Shaken Baby (Shaken Impact) Syndrome: Non-Accidental Head Injury in Infancy

Citation:

David, TJ: Shaken baby (shaken impact) syndrome: non-accidental head injury in infants. Journal of the Royal Society of Medicine 92:556-61, November 1999.

Notes:

• Belief that shaking is a form of trauma that causes subdural hematoma has led to the name shaken baby syndrome.
• There is no clear definition of what does or does not constitute SBS.
• If intracranial pressure rises above arterial pressure, the brain is no longer perfused.
• Cerebral edema may result from hypoxia, or direct damage to the medulla may lead to respiratory arrest and hypoxia.
• With conventional techniques, diffuse axonal injury may not be detectable until 15 hours after injury. With beta amyloid precursor protein immunostaining, it can be detected within 2-3 hours of injury. BAPP staining means DAI is not present or that the injury was less than 3 hours before death.
• "There is no proof of the shaking hypothesis." In favor of it are confessions. However, suspected perpetrators may confess under durress when a shaking has not occurred.
• Shaking should not be mentioned as a possible mechanism of injury during investigations.
• The strongest indicators of a violent abusive shaking are finger or hand bruising of the chest or arms.