Non-accidental Trauma as an Example of an Underestimated Problem in Pediatrics: Maltreated Child Syndrome and Shaken Baby Syndrome

Abstract

Injuries, including both accidental and non-accidental trauma, represent a common reason for hospitalization in the pediatric population. The impact of violence in the caregiver-child relationship is an important and often underestimated problem in pediatrics. Child abuse can present itself in various forms, including both psychological and physical manifestations. This study details the maltreated child syndrome and the shaken baby syndrome, also known as abusive head trauma. Non-accidental trauma presents with a broad spectrum of neurological symptoms, along with multiple injuries at different stages of healing and potential indicators of shaking. A two-month-old male infant presented with body spasms, subsequently accompanied by muscle flaccidity, following an accident of unclear mechanism. Imaging studies revealed bilateral subdural hematohygroma with acute hemorrhage, multiple fractures in various stages of healing, and retinal hemorrhage. Clinical, psychological, and social findings were consistent with shaken baby syndrome and maltreated child syndrome, suggesting non-accidental trauma. Beyond the current injuries, it is significant to be aware of the long-term effects of violence, particularly psychological and social aspects related to neurological damage. The role of medical staff is not only to provide medical help but also to ensure the child's safety and prevent a negative impact on their psychosocial development. Knowing how to recognize the signs of child abuse is relevant.

Keywords: abusive head trauma; child abuse; maltreated child syndrome; non-accidental trauma; shaken baby syndrome.

Figure 1. Non-contrast head CT, axial sections at three levels, brain window.

Bilateral subdural hematohygromas in the frontal region (A and B, blue arrows). Bleeding along the right side of the cerebellar tentorium (C, green arrow).

Figure 2. Non-contrast head CT, axial section, bone window.

Squamous part of the occipital bone: fracture line on the left side (red circle); asymmetry of the lambdoid suture.

Figure 3. The condition following fractures of the 10th and 11th ribs on the left side in the posterior segment, currently in the healing phase, with visible localized periosteal thickening.

The ninth left rib in the posterior paravertebral region shows localized thickening and periosteal layering, also raising suspicion of a fracture in the healing phase (red circle).