shaken baby syndrome

Shaken baby syndrome is a term that has been applied to cases in which brain hemorrhage (subdural hematoma) and bleeding within the eyes (retinal hemorrhages) have been found in suspected cases of child abuse. The mechanism of these injuries was believed to be violent shaking of the child's shoulders so that the head whipped back and forth with enough force to cause tearing of blood vessels between the brain and its covering (dura mater); subsequent bleeding in the space between the dura and the brain causes increased pressure within the skull, which in turn caused bleeding from the tiny blood vessels that lie on the surface of the retina. The finding of retinal hemorrhages alone has led to charges of child abuse based on suspected shaken baby syndrome.

This concept has been called into question by forensic pathologists, many of whom question whether the syndrome as originally formulated actually exists. They base this conclusion on several points. They believe that pure shaking alone cannot generate sufficient force to cause the observed injuries without also damaging the cervical spinal cord, but cervical cord injuries are not found at autopsy. They also report finding evidence of blunt trauma to the head (fine skull fractures missed with plain x-rays or CT scans) in many if not all such suspected cases, trauma that would cause both the subdural hematomas and the retinal hemorrhages. That is, the child was abused, but shaking alone did not cause the retinal hemorrhages. Next, there are other explanations for retinal hemorrhages, including resuscitation efforts. And finally, retinal hemorrhages reported to be present by the examinations of pediatricians and even ophthalmologists are actually only present about half the time at autopsy.

So "shaken baby syndrome" may not be a real entity as formerly thought. This does not mean at all that children are not abused by beatings, and does not mean that retinal hemorrhages are not found in such cases. It does call into question the concept of basing prosecution of suspected child abuse solely on a finding of retinal hemorrhages.

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