BMJ  2004;328:719-720 (27 March), doi:10.1136/bmj.328.7442.719

Editorial

The evidence base for shaken baby syndrome

We need to question the diagnostic criteria

The first 150 words of the full text of this article appear below.

The phrase "shaken baby syndrome" evokes a powerful image of abuse, in which a carer shakes a child sufficiently hard to produce whiplash forces that result in subdural and retinal bleeding. The theory of shaken baby syndrome rests on core assumptions: shaking is always intentional and violent; the injury an infant receives from shaking is invariably severe; and subdural and retinal bleeding is the result of criminal abuse, unless proved otherwise.¹ These beliefs are reinforced by an interpretation of the literature by medical experts, which may on occasion be instrumental in a carer being convicted or children being removed from their parents. But what is the evidence for the theory of shaken baby syndrome?

Retinal haemorrhage is one of the criteria used, and many doctors consider retinal haemorrhage with specific characteristics pathognomonic of shaking. However, in this issue Patrick Lantz et al examine that premise (p 754) and . . . [Full text of this article]

London (j.f.geddes@doctors.org.uk)

Regina Medical Center, 1175 Nininger Road, Hastings, MN 55033, USA

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This article has been cited by other articles:

• Hymel, K. P., Makoroff, K. L., Laskey, A. L., Conaway, M. R., Blackman, J. A. (2007). Mechanisms, Clinical Presentations, Injuries, and Outcomes From Inflicted Versus Noninflicted Head Trauma During Infancy: Results of a Prospective, Multicentered, Comparative Study. Pediatrics 119: 922-929 [Abstract] [Full text]  
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• Le Fanu, J. (2005). Wrongful diagnosis of child abuse--a master theory. JRSM 98: 249-254 [Full text]  
• Spivack, B. (2004). Distinguishing Abusive from Accidental Head Trauma. AAP Grand Rounds 12: 47-47 [Full text]  
• Donohoe, M. (2004). The evidence base for shaken baby syndrome: Meaning of signature must be made explicit. BMJ 329: 741-741 [Full text]  
• Reece, R. M (2004). The evidence base for shaken baby syndrome: Response to editorial from 106 doctors. BMJ 328: 1316-1317 [Full text]  
• LeFanu, J., Edwards-Brown, R. (2004). Patterns of presentation of the shaken baby syndrome: Subdural and retinal haemorrhages are not necessarily signs of abuse. BMJ 328: 767-767 [Full text]  

Rapid Responses:

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