Synopsis
Recognise the variable presentation of abusive head trauma, stabilise airway and intracranial emergencies, investigate brain, spine, eyes and skeleton through a coordinated specialist pathway, protect other children and avoid diagnostic shortcuts.
- Consider abusive head trauma in an infant with unexplained apnoea, seizures, encephalopathy, vomiting, poor feeding or collapse.
- Resuscitate first: protect airway, prevent hypoxia and hypotension, check glucose, treat seizures and escalate for raised intracranial pressure.
- Obtain urgent CT for acute neurological concern, followed by specialist MRI of brain and often spine when clinically appropriate.
- Arrange trained ophthalmological examination with detailed retinal documentation; retinal findings are interpreted with the whole case.
- Use the child-protection imaging and laboratory pathway to search for fractures, abdominal injury, bleeding disorders and relevant mimics.
- Take a precise timeline from each informant without challenging or leading, and record developmental capability and any resuscitation before arrival.
- Involve senior safeguarding, children's social care and police early, because protection and forensic coordination cannot wait for every final report.
- Plan neurodevelopmental, visual, hearing, feeding, epilepsy and family follow-up for survivors after acute critical care.
Key red flags
The severity of encephalopathy, intracranial bleeding or retinal findings is not accounted for by the described event or the child's developmental ability.
Apnoea, seizures, vomiting, poor feeding, lethargy, irritability or increasing head circumference can be the only early manifestations in an infant.
A severe presentation attributed to no trauma, routine handling or an unwitnessed short fall needs rigorous clinical correlation rather than automatic acceptance.
Bruising, oral injury, rib or metaphyseal fractures and other injuries increase concern for a wider pattern of inflicted trauma.
Anaemia, shock, tense fontanelle, abnormal pupils, focal weakness or deteriorating consciousness indicate urgent intracranial or systemic consequences.
No external head mark and an initially normal neurological examination do not exclude intracranial injury in a high-risk presentation.
Investigation priorities
Identify acute haemorrhage, fracture, swelling and neurosurgical emergencies rapidly.
Management branches
The child has seizures, apnoea, shock or reduced consciousness.
- Stabilise airway, cervical spine, breathing and circulation with senior support.
- Correct glucose disturbance and treat seizures without procedural delay.
- Obtain urgent CT and involve neurosurgery or critical care immediately.
- Prevent hypoxia, hypotension and fever during transfer and investigation.