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Non Accidental Head Injury

By Rebecca Ward NAI Solicitor At Brendan Fleming Solicitors

If you have been accused by doctors and the authorities of causing your child a Non-Accidental Head Injury (sometimes referred to as Shaken Baby Syndrome or Abusive Head Trauma) although it is probably little comfort, rest assured, you are not alone.

So much controversy surrounds the term Shaken Baby Syndrome that in early 2015 researchers at Cardiff University developed and validated a diagnostic test to help doctors determine how likely it is that a child with head injuries – aged less than two years old – has been abused.  These finding were published in the May 2015 edition of the Paediatrics Journal .

What is Non Accidental Head Injury?

Non-Accidental Head Injury describes an injury to a child’s brain that is unexplained.  This is caused by the moving of the brain inside of the skull.  This can sometimes result in bleeding inside and around various parts of the brain, swelling, raised intra-cranial pressure, bruising etc.  Such injuries are known to occur in cases where a child has been involved in a car crash.  Sometimes these injures can be caused by a shaking like motion alone or with trauma with a yielding or unyielding object.

There has been a lot of controversy around the cause of head injuries in children.  Whilst not shying away from the fact that some children are injured at the hands of abusive parents; many are not.  Over the years it has become wildly accepted that some children sustain bleeding to the brain at birth whereas this previously was not accepted.  It is possible that if a baby had sustained a bleed at birth that a re-bleed might happen with no or minimal force.  There are also situations in children whereby they have sustained a fall (short or high), they have been dropped or due to reckless behaviour on the part of a parent they have been sustained head injuries.  Not all head injuries to children are caused deliberately.  It is where the explanation of the injury does not fit the injuries sustained that parents find themselves accused of causing Non Accidental Head Injury.

Sometimes a triad of injuries, ribs fractures, retinal haemorhages and bleeding to the brain, would lead professionals to consider whether or not a child had been shaken.  However, it is known that even if a child is shaken, whether this is deliberately or whether this is as a result of a momentary loss of control not all children present with the triad.  Some may present with all the injuries, others may present with one or the other. What is known is that unless there is a medical reason infants do not sustain injuries as a result of normal handling.

The knowledge of Non Accidental Head Injury is always expanding with greater knowledge from the medical profession.  Where considered necessary by the Courts, medical experts are asked to assist in Care Proceedings as to the cause of the injuries sustained by a child and whether or not explanations provided could explain the injuries.


Brain Damage/Medical Conditions/Infection/Vascular Disorders/Abnormalities (Including Encephalopathy): Depending on the severity of the disruption to the brain during the injury, long term damage to the brain can occur. Some children recover entirely from an ordeal of bleeding to the brain others unfortunately do not and require long term monitoring and intervention.

Some medical conditions and infections may explain some head injuries.  For example Glutaric Aciduria type 1 is a known condition in which children have been seen with bleeding in their brain and to their eyes which historically has been mistaken for abuse. There are many different medical conditions which have to be explored by the medical professionals, this is just one of them.

Some infections may contribute to bleeding to the brain and eyes and these again have to be considered by the medical professionals.

Also rare, there are some conditions which may result in vascular abnormalities in the brain which may render a child more susceptible to easy bleeding or in some cases spontaneous bleeding.

There may be some structural abnormalities in the brain which may make a child more susceptible to easy or spontaneous bleeding.

All of things and more have to be considered when looking at a Non Accidental Head Injury.

Neck and Spinal Injuries: In some cases of Non Accidental Head Injury there may be some injuries to the neck and spine.  Although, this is not always the case they sometimes present themselves.

Subarachnoid and Subdural Haemorrhages: These are just two kinds of bleeding that can be found within the brain itself.  Each injury to a child’s brain is unique, as is the prognosis.  Sometimes children may have bleeding to specific single locations on the brain others may be multiple locations.  They may of single density of mixed density.  They may be Chronic (Old) or Acute (New) or sometimes a combination of the two.  Sometimes the bleeds will resolve themselves other require medical intervention. It is known that children can sustain bleeding to the brain as part of the birth process.  Bleeding of the brain is always suspected as a Non-Accidental Injury when there is no obvious medical reason for it, or when the parent’s explanation of an actual trauma (intentional or accidental) does not get accepted by the medical staff as being the real cause.

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