Shaken Baby Syndrome

Abstract

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.

Non‐Sexual Abuse in Children

“…Although the classic features of child abuse have already been described by Ambroise Tardieu (1818-1879), a French forensic pathologist, in 1860, the modern recognition of the syndrome dates back less than five decades (Kempe et al 1962;Knight 1986). Since then many excellent monographs and a huge extent of literature (clinical, experimental, legal, psychological) have been published (Helfer and Kempe 1968;Trube-Becker 1982;Hobbs et al 1993a;Kleinman 1998;Montelecone and Brodeur 1998;AAP 2000;Wynne 2003;Saukko and Knight 2004;Stierling and AAP Committee on Child Abuse and Neglect 2007;Jacobi 2008;Reece and Christian 2008;Smarty 2009;Squier 2009;Byard 2010;Madea et al 2011). Programmes to protect children have been developed, although national approaches differ widely as well as the legal backgrounds.…”