ABSTRACT
OBJECTIVES: To compare the characteristics of subdural haematoma (SDH) in children under the age of 2 years, between inflicted, otherwise known as abusive head trauma (AHT), and non-inflicted aetiologies. METHODS: This was a retrospective cohort study of 37 cases of SDH in children under the age of 2 years presenting to the ED at an Australian tertiary children's hospital between January 2009 and December 2012 and been assessed by the Child Protection Unit. SDH aetiology was classified into AHT and non-inflicted groups, based on child protection interagency outcome. These groups were compared to determine clinical associations with AHT. RESULTS: Of the 37 infants with SDH, 20 cases were deemed due to AHT, whereas 17 cases were determined to be non-inflicted SDH (15 cases due to accidental trauma and two cases due to congenital benign enlargement of the subarachnoid space). SDH due to AHT was associated with antenatal maternal drug use, previous Department of Child Safety involvement, delayed presentation, history of seizures, floppiness or altered level of consciousness; extracranial findings of fractures, bruising or retinal haemorrhages; radiological findings of >5 mm depth, bilateral, inter-hemispheric blood, posterior fossa blood and diffusion restriction; and outcomes of death or permanent disability. Non-inflicted SDH was associated with witnessed injury, falls and scalp haematoma on imaging. CONCLUSIONS: Infant SDH due to AHT accounts for high mortality and morbidity. Early identification of these patients in the ED with referral to specialised units that investigate for potential child abuse is essential.
Subject(s)
Child Abuse , Craniocerebral Trauma , Pregnancy , Infant , Child , Humans , Female , Child, Preschool , Retrospective Studies , Australia , Craniocerebral Trauma/complications , Hematoma, Subdural/etiology , Hematoma, Subdural/complications , Child Abuse/diagnosisABSTRACT
The use of medical cannabis in chronic illness is increasingly investigated, yet little is known about its use in paediatric populations. As child protection clinicians are often asked to provide advice around whether parents' actions to give medical cannabis to their chronically ill child constitutes harm or risk of harm, a review of the evidence base is required. This systematic review explores the use of cannabis-derived products in children with seizure disorders. While a reduction in seizure activity was observed in some children, included studies were poorly designed and too small to extrapolate reliable conclusions about clinical use. Due to the lack of high-quality evidence, the use of cannabis-derived products is currently not recommended in children with seizure disorders. However, in assessing risk and harm to subject children by child protection physicians in Australia with existing State and Territory legislation, evaluation must occur on a case-to-case basis with each instance considered on its individual merits. Clinical trials addressing drug efficacy and long-term safety of cannabis-derived products are required.
