Physical violence against children causes injury to both their bodies
and their emotions. In some cases, these physical injuries are severe and
can lead to permanent damage or even death. Because the brains of infants
and children are fragile, any physical violence or even rough play can cause inflicted traumatic brain injury (brain damage due to violence
caused by another person). The August 6, 2003, issue of JAMA includes an article about inflicted brain injuries in children.
One kind of inflicted traumatic brain injury is called the shaken baby syndrome. Infants who are shaken may not have any immediate
sign of harm, but their brains may have severe damage from bruising, swelling,
or internal bleeding. Brain injury is the leading cause of death in abused
Shaken baby syndrome is not usually a one-time event. Abuse of an infant
or young child that causes this type of injury is often part of a pattern
of abuse. Previous head injuries may be seen on special testing, such as a CT (computed tomography) scan or MRI (magnetic resonance image) of the brain.
Infants who have been shaken and are injured have a high mortality rate (chance of dying from the injury). Approximately 25%
of shaken babies die from their traumatic brain injuries. The infants who
do not die may have permanent, often severe damage to their vision, hearing,
thinking, and learning capabilities. They may be blind, have seizures, have spasticity (tension and weakness of the muscles), have
small heads with lack of growth of brain tissues, and may be severely mentally
Unexplained sleepiness or inability to awaken the child
Changes in crawling, walking, or speech patterns
Poor feeding or sucking
Unexplained bruising or fractures in any part of the body
Early recognition of possible child abuse
Parenting support through classes, public resources, health care
personnel, and family members
Stress reduction for parents
Education about age-appropriate behavior and healthy child growth
Careful evaluation of those outside the family who take care of
Contact your doctor or a child-abuse hotline if you need help.
Centers for Disease Control and Prevention National Center for
Injury Prevention and Controlhttp://www.cdc.gov/ncipc/factsheets/tbi.htm
American Academy of Pediatricshttp://www.aap.org
Childhelp USA Child Abuse Hotline800/422-4453http://www.childhelpusa.org
To find this and previous JAMA Patient Pages, go to the Patient Page
link on JAMA's Web site at http://www.jama.com. Many are available in English and Spanish. A Patient Page on intimate
partner violence was published in the August 7, 2002, issue, and one on traumatic
brain injury was published in the June 11, 2003, issue.
The JAMA Patient Page is a public service of JAMA . The
information and recommendations appearing on this page are appropriate in
most instances, but they are not a substitute for medical diagnosis. For specific
information concerning your personal medical condition, JAMA suggests
that you consult your physician. This page may be photocopied noncommercially
by physicians and other health care professionals to share with patients.
Any other print or online reproduction is subject to AMA approval. To purchase
bulk reprints, call 718/946-7424.
Sources: Centers for Disease Control and Prevention, National Center
for Injury Prevention and Control, American Academy of Pediatrics, National
Institute of Child Health and Human Development, National Institute
of Neurological Disorders and Stroke
Torpy JM, Lynm C, Glass RM. Inflicted Brain Injury in Children. JAMA. 2003;290(5):698. doi:10.1001/jama.290.5.698