Takeo Fujiwara¹, Hiroaki Nagase², Makiko Okuyama³, Takahiro Hoshino⁴, Kazunori Aoki², Tastuya Nagashima⁵ and Hajime Nakamura⁶

¹Department of Health Promotion, National Institute of Public Health, Saitama, Japan. ²Department  of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Hyogo, Japan. ³Department of Psychosocial Medicine, National Centre of Child Health and Development, Tokyo, Japan. ⁴Department of Psychiatry, Saitama Children’s Medical Centre, Saitama, Japan. ⁵Department of Neurosurgery, Hyogo Prefectural Kobe Children’s Hospital, Hyogo, Japan. ⁶Department of Paediatrics, Kobe University, Hyogo, Japan.

Abstract

Objective: The clinical presentations of head trauma due to falls among young children aged less than 2 years are controversial, particularly in Japan, as the history of trauma recounted by a caretaker is not always reliable. The purpose of this study was to assess the validity of caregiver’s reports on head trauma due to falls in young children aged less than 2 years in Japan.

Methods:  All patients <2 years of age presenting with head trauma resulting from a fall who were admitted to 3 children’s hospitals in Japan from January 2001 to December 2005 were retrospectively reviewed (N = 58). The clinical presentations were compared among groups categorized by the heights from which the patient fell (short (≤120 cm) or long (>120 cm)) and the surface on which the patient landed (carpet, tatami (Japanese mattress), hardwood floor, or concrete).

Results:  Patients who suffered short falls were more likely to present with subdural hemorrhage (SDH) than those who suffered long falls (74% and 40%, respectively, P = 0.027). More specifically, 62% of short falls showed SDH indicative of shaken baby syndrome (e.g. multilayer SDH). Neurological symptoms, cyanosis, and SDH were more commonly observed in patients who landed on carpeted or tatami surfaces than in those who landed on hardwood or concrete floors.

Conclusions:  Short falls and landing on soft surfaces resulted in the presentation of severer clinical symptoms than did long falls and landing on hard surfaces, suggesting that the validity of caretakers’ reports on infant or young children’s head trauma due to falls is low. Further research is warranted to investigate the cause of infant head trauma due to falls.