Materiały źródłowe

• #1 Pediatric Abusive Head Trauma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499836/

  Pediatric abusive head trauma (AHT), or shaken baby syndrome, most often involves shaking, blunt impact, or a combination of both in infants and young children, which can lead to neurological injury. […] The mechanism of abusive head trauma is shaking injuries that occur from repetitive rapid flexion, extension, and rotation of the head and neck. The rapid movement of the brain striking the skull can tear vessels resulting in bleeding around the brain and a hematoma. An enlarging hematoma may cause pressure within the skull, resulting in more brain damage. […] Abusive head trauma typically causes: cerebral edema, retinal hemorrhage, subdural hematoma. It is the primary cause of subdural hematoma in children. […] Infants and young child are more susceptible to head injuries than older children for many reasons: In proportion to the rest of the body, the head is larger, which means children land headfirst when they fall.

• #1 Shaken Baby Syndrome – AANS

  https://www.aans.org/patients/conditions-treatments/shaken-baby-syndrome/

  Shaken Baby Syndrome (also known as Shaken Impact Syndrome) is a serious form of abuse inflicted upon a child. […] Severe shaking causes the babys head to move violently back and forth, resulting in serious and sometimes fatal brain injury. […] Shaking, with or without the sudden deceleration of the head when it impacts a surface, can cause the following: Subdural hematoma, which is a collection of blood between the surface of the brain and the dura (the tough, fibrous outer membrane surrounding the brain.) This occurs when the veins that bridge from the brain to the dura are stretched beyond their elasticity, causing tears and bleeding. […] Subarachnoid hemorrhage, which is bleeding between the arachnoid (web-like membrane surrounding the brain filled with spinal fluid) and the brain.

• #1 Shaken baby syndrome – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/shaken-baby-syndrome/symptoms-causes/syc-20366619

  Shaken baby syndrome is a serious brain injury that results from forcefully shaking an infant or a toddler. […] Shaken baby syndrome can damage or destroy a child’s brain cells. This form of child abuse can cause permanent brain damage or death. […] Babies have weak neck muscles and can’t support the weight of their heads. If a baby is forcefully shaken, their brain moves back and forth inside the skull. This causes bruising, swelling and bleeding. […] Shaken baby syndrome usually occurs when a parent or caregiver severely shakes a baby or toddler due to frustration or anger. It often happens because the child won’t stop crying. […] Even brief shaking of an infant can cause brain damage that can’t be reversed. Many children affected by shaken baby syndrome die. […] Children who survive shaken baby syndrome may require lifelong medical care for conditions such as: Partial or total blindness, Delayed development, Troubles with learning and behavior, Seizures or epilepsy, Cerebral palsy, a disorder that affects movement and muscle coordination.

• #1 National Center on Shaken Baby Syndrome – Medical Consensus

  https://www.dontshake.org/learn-more/item/89-medical-consensus

  Abusive head trauma (AHT), which includes shaken baby syndrome, is a preventable and severe form of physical child abuse that results in an injury to the brain of an infant or child. AHT is most common in children under age five, with children under one year of age at most risk. It is caused by violent shaking or blunt impact. […] SBS is a type of inflicted, non-accidental or abusive head injury caused by shaking (either alone or combined with an impact). It mainly occurs in babies under the age of one. […] SBS, a form of non-accidental trauma, occurs when babies are shaken. This shaking damages the brain and eyes and can lead to lifelong consequences including death. […] An infants brain has a higher water content and less myelination than an adult brain and is more gelatinous and is easily compressed and distorted within the skull during a shaking episode. When shaken, the brain rotates relative to a more stationary skull, creating rotational and angular forces of the head. The lag time between the movement of the skull and the brain creates stress and tearing of blood vessels. The vessel injury leads to brain bleeding, or subdural hemorrhages.

• #1 Shaken Baby Syndrome: Retinal Hemorrhaging. A Biomechanical Approach to Understanding the Mechanism of Causation

  https://digitalcommons.odu.edu/mae_etds/134/

  Shaken Baby Syndrome (SBS) is a form of abuse where typically an infant, age six months or less, is held and shaken. […] Further, there is very little agreement on the actual mechanism of SBS. […] The physiology of infants makes injury due to SBS more likely. Infants have relatively large heads supported by weak necks that simply act as tethers. […] In addition, the cerebrospinal fluid (CSF) layer surrounding the infant’s brain is up to 10 mm thick as opposed to 12 mm in older children and adults. […] This thick layer reduces the resistance in rotation of the brain and can cause shearing injuries to the brain tissue. […] In addition, retinal hemorrhaging has been reported in SBS. […] This model shows promise in investigating the forces and kinematics of the infant eye exposed to harmonic shaking and further bolsters some of the few biomechanical studies investigating SBS.

• #1 Pediatric Abusive Head Trauma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499836/

  A shaken child is more susceptible to primary injuries, including contusion, hemorrhage, and skull fracture. Secondary injuries are biomolecular inflammatory changes causing the disintegration of neurons and interruptions in the brain’s microcirculation. […] The unmyelinated brain in an infant is more likely to experience shearing injuries. […] The skull is not fully developed and easily deformed. In trauma, it may compress brain tissue when impacted, causing coup rather than the contrecoup injuries more commonly seen in adults. […] Axons are more easily disrupted because of the shearing of long white matter tracts with acceleration-deceleration injuries resulting in cell death.

• #1 Inflicted head-injury by shaking-trauma in infants: the importance of spatiotemporal variations of the head’s rotation center | Scientific Reports

  https://www.nature.com/articles/s41598-023-42373-x

  Inflicted head injury by shaking trauma (IHI-ST) in infants is a type of abusive head trauma often simulated computationally to investigate causalities between violent shaking and injury. […] However, due to the flexibility of the infants neck and the external shaking motion imposed by the perpetrator it is unlikely that the rotation center is static. […] We further showed that implementation of a spatiotemporal-varying rotation center in an improved kinematic model resulted in strongly improved replication of shaking compared to existing methods. […] Hence, we stress that the validity of current infant shaking injury risk assessments and the injury thresholds on which these assessments are based, both often used in court cases, should be re-evaluated. […] The diagnosis of inflicted head injury by shaking trauma (IHI-ST) based on these symptoms is often debated, as these can also be caused by other events, such as traffic accidents or maternal, obstetric and neonatal factors.

• #1 Shaken Baby Syndrome – AANS

  https://www.aans.org/patients/conditions-treatments/shaken-baby-syndrome/

  Direct trauma to the brain substance itself, caused when the brain strikes the inner surfaces of the skull. […] Shearing off or breakage of nerve cell branches (axons) in the cortex and deeper structures of the brain caused by violent motion to the brain. […] Further irreversible damage to the brain substance from the lack of oxygen if the child stops breathing during shaking. […] Further damage to the brain cells when injured nerve cells release chemicals that add to oxygen deprivation to the brain. […] The prognosis for victims of shaken baby syndrome varies with the severity of injury but generally is poor. Many cases are fatal or lead to severe neurological deficits. Death is usually caused by uncontrollable increased intracranial pressure from cerebral edema, bleeding within the brain or tears in the brain tissue.

• #1 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Shaken-Baby-Syndrome.aspx

  The violent shaking causes brain cell destruction and the prevention of adequate oxygenation to the brain. […] The resulting hypoxia that ensues, as established by several studies, is the cause of the initial injury to the brain seen in SBS. […] Hypoxia is caused initially by difficulties with respiration. It leads to edema and a consequential increase in the intracranial pressure (ICP). […] A raised ICP then causes further neurological destruction due to ischemia, which arises as a result of a drop in the perfusion pressure in the brain. […] Babies with SBS are observed to have unique brainstem damage due to them having very poor muscle tone in the neck, which has to support a large head.

• #1 New Theory On 'Shaken Baby Syndrome’ : Shots – Health News : NPR

  https://www.npr.org/sections/health-shots/2011/07/02/137553701/autopsy-study-provides-new-theory-on-shaken-baby-syndrome

  Findings from a series of autopsies could alter the debate over the controversial diagnosis of shaken baby syndrome. […] A new study suggests that babies can die by violent shaking alone but not in the way doctors have previously thought. […] A team of researchers who conducted autopsies on 35 babies in Miami, Dallas and Calgary, Alberta, report that when children die after being violently shaken, they die of neck injuries and not from brain trauma. […] The researchers found that when babies are shaken, the nerve roots get injured and that knocks out the diaphragm. That leads to the brain injuries that are seen in children who are shaken but it’s original injury to those nerves in the neck that caused the death, not the brain injury, according to the new research. […] The new findings split a lot of the difference between the warring camps on shaken baby syndrome. For supporters, there’s evidence that shaking alone can lead to a baby’s death. But it also says skeptics were right to suggest it’s not the head injury that causes death and that shaking deaths are likely rare. […] It also explains why in SBS cases a fatal loss of vital functions may not be associated with the degree of traumatic brain damage that one would expect.

• #1 Azthena logo with the word Azthena

  https://www.news-medical.net/health/How-is-Shaken-Baby-Syndrome-Treated.aspx

  Shaken baby syndrome (SBS) is the consequence of an infant being violently shaken with resultant neurological damage. […] This damage causes a sequence of events in the brain, starting with hypoxia, which leads to cerebral edema and an increased intracranial pressure (ICP). The increase in ICP leads to ischemia and a decrease in the cerebral perfusion pressure, which has devastating consequences. […] Infants typically have retinal and subdural hemorrhages, which are pathognomonic for SBS. […] The morbidity and mortality associated with SBS are much worse than what are seen in accidental trauma. Up to as many as a third of affected infants die as a consequence of being shaken. SBS-associated morbidity is seen in approximately sixty percent of survivors. […] The degree of disability may be categorized as moderate to severe and include epilepsy, cerebral palsy, and blindness.

• #1 The „Shaken Baby” syndrome: pathology and mechanisms – PubMed

  https://pubmed.ncbi.nlm.nih.gov/21947257/

  The „Shaken Baby” syndrome (SBS) is the subject of intense controversy; the diagnosis has in the past depended on the triad of subdural haemorrhage (SDH), retinal haemorrhage and encephalopathy. […] While there is no doubt that infants do suffer abusive injury at the hands of their carers and that impact can cause catastrophic intracranial damage, research has repeatedly undermined the hypothesis that shaking per se can cause this triad. […] This review will focus on the pathology and mechanisms of the three physiologically associated findings which constitute the „triad” and are seen in infants suffering from a wide range of non-traumatic as well as traumatic conditions. […] The potential sources of SDH include: the bridging veins, small vessels within the dura itself, a granulating haemorrhagic membrane and ruptured intracranial aneurysm.

• #1 Robert Roberson and the controversy of shaken baby syndrome | The Texas Tribune

  https://www.texastribune.org/2024/10/17/robert-roberson-shaken-baby-controversy/

  Starting in the 1980s, shaken baby syndrome was commonly diagnosed when doctors detected whats known as the triad of symptoms unexplained bleeding on the brain, bleeding behind the retinas and brain swelling. […] Over time, a consensus emerged that shaking could be the only way this triad of symptoms could emerge. […] Since Roberson was convicted in 2002, a lot more science has emerged about the diagnosis of shaken baby syndrome. […] Starting around that time, research began to show that many of the same symptoms associated with shaken baby syndrome could also occur from short falls, as well as a wide range of naturally occurring medical conditions and accidental traumas. […] Guthkelch himself disavowed the way his hypothesis had been used and, before his death, became an outspoken advocate against the primacy of the shaken baby diagnosis.

• #1 Shaken baby syndrome Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/injury/shaken-baby-syndrome

  Shaken baby syndrome is a severe form of child abuse caused by violently shaking an infant or child. […] When an infant or toddler is shaken, the brain bounces back and forth against the skull. This can cause bruising of the brain (cerebral contusion), swelling, pressure, and bleeding in the brain. The large veins along the outside of the brain may tear, leading to further bleeding, swelling, and increased pressure. This can easily cause permanent brain damage or death. […] Most cases are due to an angry parent or caregiver shaking the baby to punish or quiet it. Such shaking most often takes place when the infant is crying inconsolably and the frustrated caregiver loses control. […] Injuries are most likely to happen when the baby is shaken and then the baby’s head hits something. Even hitting a soft object, such as a mattress or pillow, may be enough to injure newborns and small infants. […] Shaken baby syndrome does not result from gentle bouncing, playful swinging or tossing the child in the air, or jogging with the child.

• #1

  https://step2.medbullets.com/pediatrics/120614/shaken-baby-syndrome

  A form of child abuse resulting in cranial injury […] both the above is referred to as shaken baby syndrome […] absence of traumatic event in combination with these symptoms has high specificity for abusive head injury […] crescent shaped hemorrhage that crosses suture lines […] cannot cross tentorium […] midline shift due to mass effect.

• #1 Shaken baby syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Shaken_baby_syndrome

  Traumatic shaking occurs when a child is shaken in such a way that its head is flung backwards and forwards. This swift movement resulted in collision of brain to the skull, potentially tearing blood vessels and leading to bleeding around the brain, resulting in the formation of hematoma. As the hematoma enlarges, it can increase pressure within the skull, causing further injury to the brain. […] The mechanical basis for SBS comes from a combination of babies having weaker neck muscles and larger heads. For example, shaking the baby can lead to veins and nerves stretching and shearing due to the head extending beyond what the baby’s neck can support. Other types of injuries that can occur when shaking a baby, with or without the sudden deceleration of the head, are the following: Subdural hematoma, a collection of blood between the brain’s surface and the dura, due to overstretching of the veins connecting the brain to the dura, leading to tears and bleeding.

• #1 Recognition and management of Shaken Baby Syndrome – Irish Medical Journal

  https://imj.ie/recognition-and-management-of-shaken-baby-syndrome/

  Recent research has shown that whiplash shaking alone can lead to vitreo-retinal traction leading to retinal haemorrhage and rupture of the bridging veins which leads to subdural haemorrhage. […] The diagnosis of AHT should be considered if there is a combination of intracranial bleeding, retinal haemorrhage and long bone or rib fractures, macrocephaly/developmental delay, inconsistent history, or an acute life threatening event. […] In a study by Hettler et al, subdural hematomas were found in 88% of infants with AHT. […] Retinal haemorrhages occur in 70% of children with AHT from impact injuries, 84% from shaking only and 94% with those suffering impact and shake injuries. […] Traumatic retinoschisis is a particularly diagnostic lesion caused by traction applied to the retina by the vitreous jelly as the child is submitted to repetitive acceleration-deceleration forces. […] Most experts believe that AHT is largely preventable. The most common preceding incident is sustained crying. Exhausted parents and other caregivers may become frustrated and angry when infants in their care cry inconsolably.

• #1 National Center on Shaken Baby Syndrome – The etiology and significance of fractures in infants and young children: a critical multidisciplinary review

  https://www.dontshake.org/learn-more/item/111-the-etiology-and-significance-of-fractures-in-infants-and-young-children-a-critical-multidisciplinary-review

  The same kind of violent motion that happens in the brain during shaking also occurs in the eye. When a child is violently shaken, the eyeball and its contents move back and forth in many different directions within the eye socket. The forces produced during a shaking episode may cause the layers of the retina to slide across each other creating stretching and shearing of the retinal vessels resulting in hemorrhages. […] Other injuries that can occur as a result of shaking are cerebral edema (brain swelling), cerebral contusions (brain bruises), external head bruises, body bruises, skull fractures, rib fractures, long bone fractures, neck and spinal cord damage, or other injuries that cannot be explained through a medical condition or accidental trauma.

• #1 Shaken Baby Syndrome – EyeWiki

  https://eyewiki.org/Shaken_Baby_Syndrome

  Shaken Baby Syndrome (SBS) is one form of physical child abuse, a non-accidental traumatic (NAT) brain injury. […] Several mechanisms for the retinal hemorrhages in SBS have been postulated and recently been the subject of some debate (mostly in the courts). The actual cause of retinal hemorrhages is still being studied experimentally. One likely hypothesis implicates repetitive acceleration-deceleration forces which cause damage via vitreoretinal traction. […] Other possible mechanisms include blunt head impact, increased intracranial pressure, increased intrathoracic pressure, hypoxia, sodium imbalance, or coagulopathies. Vascular disruption may also lead to peripheral nonperfusion which subsequently may result in neovascularization, vitreous hemorrhage, and tractional or combined tractional / rhegmatogenous retinal detachment.

• #1

  https://link.springer.com/article/10.1007/s00247-018-4158-0

  Unequivocally, shaken baby syndrome is real. […] The findings of subdural hematoma, retinal hemorrhage and hypoxic-ischemic encephalopathy remain highly suggestive of shaken baby syndrome, particularly in the absence of evidence of an impact injury. […] It should be noted that the Swedish study in no way disproves the existence of shaken baby syndrome or abusive head trauma. Moreover, it fails to provide any coherent evidence base whatsoever for any alternative explanation for the combined findings of subdural hematoma, hypoxic-ischemic encephalopathy and retinal hemorrhage. […] All retinal hemorrhages are not the same. Innumerable bilateral, diffuse, multilayered retinal hemorrhages extending to the periphery are highly specific for child abuse. […] Biomedical simulations fail to account for complexity, variability and dynamicity of the infant head and neck.

• #1 The „Shaken Baby” syndrome: pathology and mechanisms – PubMed

  https://pubmed.ncbi.nlm.nih.gov/21947257/

  While retinal haemorrhage can be seen clinically, dural and subarachnoid optic nerve sheath haemorrhage is usually seen exclusively by the pathologist and only rarely described by the neuroradiologist. […] The term encephalopathy is used loosely in the context of SBS. […] The spectrum of brain pathology associated with retinal and subdural bleeding from a variety of causes is described. […] The most important cerebral pathology is swelling and hypoxic-ischaemic injury. […] Mechanical shearing injury is rare and contusions, the hallmark of adult traumatic brain damage, are vanishingly rare in infants under 1 year of age. […] Clefts and haemorrhages in the immediate subcortical white matter have been assumed to be due to trauma but factors specific to this age group offer other explanations. […] Finally, examples of the most common causes of the triad encountered in clinical diagnostic and forensic practice are briefly annotated.

• #1 Shaken Baby Syndrome: Magnetic Resonance Imaging Features in Abusive Head Trauma

  https://www.mdpi.com/2076-3425/11/2/179

  Shaken Baby Syndrome: Magnetic Resonance Imaging Features in Abusive Head Trauma […] In the context of child abuse spectrum, abusive head trauma (AHT) represents the leading cause of fatal head injuries in children less than 2 years of age. Immature brain is characterized by high water content, partially myelinated neurons, and prominent subarachnoid space, thus being susceptible of devastating damage as consequence of acceleration–deceleration and rotational forces developed by violent shaking mechanism. […] The mechanism of shaking is recognized as the leading mechanism of injury in AHT, with repeated forces in a whiplash-like manner applied on the infant’s chest or extremities causing shaking movements and subjecting the head to continuous accelerations and decelerations, as well as rotational forces. […] The characteristic clinical triad of AHT consists of subdural hematoma (SDH), retinal hemorrhage (RH), and hypoxic-ischemic encephalopathy, often in absence of further lesions detectable and without further possible explanations. […] Diagnosis is not straightforward, and it is based on a multidisciplinary approach with the involvement of several expert professionals in recognizing this kind of abuse. […] CT has a high sensitivity in investigating bone tissue, therefore it is decisive in identifying fracture rhymes (complex skull fractures are common following AHT), but it also detects ischemic areas, areas of cerebral edema, as well as the presence of blood collections. MRI is more sensitive than CT in the study of brain parenchyma and it is indicated in cases of suspected AHT with negative CT. […] The recent consensus statement identified an initial unenhanced CT with 3-D reformatted images of the calvarium, followed by a full multisequence MRI of the brain and spine as soon as feasible, as optimal imaging strategy for an acutely ill child with neurologic impairment. […] This paper is intended to review the main MRI findings in the central nervous system in infants and young children with AHT, focusing on shaking mechanism that causes both hemorrhagic and non-hemorrhagic injuries. […] Identifying AHT is challenging because in most cases there are no externally visible injuries and children present nonspecific symptoms. Violent shaking mechanism of the infant might lead to hemorrhagic phenomena, exposing its head to acceleration–deceleration and rotational forces and resulting in retinal and/or different patterns of extra-axial bleeding. […] The presence of retinal hemorrhage is considered pathognomonic for SBS and is generally associated with more severe neurological damage and a worse clinical outcome. […] Identifying AHT is challenging because in most cases there are no externally visible injuries and children present nonspecific symptoms. […] Parenchymal brain injury is the most significant cause of morbidity and mortality in AHT; it may be direct mechanical such as contusion, direct axonal injury, laceration, or parenchymal hematoma or indirect due to hypoxia and ischemia. […] MRI is more sensitive than CT in detecting early diffuse parenchymal injury related to AHT. […] Diffusion weighted imaging (DWI) is more effective than T2-weighted images to demonstrate the amount of cytotoxic edema in the unmyelinated brain of infants. […] The presence of spinal injury in AHT is an underestimated condition. […] Several anatomic factors predispose the neonatal and infantile spine to different types of injury in case of trauma such as shaking. […] One of the most frequent spinal findings in AHT is the presence of spinal SDH. […] Due to the specific anatomic features of the neonatal and infantile spine, which is characterized by high flexibility and cartilaginous joints, spinal fractures are extremely uncommon in AHT patients.

• #1 Patterns of presentation of the

  https://www.bmj.com/rapid-response/2011/10/30/patterns-presentation-shaken-baby-syndrome-may-not-be-caused-trauma-all

  Minns and Busottil (BMJ: 328, 27 March 2004: 766-767) summarised that patterns of presentation of the shaken baby syndrome can be delineated into four types: hyperacute encephalopathy; cervical-medullary syndrome; acute encephalopathy; subacute non-encephalopathy presentation; and chronic extracerebral presentation. […] They proposed that the generic term non-accidental head injury or inflicted traumatic brain injury should be used instead of shaken baby syndrome which implies a specific mechanism of injury. […] The pathological (MRI, X-rays and/or postmortem) findings include: CNS subdural (rarely subarachnoid) and retinal haemorrhages and detachments, together or separately, urethral bleeding, petechial bleeding into the brain, thymus, pericardium, duodenum and other organs, bleeding around the scalp hair follicles, rib separation at the costochondral junctions, bizarre fractures of long bones, scapula, clavicles and skull, typical of acute scurvy, swelling and herniation of the brain, bulging fontanelle, periorbital swelling.

• #1 Shaken Baby Syndrome (27.03.2009)

  https://di.aerzteblatt.de/int/archive/article/63967

  Shaken baby syndrome is a common manifestation of non-accidental head injury in infancy. The characteristic findings are diffuse encephalopathy and subdural and retinal hemorrhage in the absence of an adequate explanation. The correct diagnosis of shaken baby syndrome requires understanding of the underlying pathophysiology. A number of anatomical features make infants particularly vulnerable to acceleration-deceleration events with a marked rotatory component, which typically occur on shaking. The result is vigorous movements of the various intracranial compartments relative to one another, e.g., between the skull and dura on the one hand and the cerebral surface on the other, or between the white matter and the gray matter. Although many details remain unclear, the overwhelming majority of investigators agree that the resulting shear forces are responsible for subdural hemorrhages and diffuse brain damage. „Simple” shaking without impact suffices to produce the full picture of SBS with or without fatal outcome, but the energy resulting from an abrupt deceleration through impact is certainly higher and thus leads to more severe trauma. One important harmful factor is central apnea, triggered by a sudden marked extension of the medulla oblongata on shaking. Neuropathological investigation has revealed signs of corresponding focal damage in the lower brainstem. The shear forces that act on the immature brain during shaking result in traumatic diffuse axonal injury, which also participates in the development of cerebral edema. Forensic purposes, it is important that in SBS impairment of cerebral function, or symptoms, begin immediately after the shaking event. […] The explanation provided for the injuries is frequently inadequate or inconsistent. Some basic aspects of SBS, e.g., with regard to the biomechanics and the cause of death, have not been fully clarified.

• #1 Shaken baby syndrome: A South African medico-legal perspective

  http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1727-37812014000400004

  The triad, as described above, has for some years been the focus of intense scrutiny, with many voices suggesting that shaking alone cannot be sufficient to cause the injuries found in these cases. […] A 2002 biomechanical review determined that even a three foot fall produces forces up to ten times greater than shaking. […] The implication is that the triad may be caused by many other conditions, even natural diseases. […] A number of conditions and events can therefore cause the lesions found in the triad of injuries traditionally associated with SBS. […] Members of the scientific community are unable to give a unifying explanation for the presence of these lesions and are therefore also unable to state with absolute certainty that the presence of the triad of injuries is conclusive evidence of SBS.

• #1 Shaken Baby Syndrome, Abusive Head Trauma, and Actual Innocence: Getting it Right

  https://repository.law.umich.edu/articles/560/

  In the past decade, the existence of shaken baby syndrome (SBS) has been called into serious question by biomechanical studies, the medical and legal literature, and the media. […] Over the past decade, we have learned that this hypothesis fits poorly with the anatomy and physiology of the infant brain, that there are many natural and accidental causes for these findings, and that the onset of symptoms does not reliably indicate timing. […] Reliance on groups that endorse a particular hypothesis is, however, antithetical to evidence-based medicine and Daubert, which require an objective assessment of the scientific evidence. […] While we must do everything in our power to protect children, we must refrain from invoking abuse as a default diagnosis for medical findings that are complex, poorly understood, and have a wide range of causes, some doubtlessly yet unknown.

• #1 Inflicted head-injury by shaking-trauma in infants: the importance of spatiotemporal variations of the head’s rotation center | Scientific Reports

  https://www.nature.com/articles/s41598-023-42373-x

  Furthermore, there is no consensus yet about whether shaking alone can result in loading and deforming an infants anatomical structures beyond their failure thresholds and cause the abovementioned injuries. […] The center of rotation of an infants head in such FEM simulations is usually defined at a fixed point somewhere at the neck; e.g. the base of the skull, the C5-C6 junction or the base of the neck. […] Consequently, physical shaking and computational shaking simulation studies generally seem to disregard in their calculations and in applying measured kinematics to computational models that the instantaneous center of rotation (ICOR) of a childs head can be expected to fluctuate during shaking. […] The instantaneous radius of curvature (IROC) the distance between the heads center of gravity (COG) and its ICOR determines the nature of the relative motion between the skull and, e.g. the brain during motion, and hence the loads and deformations of the brain.

• #1 Patterns of presentation of the

  https://www.bmj.com/rapid-response/2011/10/30/patterns-presentation-shaken-baby-syndrome-may-not-be-caused-trauma-all

  Axonal degeneration in the CNS. […] Immunological derangements including lymphocytosis, leukocytosis, vasculitis and central diabetes insipidus. […] Haematotogical derangements including blood clotting derangements such as thrombocytopaenia, thrombocytosis, acquired von Willebrand syndrome (with low or high levels of vW and VIII factors), anaemia and haemolysis, to name just the most common ones. […] All of the above symptoms and pathological findings have been described in medical literature as caused by non-traumatic infectious and immunological events including those caused by the administration of a variety of vaccines.

• #1 Robert Roberson and the controversy of shaken baby syndrome | The Texas Tribune

  https://www.texastribune.org/2024/10/17/robert-roberson-shaken-baby-controversy/

  In 2009, the American Academy of Pediatrics widened the shaken baby syndrome term to abusive head trauma, and acknowledged that symptoms can be caused by incidents other than shaking, including short falls. […] Last year, a judge in New Jersey likened the shaken baby syndrome to junk science, and noted that no study has ever validated the hypothesis that shaking a child can cause the triad of symptoms associated with shaken baby syndrome. […] If called to testify today, the states experts would be confronted with twenty years of reputable scientific studies and publications that, if graphed, continually point away from their stated positions, the court ruled.

• #1 Child abuse: Evaluation and diagnosis of abusive head trauma in infants and children – UpToDate

  https://www.uptodate.com/contents/child-abuse-evaluation-and-diagnosis-of-abusive-head-trauma-in-infants-and-children/print

  Cranial injury may be inflicted by blunt force trauma, shaking, or a combination of these and other forces. The constellation of injuries associated with this mechanism has been referred to as „shaken baby syndrome” (SBS), „infant whiplash syndrome,” „shaken/impact syndrome,” or more simply as „inflicted or abusive head trauma” [5]. […] The significance of the diagnosis (with regards to morbidity, child protection, and criminal prosecution) may be similar, regardless of whether injury resulted from direct blows or from shaking [4]. In addition, much of the evidence to support the mechanism of injuries that result from shaking is retrospective and indirect (see „Child abuse: Epidemiology, mechanisms, and types of abusive head trauma in infants and children”, section on 'Mechanisms of injury’). For this reason, the term „abusive head injury” is preferred to „shaken baby syndrome” to permit consideration of multiple mechanisms of injury in any child. The generic term „head injury” also serves to distinguish the diagnosis of injury from the investigation of how the injury occurred [4,9,10].

• #1

  https://link.springer.com/article/10.1007/s00247-018-4158-0

  The diagnosis of abusive head trauma in children is not solely based on the findings of subdural hematoma, hypoxic-ischemic encephalopathy and retinal hemorrhage it never has been. The diagnosis of abusive head trauma is based on a thorough medical, forensic and social investigation that includes the exclusion of alternative diagnoses, underlying disease and accidental trauma. […] There is much that we don’t know about abusive head trauma. Further study on the pathophysiology is needed. Why do some infants have fatal head injury accompanied by characteristic fractures, others have fatal head injury and no fractures and yet others have characteristic fractures and seemingly no head injury? What is the pathophysiology of hypoxemic-ischemic encephalopathy?

• #1 Shaken Baby Syndrome Triad – Mark D. Freeman Esq.

  https://www.shakenbabydefense.com/science/hypothesis

  That subarachnoid and subdural hemorrhages should be appreciated as markers of brain displacement by angular force and the possibility of accompanying diffuse axonal injury, was the position taken by shaking hypothesis proponents. […] In other words, in the presence of subdural or subarachnoid hemorrhage (the marker), traumatic brain injury can be inferred without actual evidence of trauma to the brain (the presumption). […] By 2009, the American Academy of Pediatrics admitted that, despite the fact that medical and scientific advances have improved our understanding of the range of mechanisms that contribute to brain injury, controversy remains. […] There is no controversy that impact causes subdural hemorrhage and brain injury, the only controversy is whether shaking can. […] Since it is not controversial that impact causes subdural hemorrhage and brain injury, the shift in terminology away from shaken baby syndrome is a recognition of the controversy of the shaking mechanism in cases where there is minimal evidence of impact to the child.

• #1 Shaken Baby Syndrome (Abusive Head Trauma): Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/13779-shaken-baby-syndrome

  Shaken baby syndrome can cause severe medical issues, including: Subdural hematoma: A collection of blood between the surface of your childs brain and their dura (the tough outer membrane surrounding their brain). This can happen when the veins that bridge your childs brain to their dura are stretched too far, causing tears and bleeding. […] Children’s brains are softer and their ligaments are weaker. Their neck muscles arent fully developed yet. In addition, their heads are large and heavy in proportion to the rest of their bodies. The violent shaking tears the childs blood vessels, nerves and tissues, causing their brain to swell, bruise and bleed. […] Shaken baby syndrome is a very serious condition. The prognosis varies by the severity of your babys injuries but is generally poor. About 25% of babies will die due to their injuries. […] Up to 80% of those that survive will experience serious medical problems, severe neurological deficits and lifelong disabilities.

• #1

• #1 Shaken baby syndrome: pathogenetic mechanism, clinical features and preventive aspects – Minerva Pediatrica 2012 December;64(6):641-7 – Minerva Medica – Journals

  https://www.minervamedica.it/en/journals/minerva-pediatrics/article.php?cod=R15Y2012N06A0641

  The shaken baby syndrome (SBS) is an extremely serious form of child abuse and a leading cause of death and disability in childhood. […] The repetitive oscillations with rotational acceleration of the head can result in injuries of both vascular and neuronal structures. […] The most frequent injuries associated with SBS include encephalopathy, retinal hemorrhages, and subdural hemorrhage. […] Of infants who are victims of SBS, approximately 15% to 38% die and 30% are at risk of long-term neurologic sequelae, including cognitive and behavioural disturbances, motor and visual deficits, learning deficits and epilepsy.

• #1 Shaken baby syndrome can cause permanent brain damage, long-term disabilities or death – a pediatrician examines the preventable tragedy

  https://theconversation.com/shaken-baby-syndrome-can-cause-permanent-brain-damage-long-term-disabilities-or-death-a-pediatrician-examines-the-preventable-tragedy-243882

  Shaken baby syndrome is a condition that can injure babies and young children, and in some cases lead to death. […] A 2024 study on babies with shaken baby syndrome found that 20% to 25% of infants die, another 20% to 25% look normal on discharge from the hospital, and fully half are left with long-term disabilities. These include learning and behavioral problems that appear later in life. […] In the early 1970s, John Caffey, a pediatric radiologist, coined the term Whiplash Shaken Infant Syndrome. Caffey linked permanent brain damage and bleeding in the backs of the retina to violent shaking of infants. […] In these incidents, the infant is typically grabbed around the chest and shaken back and forth several times. Small blood vessels around the brain break and bleed, causing blood to flow around the brain. This condition is called a subdural hematoma. […] In the most severe forms of shaking, the tissue of the brain itself is injured, and the child may experience unconsciousness or even stop breathing. […] Bruising, fractures and retinal hemorrhages may support a diagnosis of child abuse, specifically shaken baby syndrome.

• #1 Shaken Baby Syndrome: Anger is dangerous | Psychlinks Forum — Archive Only (2004-2022)

  https://forum.psychlinks.ca/threads/shaken-baby-syndrome-anger-is-dangerous.547/

  SBS is the leading cause of death in child abuse cases in the United States. The syndrome results from injuries caused by someone vigorously shaking an infant, usually for 5 to 20 seconds, which causes brain damage. […] When someone forcefully shakes a baby, the child’s head rotates about uncontrollably because infants’ neck muscles are not well developed and provide little support for the head. The violent movement pitches the infant’s brain back and forth within the skull, rupturing blood vessels and nerves throughout the brain and tearing the brain tissue. The brain strikes the inside of the skull, causing bruising and bleeding to the brain. The damage is even greater when the shaking ends with an impact (hitting a wall or a crib mattress, for example), because the forces of acceleration and deceleration associated with an impact are so strong.

• #1 Shaken Baby Syndrome | Springhill Medical Center

  https://www.springhillmedicalcenter.com/services-treatments/birthing-suites-of-springhill/about-your-baby/shaken-baby-syndrome

  Shaken Baby Syndrome occurs when babies are shaken back and forth. Shaking causes bleeding and swelling in the brain. Parts of the brain may be injured or die. Severe damage from shaking is most common in very young babies. But, it can happen to children up to 3 years of age. […] Shaking a Baby Causes… Brain damage, Spinal Cord Paralysis, Blindness or Eye Injury, Seizures, Hearing Loss, Retardation, Slower Development, Trouble Learning in School, Broken Bones, Death (3 out of every 10 shaken babies die). […] If You Think Baby Has Been Shaken… Minutes Matter! Get baby to a doctor NOW! Quick action can save your baby’s life and limit brain damage.

• #1 Understanding Shaken Baby Syndrome

  https://www.medscape.com/viewarticle/478153

  Shaken baby syndrome (SBS) resulting in head injury is the leading cause of death and the most common cause of long-term disability and permanent damage in physically abused infants and children. […] The immediate and long-term outcomes of head injury caused by SBS are worse than head injuries from other causes. […] The National Center on Shaken Baby Syndrome reported that 500 SBS cases, either fatal or nonfatal, occurred in the U.S., the District of Columbia, Guam, Puerto Rico, Saipan, and the Virgin Islands from 1994-1998. […] Since cases with less serious injuries may not receive medical attention, or may go undetected, and no central SBS reporting registry is available, the actual incidence of SBS is unknown and likely underestimated. […] Test Findings Consistent with SBS include subdural hemorrhages, subarachnoid hemorrhages, cerebral contusions, cerebral edema, and subtle skull fractures. […] Possible Long-Term Consequences of SBS include permanent brain damage, visual impairments, developmental delays, disabilities and motor impairments, and seizures.

• #1 A Biomechanical Engineering Insight into Shaken Baby Syndrome

  https://explico.com/post/a-biomechanical-engineering-insight-into-shaken-baby-syndrome

  The Shaken Baby Syndrome (SBS) is a form of non-accidental brain injury in infants and has traditionally been thought to occur during violent shaking in the absence of head contact. […] Dr. Guthkelch hypothesized that these shaking events caused the brain to rotate within the skull, causing bleeding. […] It has been repeatably demonstrated in the biomechanical literature that these injuries occur traumatically as a result of excessive levels of rotational head acceleration. […] Thus, when an infant is presented with retinal hemorrhaging, subdural hemorrhaging, and encephalopathy, the biomechanical engineering literature is consistent with a scenario in which the infant was exposed to excessive rotational head acceleration. […] This is consistent with published biomechanical literature concluding that external head contact is necessary to cause the triad of closed head injuries typically associated with SBS. […] We concluded that the traditional triad of symptoms associated with infant shaking should be revised to include the presence of neck injury, and medical professionals should strive to determine the presence of any neck injury in cases involving suspected shaking.

• #1 Inflicted head-injury by shaking-trauma in infants: the importance of spatiotemporal variations of the head’s rotation center | Scientific Reports

  https://www.nature.com/articles/s41598-023-42373-x

  The moving-ICOR model outperformed all fixed-ICOR models in replicating the shaking kinematics. […] The assessment of the IHI-ST modeling accuracy of existing fixed-ICOR models and the proposed moving-ICOR model further underlined the importance of taking ICOR motion into account. […] The current study showed that the IROC varies from values much smaller to much larger than these commonly used fixed distances. […] Hence, it is expected that existing injury thresholds based on peak magnitudes have been overestimated in various studies and that tissue deformations simulated by computational models with the ICOR at the base of the skull, the C5-C6 junction or the base of the neck, have been underestimated. […] In general, it seems that the potentially harmful consequences of shaking an infant may have broadly been underestimated throughout IHI-ST experimental and computational studies due to neglecting the ICOR motion. […] A moving-ICOR model describing the head motion during shaking, such as provided by the present study, should be used for model-inputs in future IHI-ST simulation studies to improve their accuracy.

• #1 Shaken Baby Syndrome – Medico-Legal Approach of a Clinical Case

  https://www.heraldopenaccess.us/openaccess/shaken-baby-syndrome-medico-legal-approach-of-a-clinical-case

  Regarding the appearance of RH, the child had extensive and bilateral hemorrhage and pre-retinal hemorrhages, whose traumatic origin is highly suggestive, with a sensitivity of 75% and specificity of 93.2% for the diagnosis of child abuse. […] The infant brain is highly susceptible to serious injury due to several factors, including disproportionate size of the head, weak neck musculature, elasticity of the skull, presence of open sutures, large subarachnoid space, high brain water content and the fragility of the communicating veins involved in subdural and subarachnoid hemorrhages. […] Initial symptoms may be obscured by late seeking medical help, the most common are loss of or altered state of consciousness, vomiting, apnea and seizures. […] The suspicion of SBA requires a multidisciplinary, cautious and thorough approach, the conclusions of which must be scientifically based, given the consequences for all those involved in the scope of the Criminal Law Code.

• #2 Understanding Shaken Baby Syndrome

  https://www.medscape.com/viewarticle/478153

  Shaken baby syndrome (SBS) resulting in head injury is the leading cause of death and the most common cause of long-term disability and permanent damage in physically abused infants and children. […] The immediate and long-term outcomes of head injury caused by SBS are worse than head injuries from other causes. […] The National Center on Shaken Baby Syndrome reported that 500 SBS cases, either fatal or nonfatal, occurred in the U.S., the District of Columbia, Guam, Puerto Rico, Saipan, and the Virgin Islands from 1994-1998. […] Since cases with less serious injuries may not receive medical attention, or may go undetected, and no central SBS reporting registry is available, the actual incidence of SBS is unknown and likely underestimated. […] Test Findings Consistent with SBS include subdural hemorrhages, subarachnoid hemorrhages, cerebral contusions, cerebral edema, and subtle skull fractures. […] Possible Long-Term Consequences of SBS include permanent brain damage, visual impairments, developmental delays, disabilities and motor impairments, and seizures.

• #2 Shaken baby syndrome – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/shaken-baby-syndrome/symptoms-causes/syc-20366619

  Shaken baby syndrome is a serious brain injury that results from forcefully shaking an infant or a toddler. […] Shaken baby syndrome can damage or destroy a child’s brain cells. This form of child abuse can cause permanent brain damage or death. […] Babies have weak neck muscles and can’t support the weight of their heads. If a baby is forcefully shaken, their brain moves back and forth inside the skull. This causes bruising, swelling and bleeding. […] Shaken baby syndrome usually occurs when a parent or caregiver severely shakes a baby or toddler due to frustration or anger. It often happens because the child won’t stop crying. […] Even brief shaking of an infant can cause brain damage that can’t be reversed. Many children affected by shaken baby syndrome die. […] Children who survive shaken baby syndrome may require lifelong medical care for conditions such as: Partial or total blindness, Delayed development, Troubles with learning and behavior, Seizures or epilepsy, Cerebral palsy, a disorder that affects movement and muscle coordination.

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Shaken-Baby-Syndrome.aspx

  The violent shaking causes brain cell destruction and the prevention of adequate oxygenation to the brain. […] The resulting hypoxia that ensues, as established by several studies, is the cause of the initial injury to the brain seen in SBS. […] Hypoxia is caused initially by difficulties with respiration. It leads to edema and a consequential increase in the intracranial pressure (ICP). […] A raised ICP then causes further neurological destruction due to ischemia, which arises as a result of a drop in the perfusion pressure in the brain. […] Babies with SBS are observed to have unique brainstem damage due to them having very poor muscle tone in the neck, which has to support a large head.

• #2 Inflicted head-injury by shaking-trauma in infants: the importance of spatiotemporal variations of the head’s rotation center | Scientific Reports

  https://www.nature.com/articles/s41598-023-42373-x

  Furthermore, there is no consensus yet about whether shaking alone can result in loading and deforming an infants anatomical structures beyond their failure thresholds and cause the abovementioned injuries. […] The center of rotation of an infants head in such FEM simulations is usually defined at a fixed point somewhere at the neck; e.g. the base of the skull, the C5-C6 junction or the base of the neck. […] Consequently, physical shaking and computational shaking simulation studies generally seem to disregard in their calculations and in applying measured kinematics to computational models that the instantaneous center of rotation (ICOR) of a childs head can be expected to fluctuate during shaking. […] The instantaneous radius of curvature (IROC) the distance between the heads center of gravity (COG) and its ICOR determines the nature of the relative motion between the skull and, e.g. the brain during motion, and hence the loads and deformations of the brain.

• #2 Shaken Baby Syndrome (Abusive Head Trauma): Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/13779-shaken-baby-syndrome

  Shaken baby syndrome is a type of brain injury that occurs when a baby or toddler is shaken violently. This can cause swelling, bruising and bleeding in and around their brain. Shaken baby syndrome may damage a childs eyes, neck and spine as well. Another name for the condition is abusive head trauma. […] Shaking can cause bleeding in their brain or behind their eyes. […] Shaking a baby can cause bleeding between their brain and dura (subdural hematoma) and bleeding between their brain and arachnoid (subarachnoid hemorrhage). […] Shaken baby syndrome is a type of child abuse. It happens when someone violently shakes a baby or small child. […] The violent shaking tears the childs blood vessels, nerves and tissues, causing their brain to swell, bruise and bleed. […] Shaken baby syndrome most often happens at the hands of an overwhelmed and frustrated caregiver who cant cope with a babys inconsolable crying. The caregiver gets angry or stressed and loses control. Most times, the caregiver didnt mean to harm the baby, but its still a form of child abuse.

• #2 Pediatric Abusive Head Trauma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499836/

  A shaken child is more susceptible to primary injuries, including contusion, hemorrhage, and skull fracture. Secondary injuries are biomolecular inflammatory changes causing the disintegration of neurons and interruptions in the brain’s microcirculation. […] The unmyelinated brain in an infant is more likely to experience shearing injuries. […] The skull is not fully developed and easily deformed. In trauma, it may compress brain tissue when impacted, causing coup rather than the contrecoup injuries more commonly seen in adults. […] Axons are more easily disrupted because of the shearing of long white matter tracts with acceleration-deceleration injuries resulting in cell death.

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/health/How-is-Shaken-Baby-Syndrome-Treated.aspx

  Shaken baby syndrome (SBS) is the consequence of an infant being violently shaken with resultant neurological damage. […] This damage causes a sequence of events in the brain, starting with hypoxia, which leads to cerebral edema and an increased intracranial pressure (ICP). The increase in ICP leads to ischemia and a decrease in the cerebral perfusion pressure, which has devastating consequences. […] Infants typically have retinal and subdural hemorrhages, which are pathognomonic for SBS. […] The morbidity and mortality associated with SBS are much worse than what are seen in accidental trauma. Up to as many as a third of affected infants die as a consequence of being shaken. SBS-associated morbidity is seen in approximately sixty percent of survivors. […] The degree of disability may be categorized as moderate to severe and include epilepsy, cerebral palsy, and blindness.

• #2

  https://link.springer.com/article/10.1007/s00247-018-4158-0

  Unequivocally, shaken baby syndrome is real. […] The findings of subdural hematoma, retinal hemorrhage and hypoxic-ischemic encephalopathy remain highly suggestive of shaken baby syndrome, particularly in the absence of evidence of an impact injury. […] It should be noted that the Swedish study in no way disproves the existence of shaken baby syndrome or abusive head trauma. Moreover, it fails to provide any coherent evidence base whatsoever for any alternative explanation for the combined findings of subdural hematoma, hypoxic-ischemic encephalopathy and retinal hemorrhage. […] All retinal hemorrhages are not the same. Innumerable bilateral, diffuse, multilayered retinal hemorrhages extending to the periphery are highly specific for child abuse. […] Biomedical simulations fail to account for complexity, variability and dynamicity of the infant head and neck.

• #2 Shaken Baby Syndrome Triad – Mark D. Freeman Esq.

  https://www.shakenbabydefense.com/science/hypothesis

  Shaken baby syndrome (SBS) is the hypothesis proposed by medical doctors that an infant can be shaken hard enough to cause a bleed on the brain (a subdural hematoma or hemorrhage) without any external trauma or impact. […] Dr. John Caffey, often credited with discovering shaken baby syndrome, hypothesized that by shaking a child, special lacerating stresses are thus applied to the cerebral bridging veins at the fixed sites of their attachment to the walls of the sagittal sinuses causing subdural hemorrhage. […] Proponents further hypothesized that shaking caused immediate symptoms producing brain injury referred to as shearing injury or diffuse axonal injury. […] Thus the neuropathological triad of subdural and retinal haemorrhages and acute encephalopathy was termed the shaken baby syndrome (SBS).

• #2 Shaken Baby Syndrome (Abusive Head Trauma): Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/13779-shaken-baby-syndrome

  Shaken baby syndrome can cause severe medical issues, including: Subdural hematoma: A collection of blood between the surface of your childs brain and their dura (the tough outer membrane surrounding their brain). This can happen when the veins that bridge your childs brain to their dura are stretched too far, causing tears and bleeding. […] Children’s brains are softer and their ligaments are weaker. Their neck muscles arent fully developed yet. In addition, their heads are large and heavy in proportion to the rest of their bodies. The violent shaking tears the childs blood vessels, nerves and tissues, causing their brain to swell, bruise and bleed. […] Shaken baby syndrome is a very serious condition. The prognosis varies by the severity of your babys injuries but is generally poor. About 25% of babies will die due to their injuries. […] Up to 80% of those that survive will experience serious medical problems, severe neurological deficits and lifelong disabilities.

• #2 Shaken baby syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Shaken_baby_syndrome

  Traumatic shaking occurs when a child is shaken in such a way that its head is flung backwards and forwards. This swift movement resulted in collision of brain to the skull, potentially tearing blood vessels and leading to bleeding around the brain, resulting in the formation of hematoma. As the hematoma enlarges, it can increase pressure within the skull, causing further injury to the brain. […] The mechanical basis for SBS comes from a combination of babies having weaker neck muscles and larger heads. For example, shaking the baby can lead to veins and nerves stretching and shearing due to the head extending beyond what the baby’s neck can support. Other types of injuries that can occur when shaking a baby, with or without the sudden deceleration of the head, are the following: Subdural hematoma, a collection of blood between the brain’s surface and the dura, due to overstretching of the veins connecting the brain to the dura, leading to tears and bleeding.

• #2 Recognition and management of Shaken Baby Syndrome – Irish Medical Journal

  https://imj.ie/recognition-and-management-of-shaken-baby-syndrome/

  Recent research has shown that whiplash shaking alone can lead to vitreo-retinal traction leading to retinal haemorrhage and rupture of the bridging veins which leads to subdural haemorrhage. […] The diagnosis of AHT should be considered if there is a combination of intracranial bleeding, retinal haemorrhage and long bone or rib fractures, macrocephaly/developmental delay, inconsistent history, or an acute life threatening event. […] In a study by Hettler et al, subdural hematomas were found in 88% of infants with AHT. […] Retinal haemorrhages occur in 70% of children with AHT from impact injuries, 84% from shaking only and 94% with those suffering impact and shake injuries. […] Traumatic retinoschisis is a particularly diagnostic lesion caused by traction applied to the retina by the vitreous jelly as the child is submitted to repetitive acceleration-deceleration forces. […] Most experts believe that AHT is largely preventable. The most common preceding incident is sustained crying. Exhausted parents and other caregivers may become frustrated and angry when infants in their care cry inconsolably.

• #2

  https://link.springer.com/article/10.1007/s00401-011-0875-2

  The term encephalopathy is used loosely in the context of SBS. […] The most important cerebral pathology is swelling and hypoxicischaemic injury. […] Mechanical shearing injury is rare and contusions, the hallmark of adult traumatic brain damage, are vanishingly rare in infants under 1 year of age. […] Clefts and haemorrhages in the immediate subcortical white matter have been assumed to be due to trauma but factors specific to this age group offer other explanations. […] Finally, examples of the most common causes of the triad encountered in clinical diagnostic and forensic practice are briefly annotated.

• #2 A Biomechanical Engineering Insight into Shaken Baby Syndrome

  https://explico.com/post/a-biomechanical-engineering-insight-into-shaken-baby-syndrome

  The Shaken Baby Syndrome (SBS) is a form of non-accidental brain injury in infants and has traditionally been thought to occur during violent shaking in the absence of head contact. […] Dr. Guthkelch hypothesized that these shaking events caused the brain to rotate within the skull, causing bleeding. […] It has been repeatably demonstrated in the biomechanical literature that these injuries occur traumatically as a result of excessive levels of rotational head acceleration. […] Thus, when an infant is presented with retinal hemorrhaging, subdural hemorrhaging, and encephalopathy, the biomechanical engineering literature is consistent with a scenario in which the infant was exposed to excessive rotational head acceleration. […] This is consistent with published biomechanical literature concluding that external head contact is necessary to cause the triad of closed head injuries typically associated with SBS. […] We concluded that the traditional triad of symptoms associated with infant shaking should be revised to include the presence of neck injury, and medical professionals should strive to determine the presence of any neck injury in cases involving suspected shaking.

• #2 Shaken Baby Syndrome, Abusive Head Trauma, and Actual Innocence: Getting it Right

  https://repository.law.umich.edu/articles/560/

  In the past decade, the existence of shaken baby syndrome (SBS) has been called into serious question by biomechanical studies, the medical and legal literature, and the media. […] Over the past decade, we have learned that this hypothesis fits poorly with the anatomy and physiology of the infant brain, that there are many natural and accidental causes for these findings, and that the onset of symptoms does not reliably indicate timing. […] Reliance on groups that endorse a particular hypothesis is, however, antithetical to evidence-based medicine and Daubert, which require an objective assessment of the scientific evidence. […] While we must do everything in our power to protect children, we must refrain from invoking abuse as a default diagnosis for medical findings that are complex, poorly understood, and have a wide range of causes, some doubtlessly yet unknown.

• #2 Recognition and management of Shaken Baby Syndrome – Irish Medical Journal

  https://imj.ie/recognition-and-management-of-shaken-baby-syndrome/

  Abusive head trauma (previously referred to as Shaken Baby Syndrome) consists of a triad of findings which included subdural haemorrhage, retinal haemorrhages and encephalopathy after receiving a shake injury or blunt trauma to the head. […] Debate rages regarding the exact mechanism. […] The existence of AHT in infants and children is a settled scientific fact. The scientific support for AHT comes from over 40 years of research in a broad array of clinical and basic science disciplines. When an infant is subjected to rapid acceleration, deceleration and rotational forces, with or without impact, it results in a unique constellation of intracranial, intraocular and cervical spine injuries. […] Whether shaking alone can cause the severe intracranial injury associated with AHT is a topic of considerable debate, and a recent study concluded that blunt trauma was necessary to cause the intracranial injuries seen.

• #2 Shaken baby syndrome: A South African medico-legal perspective

  http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1727-37812014000400004

  The triad, as described above, has for some years been the focus of intense scrutiny, with many voices suggesting that shaking alone cannot be sufficient to cause the injuries found in these cases. […] A 2002 biomechanical review determined that even a three foot fall produces forces up to ten times greater than shaking. […] The implication is that the triad may be caused by many other conditions, even natural diseases. […] A number of conditions and events can therefore cause the lesions found in the triad of injuries traditionally associated with SBS. […] Members of the scientific community are unable to give a unifying explanation for the presence of these lesions and are therefore also unable to state with absolute certainty that the presence of the triad of injuries is conclusive evidence of SBS.

• #2 Inflicted head-injury by shaking-trauma in infants: the importance of spatiotemporal variations of the head’s rotation center | Scientific Reports

  https://www.nature.com/articles/s41598-023-42373-x

  The moving-ICOR model outperformed all fixed-ICOR models in replicating the shaking kinematics. […] The assessment of the IHI-ST modeling accuracy of existing fixed-ICOR models and the proposed moving-ICOR model further underlined the importance of taking ICOR motion into account. […] The current study showed that the IROC varies from values much smaller to much larger than these commonly used fixed distances. […] Hence, it is expected that existing injury thresholds based on peak magnitudes have been overestimated in various studies and that tissue deformations simulated by computational models with the ICOR at the base of the skull, the C5-C6 junction or the base of the neck, have been underestimated. […] In general, it seems that the potentially harmful consequences of shaking an infant may have broadly been underestimated throughout IHI-ST experimental and computational studies due to neglecting the ICOR motion. […] A moving-ICOR model describing the head motion during shaking, such as provided by the present study, should be used for model-inputs in future IHI-ST simulation studies to improve their accuracy.

• #2 Robert Roberson and the controversy of shaken baby syndrome | The Texas Tribune

  https://www.texastribune.org/2024/10/17/robert-roberson-shaken-baby-controversy/

  In 2009, the American Academy of Pediatrics widened the shaken baby syndrome term to abusive head trauma, and acknowledged that symptoms can be caused by incidents other than shaking, including short falls. […] Last year, a judge in New Jersey likened the shaken baby syndrome to junk science, and noted that no study has ever validated the hypothesis that shaking a child can cause the triad of symptoms associated with shaken baby syndrome. […] If called to testify today, the states experts would be confronted with twenty years of reputable scientific studies and publications that, if graphed, continually point away from their stated positions, the court ruled.

• #2 Rethinking Shaken Baby Syndrome : NPR

  https://www.npr.org/2011/06/29/137471992/rethinking-shaken-baby-syndrome

  Other scientists built on his research. Now shaken baby syndrome is diagnosed when doctors find unexplained bleeding on the brain and two other symptoms: bleeding behind the retinas and brain swelling. […] Too many medical experts see that triad of symptoms and conclude a child has been shaken without considering other possibilities, Guthkelch says. […] Some skeptics cite research by biomechanical engineers that says you can’t shake a baby with so much force that you cause internal head injuries but leave no external marks, bruises or injuries to the neck or spine. […] They say that violent shaking alone can cause a child’s death or severe brain damage with lifelong disabilities. […] Guthkelch says doctors need to be extra cautious when medicine reaches the courtroom. […] If you get the diagnosis of fatal shaken baby syndrome wrong, potentially someone’s life will be terminated. […] It’s time to get all sides together and try to agree on what can be said with scientific certainty about shaken baby syndrome.

• #2 Shaken baby syndrome can cause permanent brain damage, long-term disabilities or death – a pediatrician examines the preventable tragedy

  https://theconversation.com/shaken-baby-syndrome-can-cause-permanent-brain-damage-long-term-disabilities-or-death-a-pediatrician-examines-the-preventable-tragedy-243882

  Shaken baby syndrome is a condition that can injure babies and young children, and in some cases lead to death. […] A 2024 study on babies with shaken baby syndrome found that 20% to 25% of infants die, another 20% to 25% look normal on discharge from the hospital, and fully half are left with long-term disabilities. These include learning and behavioral problems that appear later in life. […] In the early 1970s, John Caffey, a pediatric radiologist, coined the term Whiplash Shaken Infant Syndrome. Caffey linked permanent brain damage and bleeding in the backs of the retina to violent shaking of infants. […] In these incidents, the infant is typically grabbed around the chest and shaken back and forth several times. Small blood vessels around the brain break and bleed, causing blood to flow around the brain. This condition is called a subdural hematoma. […] In the most severe forms of shaking, the tissue of the brain itself is injured, and the child may experience unconsciousness or even stop breathing. […] Bruising, fractures and retinal hemorrhages may support a diagnosis of child abuse, specifically shaken baby syndrome.

• #2

  https://www.aapos.org/glossary/shaken-baby-syndrome

  Shaken baby syndrome (SBS), also known as non-accidental trauma (NAT), is a diagnosis that may include a combination of findings including broken long bones such as arms or legs, skull fractures, brain bleeding and retinal hemorrhages. […] A baby’s head is disproportionately large and the blood vessels are fragile, which makes the brain and eyes more susceptible to bleeding from a shaking injury. […] Injuries from SBS can lead to permanent visual and developmental disabilities, or even death. […] Permanent damage to vision can also occur as a result of direct injury to the eye or the brain. Damage to the brain is the main reason for poor vision. […] Scarring of the retina or atrophy of the optic nerve may show up months after the injury and is usually irreversible. […] Brain injury may also lead to developmental delays, seizures, paralysis, and even death. Nearly a quarter of shaken infants can die from their injuries.

• #2 Shaken baby syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Shaken_baby_syndrome

  The consequences of SBS can be severe and long-lasting. They include learning disabilities, physical disabilities, visual impairment or blindness, and hearing impairments. Affected individuals may also experience speech disabilities, cerebral palsy, seizures, and behavior disorders. Cognitive impairments are common, and in the most severe cases, it can result in death.

• #2 Shaken baby syndrome: pathogenetic mechanism, clinical features and preventive aspects – Minerva Pediatrica 2012 December;64(6):641-7 – Minerva Medica – Journals

  https://www.minervamedica.it/en/journals/minerva-pediatrics/article.php?cod=R15Y2012N06A0641

  The shaken baby syndrome (SBS) is an extremely serious form of child abuse and a leading cause of death and disability in childhood. […] The repetitive oscillations with rotational acceleration of the head can result in injuries of both vascular and neuronal structures. […] The most frequent injuries associated with SBS include encephalopathy, retinal hemorrhages, and subdural hemorrhage. […] Of infants who are victims of SBS, approximately 15% to 38% die and 30% are at risk of long-term neurologic sequelae, including cognitive and behavioural disturbances, motor and visual deficits, learning deficits and epilepsy.

• #2 Shaken Baby Syndrome

  https://www.brainfacts.org/diseases-and-disorders/neurological-disorders-az/diseases-a-to-z-from-ninds/shaken-baby-syndrome

  Shaken baby syndrome is a type of inflicted traumatic brain injury that happens when a baby is violently shaken. Shaking makes the fragile brain bounce back and forth inside the skull and causes bruising, swelling, and bleeding, which can lead to permanent, severe brain damage or death. The characteristic injuries of shaken baby syndrome are subdural hemorrhages (bleeding in the brain), retinal hemorrhages (bleeding in the retina), damage to the spinal cord and neck, and fractures of the ribs and bones. […] In comparison with accidental traumatic brain injury in infants, shaken baby injuries have a much worse prognosis. Damage to the retina of the eye can cause blindness. […] The majority of infants who survive severe shaking will have some form of neurological or mental disability, such as cerebral palsy or cognitive impairment, which may not be fully apparent before 6 years of age.

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Shaken-Baby-Syndrome.aspx

  Shaken baby syndrome (SBS), also commonly referred to as abusive head trauma, or less commonly as shaken impact syndrome, is the leading cause of grave neurological injury or death in physically abused children. SBS is the end result of violently shaking infants. […] The forces generated create injuries that possess very specific features due to the unique anatomy of infants, whose heads are larger and heavier in proportion to the rest of their bodies. […] In order for abusive head trauma to occur, an infant must receive forces to the head that are either rotational or translational. […] Forces are characterized as rotational if they turn the brain on its central axis during the shaking event. […] Infants with SBS will have tearing and stretching of bridging veins in the brain due to its subdural space movement.

• #2 National Center on Shaken Baby Syndrome – The etiology and significance of fractures in infants and young children: a critical multidisciplinary review

  https://www.dontshake.org/learn-more/item/111-the-etiology-and-significance-of-fractures-in-infants-and-young-children-a-critical-multidisciplinary-review

  The same kind of violent motion that happens in the brain during shaking also occurs in the eye. When a child is violently shaken, the eyeball and its contents move back and forth in many different directions within the eye socket. The forces produced during a shaking episode may cause the layers of the retina to slide across each other creating stretching and shearing of the retinal vessels resulting in hemorrhages. […] Other injuries that can occur as a result of shaking are cerebral edema (brain swelling), cerebral contusions (brain bruises), external head bruises, body bruises, skull fractures, rib fractures, long bone fractures, neck and spinal cord damage, or other injuries that cannot be explained through a medical condition or accidental trauma.

• #2 Shaken Baby Syndrome Defense | Seattle Lawyers

  https://www.marshallandsaunders.com/abusive-head-trauma-and-related-allegations-defense

  The most peculiar shaken baby allegations are those in which the child has suffered no other injury. […] If a childs head strikes a hard surface, the brain will have what experts call rapid deceleration. […] If a baby were shaken as proponents of shaken baby syndrome hypothesize, the babys head would move in whiplash fashion, creating great rotational forces on the head. […] Physicians who question shaken baby syndrome have identified several conditions that call mimics. […] False allegations of child abuse are a problem in all forms of child abuse. […] The risk posed by a false allegation of shaking a baby or causing abusive head trauma is especially severe. […] Fortunately, there are some physicians who do not accept the theories of child abuse physicians that certain injuries can only result from violent physical child abuse.

Zobacz więcej