Abuse is the #1 cause of brain injury-related deaths among children 0-4.

I start with that sobering fact because I want to drive home the point that there’s much more to discuss on the topic of children and brain injury than solely sports-related concussions.

This month I interviewed physiatrist Dr. Maya Evans of Shriners Hospital for Children – Northern California in Sacramento. We discussed children and concussions, and one of the many things we talked about was abuse as a cause of TBI in children.

What Makes Abuse As a Cause Different

Abuse isn’t an accident, like some motor vehicle crashes or falls. Deaths and injuries from abuse are all 100% avoidable.

Physical trauma to a child’s head or shaking of the brain inside the head can lead to swelling and bleeding that causes death. For those that survive, they may be left with a variety of lifelong challenges including seizures, learning disabilities, paralysis, and blindness or other disabling conditions. Even milder cases of abuse can cause permanent changes in personality and behavior.

How Common is Abuse as a Cause of Brain Injury in Children?

Abuse is a top cause of TBI-related emergency room visits, hospitalizations, and deaths among children of all ages.

Assault is the leading cause of brain injury-related death among children 0-4, accounting for approximately 40% of TBI-related deaths in that age category. A report from the CDC found 2,250 deaths of children under 5 from what is now called abusive head trauma between 1999-2014. That’s 150 avoidable child deaths every year. Fortunately, that same report found that rates declined in the second half of the period of the study. Whether that trend will continue, we don’t know yet.

It’s important to note that these numbers are conservative. They only include cases where the injury was recorded and classified as an assault. It’s possible that many abuse-related brain injuries in children are either misclassified (as falls, for example) or aren’t treated at all. The real numbers may be higher.

What Kind of Physical Abuse Can Cause Brain Injury in Children?

The best-known form of physical abuse that results in brain injury is arguably shaken baby syndrome, which typically happens when a parent or caretaker shakes a crying baby out of frustration to make it quiet down. Children under 1 are the most common victims, though it has been seen in older children. It only takes a few seconds of violent shaking to do permanent damage.

Blunt impact is the other common cause of non-accidental brain injury in children, which includes punching, kicking, and striking either with the hand or an object.

Neglectful supervision, which is considered separate from abuse, can also lead to brain injuries in children if a caretaker isn’t paying attention or doesn’t provide a safe environment or take precautions and, for example, allows a child to climb and fall out of or off of a highchair, fall down the stairs, or out of an unsecured window.

Can It Be Stopped?

To discover ways to help prevent the kind of abuse and neglect that leads to TBI in children, look at the 2016 report from the National Center for Injury Prevention and Control on Preventing Child Abuse and Neglect (find the PDF here) which has recommended strategies at the individual and community level. There’s also a lot of information on the topic here from the US Department of Health & Human Services.

I also encourage you to watch the complete interview with Dr. Maya Evans, where we discuss this and many other topics related to children and concussions. You can find that interview here.

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If you think you may have a medical emergency, call 911 immediately.

Thanks to these colleagues for the website photo opportunities:

Kam Gardner, MS, CCC-SLP, Speech-Language Pathologist
Raymond Samatovicz, MD, Physiatrist, Brain Injury Medicine Specialist
Kaiser Foundation Rehabilitation Center, Vallejo, California