Shaken baby syndrome: the quest for evidence

Abstract

Shaken baby syndrome (SBS), characterized by the triad of subdural haemorrhage, retinal haemorrhage, and encephalopathy, was initially based on the hypothesis that shaking causes tearing of bridging veins and bilateral subdural bleeding. It remains controversial. New evidence since SBS was first defined three decades ago needs to be reviewed. Neuropathology shows that most cases do not have traumatic axonal injury, but hypoxic–ischaemic injury and brain swelling. This may allow a lucid interval, which traumatic axonal injury will not. Further, the thin subdural haemorrhages in SBS are unlike the thick unilateral space‐occupying clots of trauma. They may not originate from traumatic rupture of bridging veins but from vessels injured by hypoxia and haemodynamic disturbances, as originally proposed by Cushing in 1905. Biomechanical studies have repeatedly failed to show that shaking alone can generate the triad in the absence of significant neck injury. Impact is needed and, indeed, seems to be the cause of the majority of cases of so‐called SBS. Birth‐related subdural bleeds are much more frequent than previously thought and their potential to cause chronic subdural collections and mimic SBS remains to be established.

Comparison of accidental and nonaccidental traumatic brain injuries in infants and toddlers: demographics, neurosurgical interventions, and outcomes

“…2 This reported mechanism of injury has been questioned and has undergone scientific review and experimentation using models/ dummies, animals, and cadavers. 7,12,22,23 Based on the results of these studies, it has been difficult to prove that shaking is sufficient to produce SDH. 22 As a result of this, together with the fact that the terminology describing this type of injury continues to evolve, we have concluded that it is important to avoid terminology that assumes mechanism.…”

Ocular pathology in shaken baby syndrome and other forms of infantile non-accidental head injury

“…SBS can be considered as a common part in the broader spectrum labeled "non-accidental head injury" (NAHI), encompassing further, albeit rarer, forms of inflicted infantile neurotrauma (shaken-impact syndrome, pure blunt head trauma, crush injury, etc.). For the pathologist asked to give written or oral expertise in court, more than a basic knowledge and understanding of the entire spectrum is absolutely mandatory-even if the scientific basis of this condition is only poorly understood [111]. The present review aims at summarizing the present knowledge and most recent scientific data of ocular pathology in SBS and other forms of NAHI for the specific scope of the forensic practitioner.…”

The Relationship between “Protection of” and “Violence Against” Infants and Young Children: The U.S. Experience, 1940–2005

“…The finding of the triad of subdural hematoma, retinal hemorrhage, and encephalopathy had gained acceptance as being "evidence" indicative of intentional infant injury; commonly referred to as the "shaken baby syndrome" [21]. However, the reliability and validity of using the clinical and pathological triad associated with the shaken baby syndrome to definitively indicate intentional injury has been challenged [22][23][24][25][26].…”