Publication year
2013
Citation Title
Infant abusive head trauma in a military cohort.
Journal Name
Pediatrics
Journal Volume
132
Issue Number
4
Page Numbers
668-676
DOI
10.1542/peds.2013-0168
Summary
Administrative data were used to examine rates of, and risk factors for, abusive head trauma, a type of physical child abuse, among military families with infants 12 months old or younger. The rates of infant abusive head trauma are similar to civilian rates. Higher risk of abusive head trauma is associated with lower military pay grade, having a military mother, infant being a boy, prematurity, or having a birth defect.
Key Findings
The estimated rate of substantiated abusive head trauma in the military population was 34 cases per 100,000 live births. Including probable cases increased the rate to 39 cases, rates very similar to civilian rates.
Rates of substantiated abusive head trauma among military infants increased beginning in September 2001 and continued for several months.
Male infant sex was associated with increased risk for substantiated abusive head trauma, as were premature birth and birth defects.
Parental risk factors related to abusive head trauma included lower pay grade, young maternal age, and the presence of a military mother.
Implications for Program Leaders
Provide support services to military families when a child is born prematurely or with a birth defect to reduce the risk of abusive head trauma
Offer parenting classes to military families at high risk for abusive head trauma
Disseminate information regarding how to report child maltreatment among military families
Implications for Policy Makers
Continue to support programs that provide resources and services to young military families, particularly families of female Service members, to help reduce rates of abusive head trauma
Recommend collaboration among DoD and community-based programs that help military families cope with the stressors associated with parenting
Recommend education to service providers regarding the risk factors associated with abusive head trauma in military families
Methods
The Department of Defense Birth and Infant Health Registry was searched to identify military-associated infants born between 1998 and 2005.
International Classification of Diseases – 9th Edition (ICD-9) codes indicating traumatic brain injury were combined with the findings of the Family Advocacy Program (FAP) to identify cases of abusive head trauma for infants up to 12 months old.
Infants with at least one head injury ICD-9-CM code or a code for shaken infant syndrome were included in the study if they had a FAP report that occurred one week prior to, or within 60 days of the child receiving a head trauma diagnosis.
Participants
Participants included 676,827 infants born to military families; same-sex multiples were excluded from the sample.
The majority of infants were White (66%), male (51%), full-term (93%), and born without birth defects (97%).
Most mothers were 21 years of age or older (93%) and dependent spouses of a Service member (82%); 6% were military and single, 6% were military and married, and 6% were in a dual-military marriage.
Thirty-seven percent of the sample were Army families, 26% were Navy and Coast Guard, 25% were Air Force, and 12% were Marine Corps.
Limitations
The use of large administrative data sets leaves the data open to misclassification and coding errors, which could influence results.
Cases may have been missed if infants were born before the parent’s enlistment in the military or if the case occurred after the parent left the military.
Only a small number of abusive head trauma cases had a parent deploy and results may not be applicable to military families with higher rates of parental deployment.
Avenues for Future Research
Include information on care setting and perpetrators to understand the elevated risk associated with military mothers
Qualitatively examine antecedents to abusive head trauma to inform prevention efforts.
Explore the effectiveness of intervention programs aimed at reducing child maltreatment among military families
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
OBJECTIVE: Evaluate the rate of, and risk factors for, abusive head trauma (AHT) among infants born to military families and compare with civilian population rates. METHODS: Electronic International Classification of Diseases data from the US Department of Defense (DoD) Birth and Infant Health Registry were used to identify infants born to military families from 1998 through 2005 (N = 676?827) who met the study definition for AHT. DoD Family Advocacy Program data were used to identify infants with substantiated reports of abuse. Rates within the military were compared with civilian population rates by applying an alternate AHT case definition used in a civilian study. RESULTS: Applying the study definition, the estimated rate of substantiated military AHT was 34.0 cases in the first year of life per 100?000 live births. Using the alternate case definition, the estimated AHT rate was 25.6 cases per 100?000 live births. Infant risk factors for AHT included male sex, premature birth, and a diagnosed major birth defect. Parental risk factors included young maternal age (<21 years), lower sponsor rank or pay grade, and current maternal military service. CONCLUSIONS: This is the first large database study of AHT with the ability to link investigative results to cases. Overall rates of AHT were consistent with civilian populations when using the same case definition codes. Infants most at risk, warranting special attention from military family support programs, include infants with parents in lower military pay grades, infants with military mothers, and infants born premature or with birth defects.
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