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Shaken baby syndrome

BMJ 2004; 328 doi: (Published 25 March 2004) Cite this as: BMJ 2004;328:720
  1. Brian Harding, consultant neuropathologist,
  2. R Anthony Risdon, consultant paediatric pathologist,
  3. Henry F Krous, director of pathology
  1. Great Ormond Street Hospital for Children, London WC1N 3JH
  2. Great Ormond Street Hospital for Children, London WC1N 3JH
  3. Children's Hospital San Diego, San Diego, CA 92123, USA

    Pathological diagnosis rests on the combined triad, not on individual injuries

    Shaken baby syndrome is a form of physical non-accidental injury to infants, characterised by acute encephalopathy with subdural and retinal haemorrhages, occurring in a context of inappropriate or inconsistent history and commonly accompanied by other apparently inflicted injuries.1 2 Injuries to the neck and spinal cord may also be present. Controversy surrounds the precise causation of the brain injury, the retinal and subdural haemorrhages, as well as the degree of force required and whether impact in addition to whiplash forces is needed.1 3 4 Although most discussion has concerned fatal injuries of this nature, not all are lethal, but they may be associated with subsequent neurological disability of varying severity.

    Expert medical evidence about inflicted injury must have scientific validity, but applying the evidence based criteria appropriate to clinical practice entails some difficulties.5 In clinical practice medical management of defined clinical problems can be compared and best practice distinguished by clinical outcomes. Conversely, in inflicted paediatric injuries, one is presented with the outcome, investigation follows rather than precedes that outcome, and the history may be incomplete or deliberately misleading. A need exists for …

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