Inertial Neck Injuries in Children Involved in Frontal Collisions

Prange, Michael; Newberry, William; Moore, Tara; Peterson, Daniel L.; Smyth, Brian; Corrigan, Catherine

doi:10.4271/2007-01-1170

Cited by 8 publications

(1 citation statement)

References 32 publications

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“…Biomechanical computer modeling has also concluded that a child's neck would break at forces lower than those required to produce the intracranial injuries associated with SBS [3,35]. Cadaveric studies have quantified the mechanical properties and strength of the human infant neck [17,31,34], supporting the supposition that structural neck failure would result from even the accelerations reported during shaking of the Aprica 3.4 [28].…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Evaluation of Head Kinematics During Infant Shaking Versus Pediatric Activities of Daily Living.

N¹

2011

Journal of Forensic Biomechanics

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Abusive shaking of infants has been asserted as a primary cause of subdural bleeding, cerebral edema/brain swelling, and retinal hemorrhages. Manual shaking of biofidelic mannequins, however, has failed to generate the rotational accelerations believed necessary to cause these intracranial symptoms in the human infant. This study examines the apparent contradiction between the accepted model and reported biomechanical results. Researchers collected linear and angular motion data from an infant anthropomorphic test device during shaking and during various activities of daily life, as well as from a 7-monthold boy at play in a commercial jumping toy. Results were compared among the experimental conditions and against accepted injury thresholds. Rotational accelerations during shaking of a biofidelic mannequin were consistent with previous published studies and also statistically indistinguishable from the accelerations endured by a normal 7-month-old boy at play. The rotational accelerations during non-contact shaking appear to be tolerated by normal infants, even when repetitive.

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Section: Introductionmentioning

confidence: 99%

Biomechanical Evaluation of Head Kinematics During Infant Shaking Versus Pediatric Activities of Daily Living.

N¹

2011

Journal of Forensic Biomechanics

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Shaken Baby Syndrome

Squier

2009

Wiley Encyclopedia of Forensic Science

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Recent pathological, clinical, and biomechanical evidence questions the validity of the shaken baby syndrome (SBS), usually diagnosed by finding the triad of retinal hemorrhage, encephalopathy, and subdural hemorrhage (SDH) in infants. Retinal hemorrhages have many other causes and are more common after the occurrence of natural disease and accidents than inflicted injury. Encephalopathy results from hypoxic‐ischemic injury rather than traumatic axonal injury. Trauma is a common cause of infant SDH, but there are other causes and a quarter of normal births are associated with SDH on magnetic resonance imaging (MRI) scan. SDH is usually a thin bilateral film, and its source is traditionally ascribed to torn bridging veins. This is unproven and rarely documented. The dura is an alternative source; bleeding into the dura is common in asphyxiated infants. SDH evolves into a reactive membrane containing thin‐walled capillaries. Recurrent bleeding into these membranes is seen on microscopy. Some SDH evolves into chronic fluid collections, the causes for which are unknown. Biomechanical studies have failed to show that shaking can cause SDH. The forces generated by shaking are far less than those resulting from impact, including low‐level falls. The importance of considering the birth and early clinical history when examining a case of suspected abuse in emphasized.

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Retino‐Dural Hemorrhage of Infancy

Squier

2013

Wiley Encyclopedia of Forensic Science

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The term shaken baby syndrome (SBS), defined by the triad of retinal hemorrhage (RH), encephalopathy, and subdural hemorrhage (SDH), despite being widely accepted for 40 years, can no longer be regarded as a valid diagnosis. Multiple lines of evidence, from biomechanics to advances in understanding the anatomy and pathophysiology of the developing infant brain and its coverings, have undermined the diagnosis, and the nomenclature has been revised to reflect this. It is important to shift the focus to the objective pathological findings in babies with these closely interrelated phenomena rather than speculating on mechanisms; the term retino‐dural haemorrhage of infancy more accurately characterizes this syndrome. RHs have many causes and are more common after natural disease and accidents than after inflicted injury. Encephalopathy results from hypoxic‐ischemic injury rather than from traumatic axonal injury. Trauma is a cause of infant SDH, but there are many natural causes; almost half of normal newborns have SDH identified on brain scan. Infant SDH is usually a thin bilateral film, its source traditionally ascribed to torn bridging veins, but this remains unproved and is rarely documented. The dura is an alternative source; the infant dura is richly vascularized and innervated and bleeding into it is common. SDH evolves into a reactive membrane containing thin‐walled capillaries. Recurrent bleeding into these membranes is seen on microscopy. In some cases, SDH evolves into a chronic fluid collection; the causes for this are unknown. Biomechanical studies have shown that the forces generated by shaking are far less than those resulting from impact, but it remains correct to advise parents that babies should never be shaken. This article examines the pathology of each of these signs and their pathophysiology. The importance of considering the birth, early clinical history, and predisposing vulnerabilities when examining a case of suspected abuse is emphasized.

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Inertial Neck Injuries in Children Involved in Frontal Collisions

Cited by 8 publications

References 32 publications

Biomechanical Evaluation of Head Kinematics During Infant Shaking Versus Pediatric Activities of Daily Living.

Biomechanical Evaluation of Head Kinematics During Infant Shaking Versus Pediatric Activities of Daily Living.

Shaken Baby Syndrome

Retino‐Dural Hemorrhage of Infancy

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