Shaken Baby Syndrome: An Odyssey

Abstract

Shaken baby syndrome is evaluated in the context of its historical evolution and its veracity in referring to causal injury mechanisms. A rational assessment of the injury causation and consequent pathological states associated with the syndrome is presented. It is now evident that shaken baby syndrome evolved as a result of a faulty application of scientific reasoning and a lack of appreciation of mechanisms of injury. A brief explanation of the commonly understood usage and interface of scientific methodology and reasoning as applied to clinical medicine is given.

Child abuse and neglect

“…Rebleeding into an old subdural hemorrhage has been cited as a possible explanation for apparent abusive head trauma (72). The old hemorrhage could be the result of prior abuse or a noninflicted injury, including birth trauma (73,74).…”

The Shaken Baby Syndrome: An Odyssey -II Origins and Further Hypotheses-

“…In earlier work, 30) the chronic subdural hematoma seen in infants supposedly injured by manual shaking was addressed as an already known pathologic entity having its inception weeks or months before presentation, possibly as early as parturition. A chance observation was made of a 3-day-old infant Gorilla gorilla, holding its head erect and aware of its surroundings.…”

The Case for Shaking

“…Shortly thereafter Caffey 2,3 suggested the term whiplash shaken infant syndrome to describe infants with abusive subdural and retinal hemorrhages but without external evidence of physical trauma. [7][8][9][10] The logical conclusion is that abusive head trauma cannot be alleged in the absence of physical signs of external injury from impact, leading to widely disparate expert medical opinion in individual court cases about whether or not abuse has occurred. Intracranial injuries include acute and/or chronic SDH, axonal injury (AI), gliding contusions, cortical tears, and intracerebral edema.…”