Shaking trauma

from Wikipedia, the free encyclopedia

The right medical term Shaken (ger .: shaken baby syndrome and abusive head trauma ) denotes a result of child abuse , mostly committed by the supervisors such. B. your own parents, grandparents or babysitters on the cry baby or toddler.

In another context, the term can also stand for the result of a special form of white torture .

Clinical picture and symptoms

The clinical picture is variable and depends on the duration and intensity of the shaking, the age of the child and any accompanying injuries.

Severe neurological symptoms without (severe) external injuries are typical . The affected infants show, among other things, a reduced general condition with poor drinking, refusal to eat, vomiting and irritability, muscular hypotension, cerebral seizures, apneas and bradycardias. The severity of the clinical picture ranges from somnolence to coma and lethal death .

Examination findings may reveal retinal bleeding, skull fractures (if the head is also hit), rib fractures and possibly other fractures.

Diagnosis

CT image of cerebral hemorrhage (arrow) between the meninges and the brain caused by shaking .

Because of its rapid availability, a cranial CT is often used as the primary diagnosis . The typical subdural hematomas and post-traumatic hygromas can be detected here. An MRI is used for further diagnosis and follow-up . If available, this is also used during the initial diagnosis. Fundoscopy is performed to diagnose retinal bleeding.

Blood and urine tests are performed to rule out differential diagnoses (including coagulation and metabolic diseases).

Prevention

According to doctors at the Kassel Clinic, approaches to comprehensive prevention arise “for example in the form of establishing home visit and counseling programs for families at risk, the pediatric identification of screaming children and their treatment in so-called screaming clinics , as well as the integration of educational content and brochures in the existing pension concept as well as public campaigns, as they are especially widespread in the USA ”. Families with older infants (more than 6 months old) can be efficiently helped through sleep training . The detection and rapid treatment of shaken children is also important in order to protect the affected children from repeated abuse and, if necessary, to take preventive action in the case of siblings. The youth welfare office can also be helpful here.

Affected parents should not be afraid to admit that they are overwhelmed and seek help in order to avoid endangering the child's welfare before they lose control of themselves and their actions.

A study published in 2011 showed a significant increase in the number of children admitted to hospital with shivering trauma for the United States during the period of the economic downturn from December 2007 to June 2009 compared with immediately preceding years. The authors of the study concluded from this that prevention efforts should be stepped up in economically difficult times.

Social medical effects

In the USA, known as Shaken baby syndrome (SBS), shaking trauma is the most common cause of death in child abuse and the cause of most permanent disabilities in (young) children.

A Canadian study found that two-thirds of surviving children show severe long-term damage. The scientists reviewed the data of 364 young children admitted to 11 Canadian clinics with shaking trauma. 19 percent of the children died of the injuries, 65 percent of the survivors had visual problems and 55 percent retained permanent neurological damage.

According to the German Society for Pediatric Surgery, between 100 and 200 infants die each year from this trauma in Germany.

Historical

The neurosurgeon Norman Guthkelch first pointed out in 1971 that violent shaking of infants can lead to subdural bleeding and thus to severe (brain) damage. Guthkelch hypothesized that shaking babies is seen in society as a milder and more socially acceptable form of punishment than beating. It was not until 1974 that the clinical picture was fully scientifically described in forensic medicine . Before that, the child victims who died were diagnosed and statistically mostly classified under the inapplicable heading of sudden infant death syndrome and not examined further, so the perpetrators were not held accountable. Since the internal bleeding, tissue and bone injuries are mostly not externally visible, there is still a large dark field today . The Düsseldorf forensic doctor and professor Elisabeth Trube-Becker made lasting merits in this area , with her research and educational campaigns to sensitize paediatricians, medical specialists and the public to this topic.

See also

literature

  • Andreas Warkenthin: The data system on the child's "shaking trauma" - a comprehensive review of the literature . Charité , Univ.-Med., Dissertation , Berlin 2006, DNB 981304729 .
  • Monika Schneiders, Detlef Schröder: The shaking trauma: an often unknown form of child abuse. In: Criminology . Volume 59, No. 12, 2005, pp. 734-737.
  • Jakob Matschke et al: The shaking trauma syndrome: A common form of non-accidental head and brain trauma in infancy and early childhood . In: Dtsch Arztebl Int . tape 106 , no. 13 , 2009, p. 211-217 ( Article ).
  • B. Herrmann, R. Dettmeyer, S. Banaschak, U. Thyen: Abuse- induced head injuries and shaking trauma syndrome. In: Child abuse. Springer, Berlin / Heidelberg 2016, ISBN 978-3-662-48843-0 , pp. 39-62.

Individual evidence

  1. ↑ a b B. Herrmann, R. Dettmeyer, S. Banaschak, U. Thyen: Abuse- related head injuries and shaking trauma syndrome . In: Child abuse . Springer, Berlin / Heidelberg 2016, ISBN 978-3-662-48843-0 , pp. 39-62 , doi : 10.1007 / 978-3-662-48844-7_3 .
  2. ↑ a b The Shaken Baby Syndrome - Concepts and Forensic Controversy. (PDF; 487 kB) Accessed December 22, 2008 . Also in: Journal of the DGgKV German Society against Child Abuse and Neglect. Volume 8, 2005, pp. 4–17.
  3. ↑ Rachel P. Berger et al .: Abusive Head Trauma During a Time of Increased Unemployment: A Multicenter Analysis. In: Pediatrics. American Academy of Pediatrics, Sept. 19, 2011.
  4. ↑ Michelle GK Ward: Canadian Pediatric Surveillance Program: Recognizing and Preventing Head Injury Secondary to Suspected Child Maltreatment. ( Memento of January 8, 2011 in the Internet Archive ) 2005.
  5. ↑ DGKCH press release from June 2013 , accessed on October 24, 2014.
  6. ↑ see also English Wikipedia
  7. ↑ TO Guthkelch: Infantile subdural haematoma and its relationship to whiplash injuries. In: British medical journal. Volume 2, Number 5759, May 1971, pp. 430-431. PMID 5576003 , PMC 1796151 (free full text).

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