The evidence base for shaken baby syndromeBMJ 2004; 328 doi: http://dx.doi.org/10.1136/bmj.328.7442.719 (Published 25 March 2004) Cite this as: BMJ 2004;328:719
- J F Geddes, retired (formerly reader in clinical neuropathology, Queen Mary, University of London) ([email protected]),
- J Plunkett
- Regina Medical Center, 1175 Nininger Road, Hastings, MN 55033, USA
We need to question the diagnostic criteria
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 conclude that it “cannot be supported by objective scientific evidence.”2 Their study comes hard on the heels of a recently published review of the literature on shaken baby syndrome from 1966 to 1998, in which Mark Donohoe found the scientific evidence to support a diagnosis of …
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