Frequencies of occurrences of violence prior to a diagnosis of shaking

Introduction/Background The SBS constitutes one of the most severe paediatric head traumas. Objective When an SBS diagnosis is confirmed, take up a survey of how many children showed previous signs suggesting violence. Material and method The study spanned over 50 legal cases on child abuse from 2011 to 2015. For each case, from all medical and legal information, we established if there were previous signs of violence, which they were and when they appeared. Results The average age at the date of diagnosis was 5 months. Signs of previous violence were found among 80% of children; 42.5% had been admitted to emergency services and 67.5% had been examined by a general practitioner or a paediatrician when signs could already been noticed. The signs were: unusual vomiting without fever or diarrhoea in 64% of cases (isolated in ¼ of cases), a break in the growth chart of head circumference (45%) or in the growth chart of weight (25%), bruises (34%), an occurrence of faintness (17%). The mean age of these signs related to the occurrence of the episode leading to the diagnosis was 30 days (SD 32 days; median line 20 days). It was of at least 45 days in 25% of cases. Conclusion These results are evocative of a very frequent reiteration of violence; it is not in this case “a clap of thunder in a calm sky”. They also show the great difficulty most professionals run into when they want to speak of violence and set its diagnosis, above all when the signs are not obvious. Yet the earliest possible detection of the first signs of violence is the best to prevent reiteration and to protect the child. Lack of knowledge in this field may be an explanation and is detrimental to children. Better training for everyone is the key.