Shaken baby syndrome is a term often used by physicians and the public to describe abusive head trauma inflicted on infants and young children. Although the term is well known and has been used for a number of decades, advances in the understanding of the mechanisms and clinical spectrum of injury associated with abusive head trauma compel us to modify our terminology to keep pace with our understanding of pathologic mechanisms. Although shaking an infant has the potential to cause neurologic injury, blunt impact or a combination of shaking and blunt impact cause injury as well. Spinal cord injury and secondary hypoxic ischemic injury can contribute to poor outcomes of victims.
The use of broad medical terminology that is inclusive of all mechanisms of injury, including shaking, is required. The American Academy of Pediatrics recommends that pediatricians develop skills in the recognition of signs and symptoms of abusive head injury, including those caused by both shaking and blunt impact, consult with pediatric subspecialists when necessary, and embrace a less mechanistic term, abusive head trauma, when describing an inflicted injury to the head and its contents.
http://pediatrics.aappublications.org/content/123/5/1409.abstract
an interesting study on abusive head trauma and the male to female ratio of perps
http://pediatrics.aappublications.org/content/127/4/649.abstract
II. FROM SBS TO AHT: A DIAGNOSIS IN FLUX
Our increased understanding of the infant brain and the
biomechanics of injury is reflected in an evolving terminology that
acknowledges the flaws in the original SBS hypothesis.19 Despite
widespread acknowledgement of these flaws, the new terminology,
AHT retains the automatic diagnosis of abuse for the medical
findings previously attributed to shaking and rests on the same
assumptions as SBS, many of which have been discredited or
disproven.20 After clarifying the terminology, we discuss the shifts in
the literature that resulted in the new terminology. We then identify
the areas of current agreement and debate.
A. A Plethora of Terms
In addressing the changes in the SBS/AHT hypothesis, it is
important to distinguish between five terms and diagnoses:
shaking, shaken baby syndrome, shaken impact syndrome,
abusive head trauma, and blunt force trauma. Much of the
disagreement in this area reflects the confusion of these terms and
conflation of the underlying concepts.
1. Shaking.
Shaking refers to the physical act of shaking a child,
irrespective of injury. Shaking to punish or in frustration is always
inappropriate. In infants with large heads and weak necksor even
in older childrenviolent shaking may lead to disastrous
consequences, particularly in a child with predisposing factors.
2. Shaken baby syndrome.
Shaken baby syndrome (SBS) refers to the hypothesis that
violent shaking may be reliably diagnosed based on the triad of
subdural hemorrhage, retinal hemorrhage, and encephalopathy
(brain damage) if the caretakers do not describe a major trauma
(typically described as equivalent to a motor vehicle accident or fall
from a multistory building) and no alternative medical explanation is
identified. Under this hypothesis, the rapid acceleration and
deceleration of shaking causes movement of the brain within the
skull, resulting in the traumatic rupture of bridging veins, retinal
blood vessels, and nerve fibers throughout the brain (diffuse axonal
injury). This hypothesis came into question when biomechanical
studies consistently concluded that shaking generated far less force
than impact, did not meet established injury thresholds, and would
be expected to injure the neck before causing bridging vein rupture
or diffuse axonal injury.
3. Shaken impact syndrome.
Shaken impact syndrome was advanced to address the
biomechanical criticisms of shaking as a causal mechanism for the
triad. Under this hypothesis, subdural hemorrhage, retinal
hemorrhage, and encephalopathy were attributed to shaking
followed by impact, such as tossing or slamming the child onto a
hard or soft surface. If there were no bruises or other signs of impact,
it was hypothesized that the child was thrown onto a soft surface,
such as a mattress or pillow.
4. Abusive head trauma.
As shaking came under increasing scrutiny, a plethora of new
terms arose that did not invoke shaking as a mechanism.21 At
present, the most popular replacement termand the term used by
Dr. Narangis abusive head trauma, or AHT. AHT refers to any
deliberately inflicted injury to the head, regardless of mechanism. In
2009, the American Academy of Pediatrics recommended that
pediatricians use this term instead of SBS but endorsed shaking as a
plausible mechanism based on confession evidence.22 AHT also
includes hitting the child on the head, crushing the child, throwing
the child onto a hard or soft surface, or any other conceivable manner
of harming the head. Under the AHT hypothesis, such acts may be
inferred from the triad of findings previously attributed to shaking,
with or without other evidence of trauma, at least in the absence of
another acceptable explanation. Used in this sense, AHT is most
often used by pediatricians.
http://www.law.uh.edu/hjhlp/Issues/Vol_122/Barnes.pdf
the above is a very interesting and comprehensive article from the legal perspective. Recommended reading
