Assault is another fairly common traumatic cause of spinal cord in injury in children, leading most often to paraplegia (Costacurta et al. 2010). Common violent causes of SCI include but are not limited to gunshots, knifings, fights, war, and child abuse. Studies have found that violent etiologies, predominantly gunshots, account for a disproportionate share of SCIs in preteens and teens, as well as African American and Hispanic males (Apple et al. 1995; DeVivo & Vogel 2004). Firearm injuries are most commonly associated with thoracic spine injuries (Chu et al. 2016). Despite the low occurrence, dog attacks can cause SCI in children as well. In Kumar and colleagues (2017) study examining neurosurgical sequelae of domestic dog attacks in children, it was found that 1 out of 124 participants experienced SCI.

Child abuse is another unfortunate violent cause of SCI in the pediatric population. Infants and toddlers have been known to acquire cervical SCI as the result of physical abuse (Feldman et al. 2008). Children who are below 2 years of age, female, and non-white are more likely to sustain SCI caused by abuse; in addition, the thoracic and lumbar spine is at an increased risk of injury (Jauregui et al. 2019).

It should be noted that SCI etiology in the pediatric population can vary across different countries based on cultural and socioeconomic factors. For example, in some African countries where hunting is commonly practiced, SCI inflicted by hunting equipment such as bows and arrows may be more prevalent compared to that in Western society (van Adrichem et al. 2019). van Adrichem et al. (2019) reported a case in Tanzania, in which a teenage bird-hunter experienced an arrowhead wound to the neck, causing an incomplete and penetrating SCI, which resulted in paraplegia.

While tragic, violent, assault-based SCI in children may inevitably occur. It’s important to be aware of the trends in order to prevent and create systemic change to avoid the causes of violent SCI.