Recognizing Abusive Head Trauma in Children

To the Editor: Any diagnosis requires sound criteria to be defensible. However, 3 of the 4 factors used by Dr Jenny and colleagues¹ to determine that intentional injury in a child had been "missed" are questionable. A confession typically is obtained only after a suspect has been repeatedly confronted with the allegation that "you shook your child" or after the caretaker has been offered a plea to a reduced charge with a limited jail sentence, given a deadline for accepting the offer, and threatened with an upward sentencing departure if there is a conviction on the original charges. Such a confession should not be used as evidence that nonintentional injury occurred, and may lead to incarceration of an innocent person.^2- 3 Furthermore, the history may be inadequate if the caretaker does not know what happened, or may be considered inconsistent if the team members evaluating child abuse are unfamiliar with the biomechanics of head injury. (Too often, any history other than "I did it" is considered inadequate.) Moreover, a delay in seeking care cannot be proved by assuming that an injury occurred at a certain time, and especially not by inferring that a child with a head injury never has a lucid interval.