Crying as a trigger for abusive head trauma: a key to prevention

The devastating and for the most part irremediable consequences for an infant, his or her family, and society in cases of abusive head trauma have spurred research into ways of preventing it. In the last four or five decades, increasing interest in infant crying and its clinical manifestation of colic has led to a reconceptualization of crying in early infancy, such that most of the characteristics of colic can be understood as manifestations of the crying typical of normal infants. This includes an early increase and then decrease in the amount of crying, the unexpected and unpredictable appearance of prolonged crying bouts, and the presence of inconsolable crying that occurs in the early months of life. When these concepts are merged with anecdotal clinical experiences, perpetrator confessions and epidemiological evidence of abusive head trauma, it is clear that these crying characteristics — and caregiver responses — are the predominant, and potentially modifiable, risk factors for abusive head trauma. This unfortunate but understandable relationship between early crying, shaking and abuse has opened windows of opportunity for primary, universal prevention efforts that are appropriate for — and support — all parents and may be able to prevent at least some of these tragic cases.