Battered Child Syndrome

In 1962, Dr. C. Henry Kempe and his associates published a paper on physical abuse of children and introduced the term battered child syndrome. It describes injuries resulting from repetitive nonaccidental trauma to and maltreatment of children. The publicity that has developed around this term has been critical in focusing interest in child physical abuse. It has provided the basis of many laws for reporting child abuse throughout the country. Mandated reporters, including doctors, nurses, social workers, and teachers, are required by law to report suspicious injuries in children. They are protected by law from liability if these reports are made in good faith.

Child physical abuse is a serious problem in the United States today. Reports of abused children reach about 3 million each year. About a third of these are substantiated on further investigation. About 1,200 children die of abuse or neglect each year. It can take many forms. In early infancy, the most common form of severe child abuse is shaken baby syndrome, a term that applies to brain injuries that result when a baby is violently shaken. In older children, blunt abdominal trauma is a more typical injury in fatal abuse cases. Fractures can also be part of the battered child syndrome. When evaluating fractures as part of abuse, one must look at whether the description of the trauma fits the type and severity of the fractures. Burns, although not generally considered battering, can be part of battered child syndrome. Bruises may be the only visual evidence of trauma. Without intervention, battery often escalates to the death of the child.

Shaken Baby Syndrome

Special note should be made of shaken baby syndrome, a form of battered child syndrome that occurs mainly in children under 3 years of age, with peak incidence at about 4 months of age. The primary injury is brain damage due to shaking, often combined with an impact of the head against a surface. Fractures are found in about one third of the infants with shaken baby syndrome, indicative of the extreme violence of the shaking. It is not uncommon to find additional injuries that predate those from the shaking that brings the child to the hospital.

Rotational forces that occur with shaking lead to a number of injuries, including intracranial hemorrhage from breaking of the bridging veins and diffuse axonal injury from shearing forces, which break the fragile axons from the nerve cells. In addition, shaking leads to injury to the blood vessels of the retinas of the eyes, with hemorrhaging and occasional dislocation of the retinas.

Child abuse is a pervasive problem in many societies and cultures. Children become the targets of abuse and killing when parents and guardians exercise poor parenting skills. Long after the scars have healed, abused children remember how they were made to feel, feelings that may haunt them throughout their lives and increase the likelihood of victimization as adults.

Copyright © Peggy & Ronald Barnett/CORBIS.

Sequelae of severe shaking can include death, severe brain damage, and blindness. Within a group of 31 shaken babies seen over a 20-month period, 6 (20%) died, and an additional 4 suffered severe permanent brain damage. Less data are available regarding the long-term effects of the shaking on learning.

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