title: Abusive head trauma in young children in the Netherlands: evidence for multiple incidents of abuse.
abstract: OBJECTIVE
  We investigated the prevalence of risk factors for and the prevalence of prior abuse in abusive head trauma victims in the Netherlands.
  
  
  METHODS
  We performed a retrospective file review of all abusive head trauma cases in the Netherlands in which forensic medical expertise was requested by the courts, between 2005 and 2010. Outcome measures were risk factors and indicators for prior abuse.
  
  
  RESULTS
  Eighty-nine cases were included; 62% boys, median age 3.5 months. Impact trauma was found in 48% of cases, with a male perpetrator in 79%. Prematurity, dysmaturity and twins/triplets were found in 27%, 23% and 10% of cases, respectively, maternal age under 20 years in 17%. Of the parents, 60% had completed only primary or secondary education, 38% of the families were known to child welfare authorities. There was evidence for prior abuse in 81% of the cases.
  
  
  CONCLUSIONS
  The high number of families with prior abuse indicates that both the healthcare system and child welfare authorities failed to protect some of the children that have been in their care. Our results highlight the importance of training healthcare and child welfare professionals in recognizing physical abuse, as well as the importance of optimizing abusive head trauma prevention strategies.
authors.affiliation: Section of Forensic Pediatrics, Department of Forensic Medicine, Netherlands Forensic Institute, the Hague, the Netherlands; Department of Radiology, Academic Medical Center/Emma Children's Hospital, Amsterdam, the Netherlands.
authors.forename: Tessa
authors.initials: T
authors.lastname: Sieswerda-Hoogendoorn
authors.forename: Rob A C
authors.initials: RA
authors.lastname: Bilo
authors.forename: Lonneke L B M
authors.initials: LL
authors.lastname: van Duurling
authors.forename: Wouter A
authors.initials: WA
authors.lastname: Karst
authors.forename: Jolanda M
authors.initials: JM
authors.lastname: Maaskant
authors.forename: Wim M C
authors.initials: WM
authors.lastname: van Aalderen
authors.forename: Rick R
authors.initials: RR
authors.lastname: van Rijn
mesh_terms: D002649:Child Abuse / Q000523:psychology*; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Child abuse; Child advocacy; Head injuries closed; Risk factors; Shaken baby syndrome