The evidence base for shaken baby syndrome

doi:10.1136/bmj.328.7442.719

BMJ 2004;328:719-720 (27 March), doi:10.1136/bmj.328.7442.719

Editorial

The evidence base for shaken baby syndrome

We need to question the diagnostic criteria

The first 150 words of the full text of this article appear below.

The phrase "shaken baby syndrome" evokes a powerful image ofabuse, in which a carer shakes a child sufficiently hard toproduce whiplash forces that result in subdural and retinalbleeding. The theory of shaken baby syndrome rests on core assumptions:shaking is always intentional and violent; the injury an infantreceives from shaking is invariably severe; and subdural andretinal bleeding is the result of criminal abuse, unless provedotherwise.¹ These beliefs are reinforced by an interpretationof the literature by medical experts, which may on occasionbe instrumental in a carer being convicted or children beingremoved from their parents. But what is the evidence for thetheory of shaken baby syndrome?

Retinal haemorrhage is one of the criteria used, and many doctorsconsider retinal haemorrhage with specific characteristics pathognomonicof shaking. However, in this issue Patrick Lantz et al examinethat premise (p 754) and . . . [Full text of this article]

J F Geddes, retired (formerly reader in clinical neuropathology, Queen Mary, University of London)

London (j.f.geddes@doctors.org.uk)

J Plunkett, forensic pathologist

Regina Medical Center, 1175 Nininger Road, Hastings, MN 55033, USA

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

Technorati What's this?

This article has been cited by other articles:

Hymel, K. P., Makoroff, K. L., Laskey, A. L., Conaway, M. R., Blackman, J. A. (2007). Mechanisms, Clinical Presentations, Injuries, and Outcomes From Inflicted Versus Noninflicted Head Trauma During Infancy: Results of a Prospective, Multicentered, Comparative Study. Pediatrics 119: 922-929 [Abstract] [Full text]
Le Fanu, J (2006). Shaken baby syndrome.. Arch. Dis. Child. 91: 715-715 [Full text]
Brookman, F., Nolan, J. (2006). The Dark Figure of Infanticide in England and Wales: Complexities of Diagnosis. J Interpers Violence 21: 869-889 [Abstract]
Le Fanu, J. (2005). Wrongful diagnosis of child abuse--a master theory. JRSM 98: 249-254 [Full text]
Spivack, B. (2004). Distinguishing Abusive from Accidental Head Trauma. AAP Grand Rounds 12: 47-47 [Full text]
Donohoe, M. (2004). The evidence base for shaken baby syndrome: Meaning of signature must be made explicit. BMJ 329: 741-741 [Full text]
Reece, R. M (2004). The evidence base for shaken baby syndrome: Response to editorial from 106 doctors. BMJ 328: 1316-1317 [Full text]
LeFanu, J., Edwards-Brown, R. (2004). Patterns of presentation of the shaken baby syndrome: Subdural and retinal haemorrhages are not necessarily signs of abuse. BMJ 328: 767-767 [Full text]

Rapid Responses:

Read all Rapid Responses

will anyone listen now?: s m latta
bmj.com, 26 Mar 2004 [Full text]
The Problem As I See It: John A Vater
bmj.com, 27 Mar 2004 [Full text]
It is about time: Lois Herlihy
bmj.com, 27 Mar 2004 [Full text]
There is a Light at the End of the Tunnel: Belinda A Moran
bmj.com, 28 Mar 2004 [Full text]
Re: The Problem As I See It: CA Johnson
bmj.com, 28 Mar 2004 [Full text]
Re: It is about time: Debbie A. Grater
bmj.com, 29 Mar 2004 [Full text]
Optimal evaluation of suspicious head injury in infants and young children: terence g donald
bmj.com, 29 Mar 2004 [Full text]
another facet of the nanny state exposed: Chris Destree
bmj.com, 29 Mar 2004 [Full text]
SBS Persecution: Lisa M Mullenax
bmj.com, 1 Apr 2004 [Full text]
Re: Optimal evaluation of suspicious head injury in infants and young children: Heather Lohr
bmj.com, 1 Apr 2004 [Full text]
The evidence base for shaken baby syndrome: C. Alan B. Clemetson, M.D., et al.
bmj.com, 6 Apr 2004 [Full text]
Shaken baby syndrome or another diagnosis?: Anne Marie Oudesluys-Murphy, et al.
bmj.com, 7 Apr 2004 [Full text]
Retinal haemorrhages remain an important physical sign in the diagnosis of non accidental injury: Michael P clarke, et al.
bmj.com, 11 Apr 2004 [Full text]
Retinal haemorrhages and SBS. Fact or Fantasy?: Michael D Innis
bmj.com, 13 Apr 2004 [Full text]
Re: Retinal haemorrhages remain an important physical sign in CONJECTURING the diagnosis of non accidental injury: L. Travis Haws
bmj.com, 13 Apr 2004 [Full text]
The Editorials on shaken baby syndrome, BMJ 27th March 2004: Jeanne E Bell, et al.
bmj.com, 19 Apr 2004 [Full text]
Potential problems with autopsy based studies.: Hilary Butler
bmj.com, 22 Apr 2004 [Full text]
Re: The Editorials on shaken baby syndrome, BMJ 27th March 2004: Michael Innis
bmj.com, 20 Apr 2004 [Full text]
Refuting established medical beliefs also requires evidence: Timothy Jaspan, et al.
bmj.com, 20 Apr 2004 [Full text]
Re: Refuting established medical beliefs also requires evidence: Heather Lohr
bmj.com, 22 Apr 2004 [Full text]
Re: Re: Refuting established medical beliefs also requires evidence: Michael D Innis
bmj.com, 23 Apr 2004 [Full text]
Re: The appliance of science?: Michael P Mackey, et al.
bmj.com, 24 Apr 2004 [Full text]
Subdural Haemorrhage/Effusion � are low velocity falls or other minor impacts to the head a factor in the aetiology?: Chris J Hobbs, et al.
bmj.com, 7 Aug 2004 [Full text]
Re: Refuting established medical beliefs also requires evidence: Michael D Innis
bmj.com, 27 Apr 2004 [Full text]
Re: Refuting established medical beliefs also requires evidence: Mark Struthers
bmj.com, 28 Apr 2004 [Full text]
Re: Refuting established medical beliefs also requires evidence--seeing the vast amounts of evidence requires glasses on an open mind: L. Travis Haws
bmj.com, 23 May 2004 [Full text]
"Shaken Baby", or Barlow's Disease Variant?: C. Alan B. Clemetson, M.D., et al.
bmj.com, 19 Jun 2004 [Full text]
Clemetson Syndrome: F. Edward Yazbak
bmj.com, 23 Jun 2004 [Full text]
Re: "Shaken Baby", or Barlow's Disease Variant?: abram hoffer
bmj.com, 24 Jun 2004 [Full text]
Patience instead of Anger and Condemnation: Dr. Herbert H. Nehrlich
bmj.com, 25 Jun 2004 [Full text]
K comes after C and H in SBS: F. Edward Yazbak
bmj.com, 25 Jun 2004 [Full text]
Clemetson's work: Keith B Taylor
bmj.com, 5 Jul 2004 [Full text]
Re: Clemetson's work: Michael D Innis
bmj.com, 6 Jul 2004 [Full text]
Re: Clemetson's work: Theo H Fenton
bmj.com, 6 Jul 2004 [Full text]
Re: Re: Clemetson's work: Hilary Butler
bmj.com, 7 Jul 2004 [Full text]
Re: Re: Clemetson's work: Heather Lohr
bmj.com, 7 Jul 2004 [Full text]
Re: Re: Clemetson's work: C. Alan B. Clemetson, M.D.
bmj.com, 7 Jul 2004 [Full text]
Re: Re: Clemetson's work: Michael D Innis
bmj.com, 7 Jul 2004 [Full text]
Please tell me that was a joke: L. Travis Haws
bmj.com, 7 Jul 2004 [Full text]
Re: Re: Re: Clemetson's work: Ed Cooper
bmj.com, 8 Jul 2004 [Full text]
Re: Re: Re: Clemetson's work: Michael D Innis
bmj.com, 14 Sep 2004 [Full text]
Re:Re:Re:Re: Clemetson's Work: C. Alan B. Clemetson, M.D.
bmj.com, 9 Jul 2004 [Full text]
Clemetson's work is not at the end of a mouse.: Hilary Butler
bmj.com, 9 Jul 2004 [Full text]
Re: Re: Re: Re: Clemetson's work: Michael D Innis
bmj.com, 9 Jul 2004 [Full text]
Re: Re:Re:Re:Re: Clemetson's Work: Ed Cooper
bmj.com, 14 Jul 2004 [Full text]
Ed Cooper's response: John Stone
bmj.com, 16 Jul 2004 [Full text]
Re: Subdural Haemorrhage/Effusion - misdignosed: Michael D Innis
bmj.com, 9 Aug 2004 [Full text]
Re: Subdural Haemorrhage/Effusion � are low velocity falls or other minor impacts to the head a factor in the aetiology?: L. Travis Haws
bmj.com, 14 Sep 2004 [Full text]
�Shaken baby� conviction overturned. The case of Alan Yurko: Mark Struthers
bmj.com, 7 Sep 2004 [Full text]
Re: �Shaken baby� conviction overturned. The case of Alan Yurko: Andrew L. Schlafly
bmj.com, 8 Sep 2004 [Full text]
Re: Re: �Shaken baby� conviction overturned. The case of Alan Yurko: Heather Lohr
bmj.com, 9 Sep 2004 [Full text]
The case of Alan Yurko - A clarification: Anthony R Cox
bmj.com, 16 Sep 2004 [Full text]
Re: The case of Alan Yurko - A clarification: Mark Struthers
bmj.com, 17 Sep 2004 [Full text]
Toxic histaminaemia: C. Alan B. Clemetson, M.D.
bmj.com, 28 Sep 2004 [Full text]
the current evidence base - make believe?: Heather Lohr
bmj.com, 12 Oct 2004 [Full text]
Re: the current evidence base - make believe?: L. Travis Haws
bmj.com, 13 Oct 2004 [Full text]
A sacrificial lamb on the vaccination altar?: Jenny L Robertson
bmj.com, 13 Oct 2004 [Full text]
Re: A sacrificial lamb on the vaccination altar?: Michael D Innis
bmj.com, 14 Oct 2004 [Full text]
Subdural haematomas in infants: C. Alan B. Clemetson, M.D.
bmj.com, 22 Oct 2004 [Full text]
Errors in the diagnosis of child abuse: C. Alan B. Clemetson, M.D.
bmj.com, 21 Dec 2004 [Full text]
Re: Errors in the diagnosis of child abuse: Michael D Innis
bmj.com, 10 Dec 2004 [Full text]
Has any progress been made?: Heather Lohr
bmj.com, 31 Mar 2005 [Full text]
Re: Has any progress been made?: Michael D Innis
bmj.com, 1 Apr 2005 [Full text]