Copyright 1999 American Medical Association. All Rights Reserved.
Applicable FARS/DFARS Restrictions Apply to Government Use.1999
To the Editor: Any diagnosis requires sound
criteria to be defensible. However, 3 of the 4 factors used by Dr Jenny and
colleagues1 to determine that intentional
injury in a child had been "missed" are questionable. A confession typically
is obtained only after a suspect has been repeatedly confronted with the allegation
that "you shook your child" or after the caretaker has been offered a plea
to a reduced charge with a limited jail sentence, given a deadline for accepting
the offer, and threatened with an upward sentencing departure if there is
a conviction on the original charges. Such a confession should not be used
as evidence that nonintentional injury occurred, and may lead to incarceration
of an innocent person.2,3
Furthermore, the history may be inadequate if the caretaker does not know
what happened, or may be considered inconsistent if the team members evaluating
child abuse are unfamiliar with the biomechanics of head injury. (Too often,
any history other than "I did it" is considered inadequate.) Moreover, a delay
in seeking care cannot be proved by assuming that an injury occurred at a
certain time, and especially not by inferring that a child with a head injury
never has a lucid interval.
Plunkett J. Recognizing Abusive Head Trauma in Children. JAMA. 1999;282(15):1421–1422. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-15-jac90009
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