Evidence for shaken baby syndrome is uncertain

March 25, 2004

The concept that certain eye injuries are diagnostic of shaken baby syndrome is scientifically questionable and needs to be re-examined, argue researchers in this week's BMJ.

Shaken baby syndrome is a term used to describe the consequences of the forceful shaking of infants. It is usually recognised by a triad of injuries - bleeding into the eye and around the brain (subdural and retinal haemorrhages) and brain damage.

Patrick Lantz and colleagues report the case of a healthy 14 month old child who was brought to hospital with a severe head injury after a television fell on him at home.

Despite the father's repeated, detailed, and consistent account of the incident, Child Protective Services removed the child's 3 year old brother from the home because the injuries, particularly those in the retina of the eye (known as perimacular retinal folds), were considered diagnostic of abusive head trauma from shaking.

The authors searched the medical literature on the eye injury observed in this case that has been considered specific for child abuse. They found that the ocular criteria used by some doctors to diagnose shaken baby syndrome "are not supported by objective scientific evidence" when taken out of context.

Their findings are remarkably similar to another recently published review of the literature from 1966 to 1998, which identified "serious data gaps" in the scientific evidence to support a diagnosis of shaken baby syndrome.

In an accompanying editorial, experts stress the need to reconsider the diagnostic criteria, if not the existence, of shaken baby syndrome. A second editorial argues that no one detail can be diagnostic, as the diagnosis of shaken baby syndrome should rest on a careful evaluation of all the features of the injury.

There are clearly many uncertainties relating to shaken baby syndrome, and the scientific evidence to support a diagnosis may be less reliable than generally thought. These issues are argued in the two editorials.
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BMJ

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