About one-fourth of infants who are violently shaken by an abuser will die from brain damage

About one-fourth of infants who are violently shaken by an abuser will die from brain damage. Three-fourths of these infants will literally have the retinas of their eyes torn away from the back of the eye wall from the force of the motion.

These shocking results are part of an internal survey conducted at the Monroe Carell Jr. Children's Hospital at Vanderbilt and are no surprise to the survey's author, Chris Greeley, M.D., assistant professor of Pediatrics and medical director of the VCH Child Abuse and Neglect Program.

"This is consistent with what is reported in the literature," Greeley said. "And this tells me the database we have begun here is likely an accurate snap shot of child abuse in our region."

Greeley already has 600 entries in the child abuse database he began compiling a few years ago. He suspects a large number of injuries seen at Vanderbilt's Pediatric Emergency Department, or in other areas of the hospital that may be related to abuse, are not brought to his attention because the findings may not be compelling enough to prove the cause was related to abuse or neglect.

"This is the tip of the iceberg," Greeley said. "In the world of child abuse, there is a spectrum of certainty. These are the cases where the physician feels compelled to call the child abuse expert to document the case. These are the worst of the worst, the kids that any reasonable physician would say "yes, this is abuse."

While the numbers are a small percentage of the injured children seen at VCH, they represent a very vulnerable group of children. There are also a large number of neglected children seen at VCH and Greeley is beginning to get a sense of them as well. "About two-thirds of all child abuse is neglect. We here at VCH see a large number of child neglect as well, but they seem to fly below the radar," Greeley said. "This database is the first step in getting a real handle of the scope of the problem seen here at VCH."

Greeley says his database is not part of a formal research project. He explains there may be some difference in what is medically diagnosed as child abuse and what is found to meet the legal definition. While each case in his database is also reported to the state, as required by law, for official tracking of suspected abuse rates in Tennessee, the information that returns to the public is spotty and frequently scarce. The database is a result of multidisciplinary evaluation by the hospital's child abuse review and evaluation (C.A.R.E.) team.

This year Greeley feels the numbers in his database are solid enough to share publicly-- and he says he has strong reasons to do so. Greeley wants people to know the types of injuries he sees at Vanderbilt Children's in order to increase awareness, and to grow support for programs to prevent abuse. The most compelling fact that comes to light in Greeley's database is that tiny infants are hardest hit by violent abuse.

Here are some of the findings in Greeley's child abuse database from 2004 at Vanderbilt Children's Hospital:

There were 64 official abuse consults.
The oldest patient was 15 years old.
The youngest patient was 5 days old.
34 of the abuse victims were male (53 percent of total).

Ages
0-1 years: 37
0-4 months: 13
4-8 months: 20
8-12 months: 4
1-2 years: 14
2-5 years: 12
5-18 years: 1

Findings
23 patients suffered head injuries (36 percent of total).
17 patients suffered retinal hemorrhages (26 percent of total—74 percent of head injuries).
27 patients had fractures (42 percent of total).
21 patients suffered acute subdural hematomas (Bleeding on the brain) *15 of these patients suffered bleeding in both hemispheres indicating the most severe form of brain injury.

Outcomes
25 patients were discharged to the parent (39 percent of total).
19 patients were discharged into foster care (30 percent of total).
10 patients were discharged to a relative.
5 died at VCH (8 percent of the total—22 percent of those with head injuries).
The five fatalities ages were: 1 month, 8 months, 13 months, 13 months and 3years, 5months.

Location
57 patients were from Tennessee.
5 patients were from Kentucky.
1 patient was from Illinois.
1 patient was from Mississippi.

14 Tennessee counties were represented.
29 patients were from Davidson County (45 percent of all consults).
5 patients were from Rutherford County.
4 patients were from Sumner County.
3 patients were from Williamson County.
3 patients were from Coffee County.

Referral Origin
19 patients were from the VCH Pediatric Intensive Care Unit.
7 patients were referred from private pediatricians.
5 patients were from the VCH Pediatric Emergency Department.

"These are completely preventable injuries, and in fact, some research has shown you can make an impact on the rates of child abuse with startlingly simple actions," Greeley said.

Greeley has a plan to curb numbers of child abuse among Children's Hospital patients. Greeley has partnered with Pat Temple, M.D., professor of Pediatrics and medical director of Nurses for Newborns of Tennessee. The two envision a pilot project to intervene and prevent abuse. The details of this plan are still in the works, but generally families of babies born at Vanderbilt will be followed closely for the first two months of the baby's life, beginning before hospital discharge, and followed by in-home visits from a nurse or other home visitor.

"The goal is to take this family under our wing for the first year of life, to ensure as much as possible that the family gets off to a good start," Greeley said. "Studies show that something as simple as teaching new parents that shaking a baby is dangerous and following up in the first months of life can cut the rates of abuse in half."

Greeley is hoping to get a chance to prove that. He and Temple are working with administrators at Vanderbilt Children's Hospital and hope to find funding for the pilot program soon.