Reply to Dr John Melville: the scientific controversy over abusive head trauma in infants

Abstract

markedly between the two studies, abuse being much more common when only intradural lesions are considered. Regarding the diagnosis of child abuse, our protocol is similar to many centers', with the originality of systematic fundoscopy for all head-injured infants and a very regular and systematic approach to the eventuality of abusive trauma. We assume that our approach has been fairly uniform all along the recruitment of this database, now in its tenth year. We agree with Dr. Melville that systematic X-rays and social inquiry might have disclosed more cases of abuse; however, such measures are perceived as invasive and intrusive, and we know of no team in which this practice is standard in clear-cut cases of mild trauma, with a consistent history compatible with the lesions and the child's developmental level, no clinical evidence of extracranial lesion, and with the additional security of fundoscopy showing no evocative retinal hemorrhage.