Letters

Authors' reply

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6994.1600c (Published 17 June 1995) Cite this as: BMJ 1995;310:1600
  1. Helen Carty,
  2. Jane Ratcliffe
  1. Consultant radiologist Consultant in paediatric intensive care Alder Hey Children's Hospital, Liverpool L12 2AP

    EDITOR,—We wish to respond first to Stephen Leadbetter and colleagues. Our editorial was written to highlight the dangers of shaking and not to enter into a review of the literature on the role of shaking versus impact in causing the often fatal and frequently devastating brain injury suffered by these infants. We are familiar with the work of Duhaime et al and the model of trauma due to impact that they describe,1 but work in primates suggests that shaking with rotation is the critical factor.2 3 We do not dispute that impact trauma is a factor in many cases. Perpetrators who have admitted shaking do not necessarily describe impact injuries. In such circumstances, we consider it unlikely that they would withhold information about impact. This is both our personal experience and well documented.4 5 The comments about lack of precision in citing references are inaccurate.

    We support Alison M Kemp and Jo Sibert's statement about dealing with minor episodes of abuse to prevent more serious injuries. In 15 shaken infants who required management in the intensive care unit in our hospital over four years (of whom seven died), 10 had associated injuries typical of abuse. In all 15 infants, however, the admission to the intensive care unit was the first occasion when concerns about the family had been recognised.

    We also agree that a publicity campaign about the dangers of shaking is only one aspect of preventing these appalling injuries. The educational leaflet published by the National Society for the Prevention of Cruelty to Children and the Department of Health, Handle with Care, is a starting point for educating parents and other carers. This leaflet can be used by midwives and health visitors as a basis for individual work with parents, particularly targeting those considered to be most at risk.

    We stated that shaking a baby is dangerous, and this is recognised by paediatricians. The purpose of the editorial and the campaign by the National Society for the Prevention of Cruelty to Children was to alert carers to the dangers of shaking infants and to offer help and support in dealing with stressful situations engendered by an infant's incessant crying. The hope is that, if carers are alerted when they are not stressed, they will refrain from inflicting injury during stress.

    References

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