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EDITORIALS: Catherine M Hill and Mary Mather Achieving health for children in public care BMJ 2003; 326: 560-561 [Full text]

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Neurodevelopmental surveillance for children suffering inflicted head injury

Jonathan Arthur Punt, Nina Punt BA Psych(Hons)   (3 April 2003)

Neurodevelopmental surveillance for children suffering inflicted head injury 3 April 2003
Jonathan Arthur Punt, Consultant paediatric neurosurgeon (retired) BUPA Hospital Leicester, Gartree Road, Oadby, Leicester, LE2 2FF, Nina Punt BA Psych(Hons) Send response to journal: Re: Neurodevelopmental surveillance for children suffering inflicted head injury	EDITOR Hill and Mather bring a glimmer of hope, and also a caution, regarding the improvement of health care for looked after children1. A particular area of unmet need that should be highlighted is the neuropsychological sequelae of inflicted head injury in early childhood. Several studies have shown that babies and infants who are subjected to inflicted shaking-impact injury have considerable long-term morbidity: 15 out of 33 infants sustaining subdural haematomas had profound disabilities2; 68% of 25 surviving children had significant morbidity3; 34% of 120 children had development delay4. When there are obvious physical neurological disabilities it is probable that these will be identified and monitoring put in hand to ensure appropriate support in the community and during education. Our concern is for those children who do not have overt major physical disabilities, but who are still at very real risk of neuropsychological sequelae that may not become fully apparent until later in childhood, when they may manifest themselves as learning difficulties and behavioural problems5. Sadly, as with many children with acquired organic brain injury, the education system is not good at identifying these children, and there is always the danger that they will go on to fail at school, perhaps excluded on account of their behaviour, and will just drift off to become the next generation of disadvantaged people. Our plea is that each child who comes into contact with the local authority on account of inflicted shaking-impact injury should be provided with a planned clinical neuropsychology and educational assessment during primary and secondary education, even when there is no evidence of overt neurological dysfunction or impairment of special senses. Jonathan Punt MB BS FRCS FRCPCH Consultant paediatric neurosurgeon PO Box 6016, Keyworth, Nottingham NG12 5QS Nina Punt BA Psych(Hons) Research assistant PO Box 6016, Keyworth, Nottingham NG12 5QS 1. Hill CM, Mather M. Achieving health for children in public care.BMJ 2003;326:560-561, (15 March) 2. Jayawant S, Rawlinson A, Gibbon F, Price J, Schulte J, Sharples P, Sibert JR, Kemp AM. Subdural haemorrhages in infants: population based study. British Medical Journal 1998; 317:1558-1561 3. Barlow KM Thomson E, Minns RA. The effects of shaking injury on cognitive and neurodevelopmental outcome 2000 Dev Med & Child Neurol. 41(suppl 82): 4-5 4. Stevens K J, Jaspan T, Holt JC, Bagnall MJC, Punt JAG. Social, clinical and medicolegal aspects of cranial trauma in cases of suspected non-accidental injury. Child’s Nerv Syst 1998;14:679. 5. Perez-Arjona E, Dujovny M, DelProposto Z, Vinas F, Park H, Lizarraga S, Park T, Diaz FG. Late outcome following central nervous system injury in child abuse. Childs’ Nerv Syst 2003;19:69-81. Competing interests:   Competing interests: JP & NP operate an independent medico-legal practice providing reports for the Courts and for the CICA in cases of suspected inflicted shaking-impact injury.