title: Nonaccidental head injury in children. Historical vignette.
abstract: Our current understanding of nonaccidental head injury in children is the result of decades of effort and the tireless work of numerous physicians. In 1860 Auguste Ambroise Tardieu, a French forensics expert, recognized important patterns of injury in children and identified nonaccidental trauma as the cause of these injuries. His work was ignored. In the years that followed, physicians continued to report these patterns of injury but were unable to identify the etiology. A fundamental misunderstanding of the usual cause of subdural hematoma (SDH) contributed to the confusion at that time. Early in the 20th century, neurosurgeons such as Wilfred Trotter recognized that SDHs were traumatic in origin. However, even Trotter's efforts to expose faults in the theories that SDHs primarily resulted from inflammatory or infectious processes were not accepted immediately. Eventually, the pattern of injuries in children was again recognized both by neurosurgeons, who began to identify an association between trauma-induced SDHs and retinal hemorrhages, and by radiologists, who began to note SDHs in conjunction with osseous lesions. Not until the 1950s and 1960s, however, did physicians begin to routinely identify nonaccidental trauma as the cause of these injuries. Following the recognition of child abuse, a pattern of injuries in conjunction with shaking was identified and is currently known as shaken baby syndrome. Since its identification, our understanding of this syndrome has been modified as a result of new medical research, legal challenges, and popular media forces.
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan 48109-5338, USA.
authors.forename: Wajd N
authors.initials: WN
authors.lastname: Al-Holou
authors.forename: Edward A
authors.initials: EA
authors.lastname: O'Hara
authors.forename: Aaron A
authors.initials: AA
authors.lastname: Cohen-Gadol
authors.forename: Cormac O
authors.initials: CO
authors.lastname: Maher
mesh_terms: D002648:Child; D002649:Child Abuse / Q000266:history*; D006259:Craniocerebral Trauma / Q000266:history*; D005554:Forensic Medicine / Q000266:history; D005602:France; D006408:Hematoma, Subdural / Q000266:history; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D038642:Shaken Baby Syndrome / Q000266:history; D006113:United Kingdom