Traumatic head injury in infants and toddlers

Abstract

In this thesis both a clinical and epidemiological approach were used to study injuries in young children. In a retrospective study of 91 children younger than 36 months of age admitted to hospital with a traumatic head injury 17 cases met the criteria for inflicted injury, 35 cases met the criteria for accident, and the remaining 39 cases were regarded as indeterminate. Nearly two-thirds of the subdural haemorrhages (SDH) were classified as inflicted. Seizures occurred more frequently in the inflicted group. Compared with children in the accident group, the children in the inflicted group were more likely to have been hospitalised earlier despite being considerably younger. Children in indeterminate group shared some characteristics with children in the inflicted injury group, which may indicate that some children in the indeterminate group have been abused or neglected. Data from the Norwegian Mother and Child Cohort study were used to explore the public health perspective. The study sample comprised 27,000 mother and child pairs. Both child characteristics and familial factors predicted injuries in toddlers. Risk factors for injuries were: Male gender, younger maternal age, financial problems, maternal mental distress, having older siblings, fine motor problems and attention problems. Shyness, gross motor problems and preterm birth reduced the risk. In addition, the possible long-term consequences of childhood abuse in mothers were explored in the same sample, and we found that mothers who had experienced abuse in childhood reported more externalising behaviour in their children at three years of age compared with mothers without such experiences. Maternal mental health problems constituted a partial mediator of the relationship. The study suggested that even in low-risk populations, an intergenerational transmission of adverse effects of childhood abuse may occur. List of papers. Paper I is removed from the thesis due to publisher restrictions. Paper I Myhre MC, Grøgaard JB, Dyb GA, Sandvik L, Nordhov M Traumatic Head Injury in Infants and Toddlers Acta Paediatrica 2007 Aug; 96(8):1159-1163 doi:10.1111/j.1651-2227.2007.00356.x Paper II Myhre MC, Thoresen S, Grøgaard JB, Dyb G Familial factors and child characteristics as predictors of injuries in toddlers: a prospective cohort study. BMJ Open 2012 Mar 8; 2(2):e000740 doi:10.1136/bmjopen-2011-000740 Distributed under the terms of the Creative Commons Attribution Non-commercial License. Paper III Myhre MC, Dyb G, Wentzel-Larsen T, Grøgaard JB, Thoresen S Maternal childhood abuse predicts externalising behaviour in toddlers: a prospective cohort study. Submitted version, the final version to be viewed at: Scand J Public Health. 2013 Nov 21. [Epub ahead of print] doi:10.1177/1403494813510983 Copyright 2013 the Nordic Societies of Public Healt