Every pediatric hospitalist has faced a scenario like this many times. Making the correct diagnosis is critical, because children with missed inflicted head trauma are at high risk for sustaining more trauma, and head trauma represents the most common cause of death in abused children.1 Although the literature concerning child abuse has evolved, establishing the diagnosis still requires astute clinical judgment along with evidence-based practice. Unfortunately, no definitive test for abusive head trauma currently exists.

The known subjection of children to abuse dates back to ancient times with King Nimrod slaying every first-born child upon being informed a boy would be born that would declare war on the king.2 Killing “deformed” children was common in ancient Greece. During the Industrial Revolution, child abuse became a recognized entity. The writing of Charles Dickens exemplifies the hardship of children in a growing industrial society. In 1962, Kempe and colleagues3...

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