Abusive Head Trauma through Shaking: Examination of the Perpetrators According to Dating of the Traumatic Event

Abstract

Effective prevention of abusive head trauma (AHT) requires the identification of potential perpetrators. Current evidence suggests that infant shaking, as a mechanism of AHT, produces immediate symptoms, allowing for the dating of the event based on clinical symptoms. Determining precisely when symptoms occurred may help law enforcement to identify the perpetrator. We retrieved written legal statements and medical records from birth to age at diagnosis of 100 infants consecutively diagnosed with AHT through shaking (2011-17), using forensic expertise files. Timing of abuse allowed for the identification of perpetrators in 91 cases. All abusive events occurred inside a home (parent's or nanny's), never outdoors or in a public place, and always in the presence of only one adult. Approximately one-third (n = 32) of the perpetrators were males (31 fathers) and two-thirds (n = 59) were females: 49 of them were the infant's nanny and ten were the infant's mother. Infants were not described as crying habitually. Better knowledge of the context of AHT events and risk situations, including recent implementation of a new or unusual modality of childcare, and being the only adult in a home with an infant, should facilitate prevention, including targeted training and avoidance of situations associated with risk.

Recognising Limitations: Author's Response

“…T hank you to George Edwards for his comments (Edwards, 2021) on Laurent-Vannier et al (2021). Nevertheless, I do not agree with the points he made and would like to provide additional information on the diagnostic strategy we used.…”

Recognising Limitations: Pitfalls in Drawing Conclusions about Abusive Head Trauma

“…This difficulty in specifying the mechanism is in part why the American Academy of Pediatrics has recommended the use of the term 'abusive head trauma' that does not imply a single injury mechanism (Christian and Block, 2009). Laurent-Vannier et al (2021) use clinical dating to identify perpetrators in their case series. The onset of symptoms from AHT very likely occurs immediately or shortly after the abusive event.…”

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An Invited Comment on 'Abusive Head Trauma through Shaking: Examination of the Perpetrators According to Dating of the Traumatic Events' by Laurent-Vannier et al (2021)T he article by Laurent-Vannier et al (2021) in this issue of Child Abuse Review is a compelling study with new and useful findings. Nonetheless, the article raises questions regarding the certainty of conclusions on two issues: determination of the mechanism of inflicted head injury and clinical dating to identify perpetrators of abusive head trauma (AHT).

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“…Nonetheless, the article raises questions regarding the certainty of conclusions on two issues: determination of the mechanism of inflicted head injury and clinical dating to identify perpetrators of abusive head trauma (AHT). This commentary will discuss these two issues and why they are important.In their case series, Laurent-Vannier et al (2021) indicate that shaking was the main and constant mechanism of injury. While some of their cases include confessions of shaking alone, most do not have confessions.…”

“…In their case series, Laurent-Vannier et al (2021) indicate that shaking was the main and constant mechanism of injury. While some of their cases include confessions of shaking alone, most do not have confessions.…”