ASSOCIATION OF CHILDREN'S WELFARE AGENCIES CONFERENCE 2010 - [PPT Powerpoint] (2022)

  • ASSOCIATION OF CHILDREN'S WELFARE AGENCIES CONFERENCE 2010

    Inflicted Traumatic Brain Injury in Children How Big is the Iceberg?

    Sydney August 3, 2010Nick Rushworth Executive OfficerBrain Injury Australia

  • peak of peaks

  • abusive head traumainflicted head injuryinflicted traumatic brain injuryshaken baby syndromenon-accidental head injury[shaken impact syndrome]

  • inflicted traumatic brain injury type 1Queensland Police Service - review of 52 X fatal ITBI

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    victims were shaken, thrown, punched, head-butted, and attacked with objects such as lumps of wood

  • inflicted traumatic brain injury type 2a significant amount of [ITBI] is not necessarily deliberately inflicted, that is; premeditatedA lot of it occurs in the heat of the moment, in the middle of the night.

  • inflicted traumatic brain injury type 2crying = the only child-specific variable consistently identified as important in the cycle of escalation to shaking PURPLE Crying

  • defendants have been proven guilty of shaking babies to death based on the presence of retinal hemorrhages [bleeding in the eye], subdural hematomas [bleeding on the brain] and cerebral edemas [swelling], then the presence of these symptoms must mean that someone is guilty of shaking a baby to death. All that remains is to identify the last person with the conscious child.That person becomes the suspect, who can then be confidently pursued.SBS comes as close as one could imagine to a medical diagnosis of murder: prosecutors use it to prove the mechanism of death, the intent to harm, and the identity of the killer.

  • the severity of the shaking force required to produce injury is such that it cannot occur in any normal activity such as play, the motions of daily living or a resuscitation attempt. The act of shaking that results in injury to the child is so violent that untrained observers would immediately recognize it as dangerous.

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  • International Statistical Classification of Diseases and Related Health Problems (10th edition)incidence - hospitalisationsUS version (9th edition): shaken infant syndromeICD-10-AM (Australian Modification): T74.1 Maltreatment syndrome, physical abuse. Battered: baby or child syndrome

  • incidence - hospitalisations

  • The Children's Hospital in Denver, Colorado; 1990-1995 54 (31.2%) of 173 "abused children with head injuries had been seen by physicians after [ITBI] and the diagnosis was not recognised" 15 (27.8%) "reinjured 4/5 "deaths in the group with unrecognised [ITBI] might have been prevented by earlier recognition of abuse" ("...Infants with recognized [ITBI] were more likely to be minority children or children whose mothers and fathers were not living together...)- hospitalisations(missed cases)

  • irritability vomiting poor appetite lethargyincidence - hospitalisations(missed cases)The fact that 60% of children present to hospital with symptoms that would be consistent with many childhood illnesses seen in this age group suggests that [ITBI] may never be considered in many cases.

  • the short-term outcome in infants with [ITBI] is poor and the associated mortality ranges from 11% to 36%; in surviving children, long-term morbidity is usual and ranges from mild learning difficulties to severe physical and cognitive impairment. outcomes? 4 died 7 vegetative state 17 discharged with severe disability 12 moderate disability 25 good outcome Childrens Hospital at Westmead (1995 and 2002, n=65) (follow up @ 1-73 months - n=56) 17 severe disability 12 moderate disability 19 good outcome

  • 2002; 1435 households @ North and South Carolinas (US)

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    incidence community telephone survey (mothers) of "potentially abusive behaviours used by either themselves or their husbands or partners"'v' incidence of hospitalised ITBI in North Carolina over 2 years for every 1 child less than 2 years of age who sustains a serious or life-threatening injury, another 152 children may be shaken by their caregivers and sustain sub-clinical brain trauma that goes undetected."

  • incidence community(NSW Community Services, 2005 - 2009) 514 Child Protection Reports relating to shaking of children aged 0-2 years 236 secondary assessments determined actual harm or risk of harm relating to shaking of children(Families and Communities South Australia, 2004-2009) of 7973 children in Notifications of child abuse less than 2 years of age, there were 2089 children in Substantiations 23 Substantiations involving Shaking 7 Substantiations involving Skull Fracture.

  • incidence community; outcomes?habitual, prolonged, casual whiplash shakings may produce an insidious progressive clinical picturewhich is often inapparent to both parents and physicians. It usually first becomes evident at school age when minor cerebral motor defects are first detected along with mild mental retardation...The actual number of such cases is incalculable from current evidence but it appears to be substantial.- John Caffey

  • incidence community; outcomes?(samples; 400 - 1,000 mothers from India, Chile, the Philippines, Egypt, and Brazil )

    the frequency of shakingof children aged less than 3 years ranged from 6.6% of mothers in the Manila, Philippines, neighbourhood of Paco to 42% of mothers in the urban slums of India.ITBI: may be an occult but leading cause of infant mortality and mental retardation in the developing world"

  • Australian Early Development Index (AEDI)(261,203 five yr-olds surveyed = 97.5% of the estimated population) 21,800 developmentally vulnerable , 34,300 developmentally at risk, in the language and cognitive (school-based) domain 21,700 vulnerable 37,900 at risk in the emotional maturity domain 23,200 vulnerable and 37,300 at risk in the social competence domain 22,600 vulnerable and 38,800 at risk in the communications skills and general knowledge domainincidence - community; outcomes?

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  • incidence community; outcomes?10-18% of cerebral palsy in Australia acquired post-neonatally (n = 60-100 p.a.) 1/10 the result of ITBIthe non-accidental group is slightly rising

  • incidence community; outcomes?Attention Deficit Hyperactivity Disorder (ADHD)1998: 355,600 children/ adolescents estimated to have ADHD (11.2% aged @ 4 - 17)RACP guidelines on ADHD: a thorough medical history and examination are required to identify any ABI or other neurological condition that may contribute to the presenting symptoms. ADHD: occurs in 20%-50% of children following ABI

  • www.braininjuryaustralia.org.au

    nick.rushworth@braininjuryaustralia.org.au

    1800 BRAIN1

    Apologise in advance teaching you how to suck eggsnot a clinician, not a medical researcher, former journalist (PWABI?)

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    at the base of the triangle, not a large number of ATSI membersnot a great deal of engagement. ABI advocacy lags around 20/30 years behind that of other disabilities, disability awareness in Indigenous communities lags?N: AHT = USNAHI = UK (both have potential to prejudice medico-legal investigation...)No perfect nomenclature...that's going to please all stakeholders...Some describe a type of injury, others a type of disability...There was also, however, near-unanimity that, while shaken baby syndrome (SBS) might have the highest level of public recognition and thus make it the most serviceable for parent education and abuse prevention campaigns SBS has outlived its usefulness in clinical or forensic/legal settings. Firstly, SBS fails to capture other forms of abusive head trauma apart from shaking. Secondly, SBS carries the suggestion that infants alone are at risk of such abuse when it is clear older children experience ITBI from being shaken as well. Thirdly, many felt that SBS currency had been degraded by the ongoing debates, described above and the choice of another descriptor avoidedthe whole pointless courtroom controversy as to whether this was shaking alone, impact alone, or a combination of both. Lastly, it also sidesteps concerns over syndrome evidence that the presence of a so-called triad of clinical findings (bleeding in the eye and on the brain, with damage to the brain) is ordinarily the result of violent shaking. BIA's preference...Brain Injury Australias other general objection to the use of head injury as a term inclusive of traumatic brain injury is that only a minority of the former result in the latter. Except, perhaps, in young children. In the absence of compelling bio-mechanical evidence - that the application of a certain amount of force, from impact, from acceleration or rotation of a childs head results in a certain amount of injury to the brain - any injury to the childs head has the potential to cause brain damage even if it is not apparent, radiologically or clinically, at the time of the injury. We simply dont know what the injury thresholds are for infant brains undergoing repetitive accelerational movements [from shaking]. Moreover, where community awareness about brain injury is low the other benefit from the use of inflicted traumatic brain injury as the descriptor, in parent education for example, is its directness in naming the most serious consequences of head injury in young children.N: array of, often escalating abuses..The backgrounds to such abuse commonly involve domestic violence, parental alcohol and drug abuse and mental health problems. Most of the paediatricians Brain Injury Australia consulted with thought that, even if ITBI was preventable in such circumstances, it demanded a different order of response from universal parent education: prevention involves the recognition of adversity in families, assessing its level of activity, supporting those who are managing the adversity themselves and actively intervening in those fa

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