False Assumptions about
Shaken Baby Syndrome

It is estimated that there were nearly 1,500 reported cases of Shaken Baby Syndrome last year alone. But, even more astonishing is that the number of cases appears to be growing at an alarming rate. Are there really more children who suffer abuse by violent shaking or are there underlying illnesses or other possible explanations for the infant's injuries and/or death?

Currently, there are 5 major controversies in the field of Nonaccidental Trauma to Children. These controversies surround 5 major assumptions offered by the sworn testimony of state medical experts.

Assumption #1: It is shaking alone, of an otherwise healthy child, that causes retinal hemorrhages and subdural hematomas.

Controversy: Biomechanical research and human case material does not unequivocally support the theory that shaking alone can cause these symptoms but that short falls cannot.

Assumption #2: Short distance falls do not kill infants or children.

Controversy: Medical research and case studies indicate that some children can and do die from short falls.

Assumption #3: Chronic subdural hematomas do not rebleed spontaneously or with lesser trauma or no trauma at all.

Controversy: It is undisputed in adult literature that subdurals can rebleed within the healing course, and there are no reasons to think that children's brains would act differently. Plus, medical literature and case studies going back 60+ years have documented the same processes in pediatric subdural hematoma with or without known abuse.

Assumption #4: A child suffering from an ultimately fatal head injury cannot experience a lucid interval between the inception of the subdural and his or her respiratory arrest.

Controversy: It is undisputed that adults can experience "lucid" intervals after an intracranial hemorrhage and there is NO data to support a conclusion that children's brains are different. Medical literature and case studies have documented numerous instances of lucid intervals in fatal childhood head injury cases.

Assumption #5: Retinal hemorrhages only occur in cases of "Shaken Baby Syndrome" or nonaccidental trauma.

Controversy: Retinal hemorrhage can be found in a myriad of different scenarios (child birth, CPR, coagulation disorders, etc.) and cannot be pathologically interpreted or dated with any accuracy. At one time, retinal hemorrhages were a sign of possible chronic subdurals in children (Matson, Neurosurgery of Infancy and Childhood).

In order to answer the questions regarding how to properly diagnose accidental and nonaccidental trauma in children, and how to accurately prosecute the correct perpetrator in child abuse cases, more research needs to be done on the following areas:

· The biomechanics of short falls and other accidental injuries
· The pathology and diagnostic quality of retinal hemorrhages
· The timing and dating of retinal hemorrhages
· The amount of force required to cause a subdural hematoma
· The etiology and clinical course of a chronic subdural hematoma
· The timing and dating of subdural hematomas
· The amount of force required to cause a subdural hematoma to rebleed
· The underlying conditions that might increase a child's vulnerability to a fatal head injury or a rebleed.
· Other conditions that can mimic Shaken Baby Syndrome