Intended for healthcare professionals


The evidence base for shaken baby syndrome

BMJ 2004; 328 doi: (Published 27 May 2004) Cite this as: BMJ 2004;328:1316

Response to editorial from 106 doctors

  1. Robert M Reece, clinical professor of paediatrics (
  1. PO Box 523, 122 Hawk Pine Road, Norwich, VT 05055, USA

    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.25 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.

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    Retinal haemorrhages

    Geddes and Plunkett then consider retinal haemorrhages. Lantz et al, in the same issue, question the specificity of perimacular folds in abusive head trauma in infancy.6 They conclude from a literature review that there was no support for the contention that perimacular folds are pathognomonic for abusive head injury. Geddes and Plunkett applied these authors' conclusions not only to perimacular folds but also to retinal haemorrhages.

    Although research on the subject of inflicted childhood neurotrauma—over 600 peer reviewed articles—does not claim that retinal haemorrhages are pathognomonic for …

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