Babies are at far greater risk of brain damage than
previously thought.
Even activities that seem innocent, like a quick run in a
jogging stroller, can inflict abusive head trauma. And head injuries often go
entirely undetected, so parents unwittingly repeat the same harmful behaviors
over and over again.
These conclusions, which come from a new study I co-authored
in the Journal of Pediatric Neurology, must be used to better educate new
parents and inform manufacturers as they design car seats, safety helmets, and
the like.
Abusive head trauma, or AHT, is typically referred to as
--"shaken baby syndrome" -- the consequence of awful, deliberate
abuse. Every year, an estimated 1,300 infants suffer this brain trauma. Roughly
one in four tragically dies. Of those who survive, about 80 percent develop
lifelong disabilities.
Of course, the overwhelming majority of parents would never
intentionally harm their children. But, as our new research makes clear, it's
possible to inflict AHT without even knowing it.
There are several reasons why this unsettling truth is just
now coming to light. For starters, it's difficult to diagnose AHT. Some cases
result in noticeable injuries, including bone fractures. But others result in
far milder symptoms, such as fussiness. Many victims of AHT show no signs of
trauma whatsoever.
Plus, studying the biomechanics of AHT -- what physically
occurs inside a child's skull when his or her head moves back and forth rapidly
-- presents its own challenges. After all, there's no ethical way to observe or
replicate such injuries in a scientific setting.
But thankfully, there's another way to study the problem. My
colleagues and I used computer models to simulate the biomechanics of AHT.
Specifically, we looked at how the cerebrospinal fluid cushions the brain when
a child is shaken repeatedly.
What our models revealed is startling. Even at the lowest
frequency we studied -- two shakes per second -- a single shake is dangerous.
More troubling still, after that initial shake, the cerebrospinal fluid stops
cushioning the brain altogether, causing the child’s brain to collide with the
skull wall.
In other words, it doesn't take a violent act of frustration
to damage a baby's brain. Something as ordinary as playfully tossing a child in
the air or jogging with a baby could be enough to inflict severe head
trauma.
Of course, additional research is needed to develop even
more precise AHT simulations. But our conclusions suggest several strategies
for preventing head trauma in young children.
The first is simple -- parents must avoid any activity that
shakes their infant's head even once, however harmless it might seem.
Just as important, designers should rely on biomechanical
models when designing items like car seats, strollers, and other baby products.
In 2018 alone, U.S. emergency rooms treated children under five for 59,000
injuries related to nursery products -- such as walkers, bouncer seats, and
baby swings. Strollers were involved in 8,200 of those injuries. And across all
of these incidents, the child's head was the most commonly injured part of the
body.
Of course, faulty design didn't cause all of these
accidents. But better-constructed products based on the latest biomechanics
research could go a long way toward reducing head injuries in young children.
Such research might reveal that jogging strollers require better shock
absorbers, or that car seats should include more protective headgear.
At the very least, researchers should use biomechanical
simulations to evaluate the safety of existing baby products. The results might
surprise them -- newer products are not necessarily safer than older ones. In
February, biomechanics researchers at Duke University found that World War
I-era combat helmets provided better protection from certain kinds of
explosions than current military helmets. Imagine what researchers might find
if they subjected modern baby products to the same scrutiny.
The latest biomechanics research reveals that babies are far
more vulnerable to head trauma than previously thought. It's time to minimize
this trauma -- or eliminate it -- by using these findings to better educate new
parents and design safer baby products.
Milan Toma, Alfonso Dehesa-Baeza , Rosalyn Chan-Akaley, Paul
D. H. Nguyen, Hallie Zwibel. Cerebrospinal Fluid Interaction with Cerebral
Cortex during Pediatric Abusive Head Trauma.
Journal of Pediatric Neurology. DOI: 10.1055/s-0040-1708495
Abstract
Abusive head trauma is the leading cause of fatal brain
injuries in children younger than 2 years. It is a preventable and severe form
of physical child abuse often linked to the forceful shaking of an infant or
toddler. Victims of abusive head trauma can suffer permanent neurological
damage, resulting in developmental delay and disability. The long-term effects
of abusive head trauma are difficult to diagnose and predict. In this model, we
use a high-order finite element method paired with the most comprehensive and
current head/brain model and next-generation smoothed particle hydrodynamics.
This is one of the first fluid–structure interaction frameworks that uses fluid
material properties to represent the cerebrospinal fluid (CSF) while including
all major anatomical features of the brain. The interaction of CSF with the
brain cortex during abusive head trauma is demonstrated during multiple shaking
cycles. A comprehensive and precise model that calculates for the role of CSF
in neurological trauma will be useful both in the prevention and treatment of
abusive head trauma and the determination of prognosis and patient outcomes.
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