let me be clear: There is no controversy.
A 2016 study of doctors at 10 leading U.S. children’s hospitals found the vast majority of physicians — 93% — agreed that AHT is a valid diagnosis. And a 2018 consensus statement, supported by eight medical societies representing subspecialists in a number of countries, including Norway, Sweden and Japan, affirmed that AHT is scientifically non-controversial and recognized throughout the world.
Creating confusion about what constitutes abusive head trauma could discourage people from coming forward when they suspect abuse. And it puts vulnerable kids who cannot advocate for themselves at terrible risk. About five children die every day in the U.S. as a result of abuse and neglect.
In documented cases of abusive head trauma, nearly one-fourth of babies under 1 died. Almost 70% of survivors have permanent brain injury, including cerebral palsy, seizures, intellectual disabilities, behavioral problems and learning disabilities.
It’s appalling that criminal defense attorneys have portrayed child abuse specialists as zealots who see abuse in every child they evaluate. That’s no more true than saying that infectious disease experts are motivated to diagnose coronavirus where none exists.
When children with suspicious injuries are rushed through their doors, pediatricians seek to understand what happened. They actively search for rare disorders and other possible explanations. According to one study, child abuse pediatricians did not find abuse in 44 percent of the cases referred to them.
The diagnosis is based on a physical exam; medical tests; imaging, including X-rays and CT scans; health history; and an explanation of how the injury happened. It often is made in consultation with a medical team.
And to clear up a misconception: In cases of suspected abuse, child protective services and the court system make the final decision on whether to remove a child from the home.
Pediatricians greatly respect the bond between parents and their children. Many of us are parents ourselves. We know that raising children is hard and that the vast majority of parents want what’s best for their children.
The overriding goal is to get families and other caregivers — baby sitters, day care providers, teachers and others — the support they need so we can prevent child abuse.
That’s why the AAP supports paid family leave, home visitation services for new parents, high-quality child care and education programs, and efforts to educate caregivers about how to soothe an infant and deal with the frustration of a crying baby. We also encourage our members to talk to caregivers about the dangers of shaking or striking babies.
Pediatricians’ No. 1 job is to make sure every child in our care is healthy and safe. Our heartfelt desire to protect them is what motivates us to do this work every day.
