What question did this study set out to answer?

The aim is to review evidence regarding clinical manifestations, neuroimaging results, differential diagnosis, and outcomes of abusive head trauma in infants and children.

June 15, 2026Open Access

Abusive Head Trauma in Infancy and Early Childhood: A Systematic Review of Clinical Manifestations, Neuroimaging Findings, Diagnosis, and Outcomes

Key Points

The aim is to review evidence regarding clinical manifestations, neuroimaging results, differential diagnosis, and outcomes of abusive head trauma in infants and children.
Systematic review following PRISMA 2020 guidelines
Search of databases included PubMed/MEDLINE, Scopus, and Web of Science
Included observational, cohort, case-control studies, and relevant reviews published from January 2020 to March 2026.
Identified 428 records with 25 studies included after screening.
Common clinical manifestations: seizures, irritability, altered mental status, apnea, vomiting, and developmental impairment.
Neuroimaging findings: subdural hematoma, retinal hemorrhage, cerebral edema, and hypoxic-ischemic injury. Long-term effects include developmental delay, epilepsy, and behavioral issues.

Abstract

Background: Abusive head trauma (AHT), historically referred to as shaken baby syndrome (SBS), is a major cause of severe traumatic brain injury in infants and young children and is associated with substantial morbidity, mortality, and diagnostic complexity. Objective: To systematically review current evidence regarding the clinical manifestations, neuroimaging findings, differential diagnosis, and neurodevelopmental outcomes associated with AHT in pediatric patients. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, and Web of Science were searched for studies published between January 2020 and March 2026. Eligible studies included observational studies, cohort studies, case-control studies, imaging-based investigations, clinically relevant review articles, and consensus statements evaluating clinical, radiological, or neurodevelopmental outcomes in infants and children with AHT. Because of heterogeneity in study design, outcome reporting, and availability of extractable data, findings were synthesized qualitatively. Results: A total of 428 records were identified. After removal of duplicates and screening, 25 studies were included in the qualitative synthesis. The most frequently reported clinical manifestations included seizures, irritability, altered mental status, apnea, vomiting, feeding difficulties, and developmental impairment. Subdural hematoma, retinal hemorrhage, cerebral edema, and hypoxic-ischemic injury were the predominant neuroimaging findings. Several studies emphasized the importance of differentiating AHT from benign enlargement of the subarachnoid spaces, coagulation disorders, accidental trauma, and other non-traumatic conditions. Long-term sequelae included developmental delay, epilepsy, cognitive impairment, motor dysfunction, visual impairment, and behavioral abnormalities. Conclusion: AHT remains a complex pediatric condition associated with significant neurological morbidity and diagnostic challenges. Neuroimaging plays a central role in evaluation, but multidisciplinary assessment and careful differential diagnosis are essential to avoid misclassification. Long-term neurodevelopmental follow-up is critical for affected children.

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