Non-accidental head injuries in infants: increased risk during COVID

What is non-accidental head injury (NAHI)?

Emerging evidence suggests that the coronavirus (COVID-19) pandemic has left babies increasingly vulnerable to non-accidental head injuries (NAHI).

Non-accidental head injury, also referred to as abusive head trauma (AHT), is a serious form of physical abuse causing injury to the brain. The condition may arise from shaking, impact injuries, or a combination of both. It most commonly occurs in children under the age of two, and can result in long-term disabilities or death (NSPCC and Cardiff University, Department of Child Health, 2009)¹.

> See our leaflet for more information on abusive head trauma and spinal injuries in children

Increased risk factors

Non-accidental injuries have always been a cause for concern, but a number of risk factors have been heightened by COVID-19, including:

• social isolation – the support for parents and carers that normally comes from socialising with friends and family has been restricted by social distancing rules (British Orthopaedic Association, 2020)²
• lack of access to services – a reduction in access to services including health visits (Institute of Health Visiting, 2020)³, childcare and mental health services have taken away important sources of support for parents. It has also reduced the ability of professionals to pick up on early warning signs (British Orthopaedic Association, 2020)⁴
• financial uncertainty – times of financial insecurity, such as economic recessions, have been linked to an increase in abuse and mortality from non-accidental head trauma (Huang, 2011)⁵.

Recent data on non-accidental injuries

Some early releases of data suggest there has been an increase in non-accidental injuries during the coronavirus pandemic.

Great Ormond Street reviewed the number of cases of suspected abusive head trauma between 23 March and 23 April 2020. 10 children with suspected abusive head trauma were seen during this period, which is 15 times higher than the average for the same period over the previous three years (0.67 cases per month) (Sidpra, J. et al, 2020)⁶.

Between April and October 2020, Ofsted had over 300 serious incident notifications. Almost 40% of these were about babies, over a fifth more than for the same period the previous year. Over half of the cases about babies related to non-accidental injuries (Ofsted, 2020)⁷.

The government’s 2020-21 data on serious incident notifications found that from April to September 2020, there was a 31% rise in incidents of death or serious harm to children under 1 when compared with the same period in 2019 (Child Safeguarding Incident Notification System, 2021)⁸.

The NSPCC is calling on government to ensure that families with young babies get the mental health support they need.

Support our Fight for a Fair Start campaign

Resources to help

COVID-19 is having a serious impact on the wellbeing of children and on parents who may be struggling with additional pressures.

It’s important that people working with families with young babies know how to identify risks, support parents to safe-care and respond to any concerns. We’ve pulled together a list of resources and services to support you in your work.

Training to support parents with their baby’s crying

Our online training will help you provide advice and guidance to parents around keeping their babies safe and reducing the risk of non-accidental head injuries. The course is aimed at health visitors, midwives and children’s centre staff who will learn how to effectively implement the programme.

> Learn more about our Coping with Crying programme

Advice for parents on keeping their baby safe

This guide explains the dangers of rough handling, especially shaking, and provides tips to parents on safe ways to hold their baby, care for them and cope with crying. A list of services is included at the end for anyone that requires additional support.

> Share the Handle with Care guide with parents

Services for children and families

The NSPCC offers a variety of services to support parents who might be feeling the pressures of a new baby; want to improve their parenting skills or relationships with their child; or might be experiencing difficulties related to mental health or substance misuse.

> Browse our services

Head and spinal injuries in children

This leaflet explains how to identify whether a child has suffered from abusive head trauma, including what tests need to be performed and what types of spinal injuries are caused by child abuse.

> See the leaflet

The invisible voice of children under two

We recorded a podcast episode with social workers from the NSPCC to explore the vulnerabilities of infants and the importance of preventative intervention. Includes tools and techniques to help you improve your own practice.

> Listen to the episode

Learning from case reviews

Do you work closely with children aged two or under? This briefing highlights the importance of professionals working together to ensure the needs and experiences of very young children in vulnerable families are heard. It also summarises the risk factors involved and how practice can be improved.

> View the briefing

Forthcoming review of non-accidental injury (NAI)

England’s Child Safeguarding Practice Review Panel announced in January 2020 that their third national thematic review would focus on non-accidental injuries in children under one.

The review commenced in spring 2020, and is expected to be published later in 2021 (Child Safeguarding Practice Review Panel, 2020).