The role of household composition of children diagnosed with abusive head trauma

Background: To prevent abusive head trauma (AHT), many studies focus on understanding the risk factors. Few studies assess the role of household composition.Objective: To describe the household composition of children diagnosed with AHT and assess the relationships between patient and household characteristics, perpetration, and fatality. Participants and setting: Children admitted to a large pediatric hospital with AHT between January 1, 2010 and December 31, 2019.Methods: The diagnosis of AHT was made at initial hospitalization by a child abuse pediatrician with a multidisciplinary team review. The electronic medical records of identified patients were reviewed to identify demographic information, the number and ages of all of their siblings and the number and relationship to patients of all adults who were reported as being present at the time of AHT and therefore considered to be possible perpetrators. Descriptive statistics were used to characterize the sample. Comparisons were made using Fisher exact tests and Mann-Whitney tests.Results: Children with AHT who were under 12 months of age and had siblings in the home, particularly siblings under age 5, had greater odds of being injured by a biological parent. Children 12 months or older and children without siblings had greater odds of being injured by a boyfriend or girlfriend of their parent or guardian. Conclusions: In cases of AHT, the possible perpetrator differed based on the presence of young siblings living in the home, which has important implications for AHT prevention.