Child Abuse Expert Witness On Abusive Head Trauma

On his website, child abuse expert witness Dr. Michael R. Weinraub, FAAP, explains Abusive Head Trauma. Dr. Weinraub is a Board Certified Pediatrician with three decades of clinical practice experience.

Formerly called Shaken Baby Syndrome (SBS) this form of child abuse is now called Abusive Head Trauma (AHT). While protecting children from infancy onwards from abusive head trauma (AHT) is of primary importance, recent concerns have been raised in specific cases about the degree of medical certainty of AHT as a diagnosis where a broader differential diagnosis may offer explanations of the findings that are not due to abuse.

A standard of care medical work-up of a case of suspected AHT starts with a medical history including a determination of when the child was last well, if ever; a physical examination and review of prior physical examinations and other findings in the medical records; and consideration of current laboratory and radiology findings resulting in a differential diagnosis. This differential diagnosis consideration of various medical conditions as well as of the timing of the findings will assist the physician in forming an opinion of the causation of these findings. For example, findings of brain swelling may arise from an abusive event or may be secondary to a medical condition such as a seizure that caused hypoxic brain injury and swelling. In the process of a medical work-up, one medical explanation may offer the most reasonable explanation for the findings or a medical explanation may offer a reasonable explanation of the findings equally as well as an abusive cause.

Most significantly, the finding of the SBS triad of retinal hemorrhage (RH), subdural hematoma (SDH), and brain swelling is no longer sufficient for making the medical diagnosis of AHT. A closer look at more descriptive factors of each element of the triad is needed including: other causes of retinal bleeding may be found from noting the location, type and quantity of RH along with other findings of retinal injury; SDH may have occurred due to birth injury or a prior infection and an abnormal birth record or pediatric outpatient history may offer evidence of a chronic SDH with re-bleeding as the cause of a child’s sudden deterioration; and brain swelling due to hypoxia from non-abusive causes may be noted without invoking a theory that severe shaking has occurred. As a pediatrician I have the responsibility to both protect children and to preserve families by offering a thorough medical review of the all of the facts available and to examine the reasonableness and certainty of the medical opinions and diagnoses concluded from those facts.

Read more: Dr. Weintraub.