Based on CDC's recommended definition for AHT for public
health surveillance, the rates of fatal
AHT remained relatively stable during 1999–2009, followed by a significant
decline during 2009–2014. The fatal AHT rates in 2013 and 2014 (0.41 and 0.43
per 100,000 children aged <5 years, respectively) were the lowest rates
reported during the 16-year study period. This is the first documentation of a
decline in AHT rates after 2009. These encouraging results are consistent with
downward trends in other indices of child maltreatment and data systems, such
as the recent analysis by the Children's Bureau of the National Data Archive on
Child Abuse and Neglect, which found that the number of children experiencing
maltreatment decreased 3.8 percent during 2009–2013.
Examining both definite or presumptive and probable fatal
AHT cases illustrates that although definite or presumptive cases declined,
probable cases did not increase, suggesting that the observed decline in
definite or presumptive cases does not represent a change in case
classification. In addition, data on fatal assault-related TBI (with and
exclusive of AHT) similarly illustrate that classification of cases did not
change over time from AHT to assault-related TBI exclusive of AHT. Sensitivity
of clinical ascertainment of signs and symptoms associated with AHT might have
systematically decreased or the coding of death data might have systematically
changed over time. However, the nearly consistent annual number of
injury-related death records listing an AHT-related cause code and constant
annual rates of assault-related TBI exclusive of AHT during 2009–2014 suggest
that such systematic changes are unlikely…
Fatal abusive head trauma, like all forms of child
maltreatment, is preventable. An important step in the prevention of AHT and
child maltreatment is the ongoing, systematic collection of data that help
guide and monitor prevention approaches. Using CDC's uniform definitions of AHT
and child maltreatment are important steps in strengthening surveillance. Data
collected from surveillance systems, in combination with information on the
implementation and results of interventions and policies, can help shape
continuing public health efforts to prevent AHT.
Although the decrease in fatal AHT during 2009–2014 is
encouraging, additional efforts are needed to prevent AHT. Prevention of child
maltreatment requires understanding and addressing behavioral and environmental
characteristics that increase and reduce the risk for child maltreatment. There
is growing evidence that child maltreatment prevention strategies, such as
those that change interactions, including those between parents and children,
parents and other caregivers, and parents and health care providers are
effective interventions.
Summary
What is already known about this topic?
In the United States, abusive head trauma (AHT) is one of
the leading causes of child maltreatment fatalities, accounting for
approximately one third of these deaths. CDC developed a formal case definition
for fatal AHT to facilitate consistent tracking over time and evaluation of
interventions focused on prevention.
What is added by this report?
During 1999–2014, AHT resulted in nearly 2,250 deaths among
U.S. resident children aged <5 years. During 2009–2014, annual rates of
fatal AHT declined significantly, with an average annual decrease of 13.0%, and
there was no evidence that cases were simply being classified differently
during this time. This is the first report of a decline in AHT rates after
2009. The fatal AHT rates in 2013 and 2014 were 0.41 per 100,000 children aged
>5 years and 0.43 per 100,000, respectively, the lowest rates in the 16-year
study period.
What are the implications for public health practice?
Communities can use evidence-based approaches, such as
family-based interventions, and CDC’s Essentials for Childhood Framework: Steps
to Create Safe, Stable, Nurturing Relationships and Environments for All
Children and Preventing Child Abuse and Neglect: A Technical Package for
Policy, Norm and Programmatic Activities to promote safe, stable, nurturing
relationships and environments for children. Ongoing surveillance for AHT, in
combination with information on the implementation and results of interventions
and policies, can help shape prevention.
Erica L. Spies, PhD; Joanne Klevens, MD, PhD Fatal Abusive Head Trauma Among Children Aged
<5 Years — United States, 1999–2014. Morbidity
and Mortality Weekly Report. 2016;65(20):505-509.
http://www.medscape.com/viewarticle/864058?nlid=106688_3001
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