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General Reference

Nejm 1998;338:1822

Pathophys and Cause

Cause:Nonaccidental trauma

Pathophys:Subdural and subarachnoid bleeds from torn bridging vessels

Epidemiology

Infants <3 yr, most <1 yr; 24% of all trauma in children under age 2 yr. Assoc w poverty and low socioeconomic status

Signs and Symptoms

Sx:Lethargy, decreased tone, seizures (40-70%), bruises, burns; facial bruises w any nonspecific set of sx under age 3 yr should prompt queries, CT, and skeletal series (Jama 1999;281:621, 657)

Si:Hydrocephalus

Lab and Xray

Xray:MRI (Peds 2003;112:808); plain films (skeletal survey) for fractures

Treatment

Rx: Hospitalize, child protection, mandatory reporting