Miller and Miller have noted the overrepresentation of males in
presumed shaken baby syndrome and its possible relationship to head
size. [1] Lines [2] has reported on the larger head size of the Maori in a
high school age group (European 55.2 cm, Maori 55.6) and Anderson
[3] in 0-2 year old non-breast fed children (European mean head
circumference 43.3 percentile, Maori 48.6). Anderson did show a higher
mean in a smaller number of breast fed European children but the
combined figures support the larger size in the Maori (European 47.4,
Maori 48.9). I have reviewed medical records concerning two Maori
children suspected to have been abused. In each case, these children
had unusually large heads (each exceeding the 97th percentile). That this
would occur by chance is less than 3% for each case. Since these are
independent events, the chance they would both occur is the product
of the two or 3% times 3% - less than one in a thousand. Both also
had evidence of increased cerebrospinal fluid spaces. This condition,
known by many different names, my preference being craniocerebral
disproportion, was noted by Piatt [4] to present a possible "pitfall" in
the diagnosis of child abuse and more recently confirmed by Vinchon
[5] to be associated with the spontaneous occurrence of subdural and
retinal hemorrhage, a combination considered highly suspicious for
abuse. Alvarez [6] has noted this condition to be "closely related to
benign familial macrocephaly", a finding confirmed by Karamzadeh [7],
who reported a non-abusive subdural in one of his 20 cases. Kelly [8]
has reported a higher incidence of child abuse in the Maori population,
noting that "racial susceptibility to accidental SDH" (nature) has been
suggested but labeling 2 articles by neurosurgeons "dubious" and
preferring cultural factors (nurture). Kelly grouped the new Zealand population into Maori and Non-Maori and based his incidence on the
group of the victim and not of the presumed perpetrator. In one of the
cases reviewed, the presumed perpetrator was non-Maori, so neither
genetic or cultural factors would apply. Are we perhaps attributing to
nurture (abuse) what is actually nature (familial macrocephaly)?
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