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Edited by Robert A Minns, J Keith Brown. Published by Mac Keith Press, London, 2006, £95 (hardback), pp 526. ISBN 1-898683-35-2
Non‐accidental injury in children rarely seems to be out of the spotlight. The public eye intermittently falls upon tragic cases and disputed medical evidence, the healthcare professions engage in a never‐ending round of child protection awareness raising and induction training, and meanwhile a depressingly steady stream of children continue to enter the child protection system after a shaking or inflicted head injury.
This book is aimed particularly at paediatricians in both the hospital and the community setting, but also at the wider child protection team including legal, police and social work professionals, with chapters written by contributors from each of these three fields. At just over 500 pages it is a big read, but the editors have helpfully written the first chapter as an overview, and thus the first hundred or so pages contain most of what your average paediatrician would need to know about non‐accidental head injury (NAHI) and shaken baby syndrome (SBS). Within this overview we are given the range of clinical presentations, much detail on brain injury, subdural and retinal haemorrhage, fractures and other associated findings, and the mechanics of NAHI and SBS. A huge amount of the existing literature base is incorporated and presented in a clear and readable way, and the authors' suggested approach to the diagnosis of “suspected” NAHI, with varying levels of certainty dependent on history, findings and other contributory factors, is particularly helpful.
It is perhaps inevitable that there is a good deal of overlap with the chapters that follow, as these provide more detail, and presentation of evidence, in specific areas of the subject. Epidemiology, retinopathy, subdural haemorrhage, the various radiological modalities and neuropathology of NAHI and SBS are looked at in great depth, with the reader able to find much to supplement what has been set out in the opening chapter. Special mention must go to the chapter on the biomechanics of shaking, which is extremely impressive in its detail and rigour, and completely incomprehensible to this reader.
Non‐surgical management of acute encephalopathies is covered, and while information on the management strategies is available elsewhere in standard critical care texts, again the evidence base for each treatment is well set out. Outcome and prognosis of NAHI is also described in depressing detail – 20% mortality and 60% suffering severe or moderate disability – and these stark figures alone emphasise the importance of this topic. In view of this, the four pages devoted to prevention of child abuse seems to be skimping a little, even though much prevention strategy is necessarily at a societal level and little under our individual control.
It is difficult, as a health professional, to know to what extent the chapters written from the police, legal and social work perspectives are helpful in adding to the knowledge of personnel in these fields, but they are both interesting and useful to the paediatrician reader, adding to our understanding of where our colleagues in the child protection process are coming from.
Involvement in cases of NAHI and SBS is invariably challenging for all concerned, but this book will undoubtedly serve as an excellent and reassuring reference for clinicians who have to weigh up clinical findings in what can often be emotive and contentious circumstances. As Alan Craft notes in his foreword, this is a “state of the art” collection of evidence, and it would be hard not to recommend a copy finding its way onto the shelves of every paediatric department.department.