The evidence base for shaken baby syndrome

Response to editorial from 106 doctors

EDITOR—In challenging the diagnosis of shaken baby syndrome in their recent editorial Geddes and Plunkett make a number of serious errors in interpreting the research on this issue, and they display a worrisome and persistent bias against the diagnosis of child abuse in general.1

In their opening sentence Geddes and Plunkett describe shaking a child to “produce whiplash forces that result in subdural and retinal bleeding,” omitting the most important element in this condition: brain injury itself. They elaborate that the “theory” of shaken baby syndrome rests on some core assumptions, including that “the injury an infant receives from shaking is invariably severe.”

This is in conflict with the research of Alexander et al, Ewing-Cobbs et al, Kemp et al, and Jenny et al, who found that 30%-40% of newly diagnosed shaken baby cases had medical evidence of previously undiagnosed head injury.2^–5 These infants had such mild or non-specific symptoms and signs that their trauma was previously not diagnosed. The diagnosis was ultimately made when the children had subsequent severe episodes of abuse, with computer tomographic evidence of both acute and older subdural haematomata and brain injuries.