The shaken baby syndrome

A clinical, pathological, and biomechanical study

Ann-Christine Duhaime Division of Neurosurgery and Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania

Search for other papers by Ann-Christine Duhaime in
Current site
Google Scholar
PubMed Close
 M.D.
,
Thomas A. Gennarelli Division of Neurosurgery and Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania

Search for other papers by Thomas A. Gennarelli in
Current site
Google Scholar
PubMed Close
 M.D.
,
Lawrence E. Thibault Division of Neurosurgery and Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania

Search for other papers by Lawrence E. Thibault in
Current site
Google Scholar
PubMed Close
 Sc.D.
,
Derek A. Bruce Division of Neurosurgery and Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania

Search for other papers by Derek A. Bruce in
Current site
Google Scholar
PubMed Close
 M.D.
,
Susan S. Margulies Division of Neurosurgery and Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania

Search for other papers by Susan S. Margulies in
Current site
Google Scholar
PubMed Close
 M.S.E.
, and
Randall Wiser Division of Neurosurgery and Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania

Search for other papers by Randall Wiser in
Current site
Google Scholar
PubMed Close
 M.S.E.
Page Range:
409–415
Volume/Issue:
Volume 66: Issue 3
DOI link:
https://doi.org/10.3171/jns.1987.66.3.0409
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $525.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $624.00
Click here for subscription options

  • Purchase Now

    USD  $45.00

  • JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

    USD  $525.00

  • JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

    USD  $624.00
USD  $45.00
USD  $525.00
USD  $624.00
Print or Print + Online Sign in

✓ Because a history of shaking is often lacking in the so-called “shaken baby syndrome,” diagnosis is usually based on a constellation of clinical and radiographic findings. Forty-eight cases of infants and young children with this diagnosis seen between 1978 and 1985 at the Children's Hospital of Philadelphia were reviewed. All patients had a presenting history thought to be suspicious for child abuse, and either retinal hemorrhages with subdural or subarachnoid hemorrhages or a computerized tomography scan showing subdural or subarachnoid hemorrhages with interhemispheric blood. The physical examination and presence of associated trauma were analyzed; autopsy findings for the 13 fatalities were reviewed. All fatal cases had signs of blunt impact to the head, although in more than half of them these findings were noted only at autopsy. All deaths were associated with uncontrollably increased intracranial pressure.

Models of 1-month-old infants with various neck and skull parameters were instrumented with accelerometers and shaken and impacted against padded or unpadded surfaces. Angular accelerations for shakes were smaller than those for impacts by a factor of 50. All shakes fell below injury thresholds established for subhuman primates scaled for the same brain mass, while impacts spanned concussion, subdural hematoma, and diffuse axonal injury ranges. It was concluded that severe head injuries commonly diagnosed as shaking injuries require impact to occur and that shaking alone in an otherwise normal baby is unlikely to cause the shaken baby syndrome.

  • Collapse
  • Expand

Contributor Notes

Address reprint requests to: Ann-Christine Duhaime, M.D., Division of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania 19014.
Keywords:
shaken baby syndrome; head injury; child abuse
Page Count:
7
  • 1.

    Adams RD, & Victor M: Principles of Neurology, ed 2. New York: McGraw-Hill, 1981, pp 387–417 Adams RD, Victor M: Principles of Neurology, ed 2. New York: McGraw-Hill, 1981, pp 387–417

    • Search Google Scholar
    • Export Citation
  • 2.

    Bruce DA, , Alavi A, & Bilaniuk L, et al: Diffuse cerebral swelling following head injuries in children: the syndrome of “malignant brain edema.” J Neurosurg 54:170–178, 1981 Bruce DA, Alavi A, Bilaniuk L, et al: Diffuse cerebral swelling following head injuries in children: the syndrome of “malignant brain edema.” J Neurosurg 54:170–178, 1981

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Caffey J: On the theory and practice of shaking infants. Its potential residual effects of permanent brain damage and mental retardation. Am J Dis Child 124:161–169, 1972 Caffey J: On the theory and practice of shaking infants. Its potential residual effects of permanent brain damage and mental retardation. Am J Dis Child 124:161–169, 1972

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Caffey J: The whiplash shaken infant syndrome: manual shaking by the extremities with whiplash-induced intracranial and intraocular bleedings, linked with residual permanent brain damage and mental retardation. Pediatrics 54:396–403, 1974 Caffey J: The whiplash shaken infant syndrome: manual shaking by the extremities with whiplash-induced intracranial and intraocular bleedings, linked with residual permanent brain damage and mental retardation. Pediatrics 54:396–403, 1974

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Calder IM, , Hill I, & Scholtz CL: Primary brain trauma in non-accidental injury. J Clin Pathol 37:1095–1100, 1984 Calder IM, Hill I, Scholtz CL: Primary brain trauma in non-accidental injury. J Clin Pathol 37:1095–1100, 1984

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Gennarelli TA, & Thibault LE: Biomechanics of head injury, in Wilkins RH, & Rengachary SS (eds): Neurosurgery. New York: McGraw-Hill, 1985, pp 1531–1536 Gennarelli TA, Thibault LE: Biomechanics of head injury, in Wilkins RH, Rengachary SS (eds): Neurosurgery. New York: McGraw-Hill, 1985, pp 1531–1536

    • Search Google Scholar
    • Export Citation
  • 7.

    Gennarelli TA, , Thibault LE, & Adams JH, et al: Diffuse axonal injury and traumatic coma in the primate. Ann Neurol 12:564–574, 1982 Gennarelli TA, Thibault LE, Adams JH, et al: Diffuse axonal injury and traumatic coma in the primate. Ann Neurol 12:564–574, 1982

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Guthkelch AN: Infantile subdural haematoma and its relationship to whiplash injuries. Br Med J 2:430–431, 1971 Guthkelch AN: Infantile subdural haematoma and its relationship to whiplash injuries. Br Med J 2:430–431, 1971

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Hahn YS, , Raimondi AJ, & McLone DG, et al: Traumatic mechanisms of head injury in child abuse. Childs Brain 10:229–241, 1983 Hahn YS, Raimondi AJ, McLone DG, et al: Traumatic mechanisms of head injury in child abuse. Childs Brain 10:229–241, 1983

    • Search Google Scholar
    • Export Citation
  • 10.

    Langfitt TW, & Gennarelli TA: A holistic view of head injury including a new clinical classification, in Grossman RG, & Gildenberg PL (eds): Head Injury: Basic and Clinical Aspects. New York: Raven Press, 1982, pp 1–14 Langfitt TW, Gennarelli TA: A holistic view of head injury including a new clinical classification, in Grossman RG, Gildenberg PL (eds): Head Injury: Basic and Clinical Aspects. New York: Raven Press, 1982, pp 1–14

    • Search Google Scholar
    • Export Citation
  • 11.

    Lindenberg R, & Freytag E: Morphology of brain lesions from blunt trauma in early infancy. Arch Pathol 87: 298–305, 1982 Lindenberg R, Freytag E: Morphology of brain lesions from blunt trauma in early infancy. Arch Pathol 87:298–305, 1982

    • Search Google Scholar
    • Export Citation
  • 12.

    Ludwig S, & Warman M: Shaken baby syndrome: a review of 20 cases. Ann Emerg Med 13:104–107, 1984 Ludwig S, Warman M: Shaken baby syndrome: a review of 20 cases. Ann Emerg Med 13:104–107, 1984

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    McClelland CQ, , Rekate H, & Kaufman B, et al: Cerebral injury in child abuse: a changing profile. Childs Brain 7:225–235, 1980 McClelland CQ, Rekate H, Kaufman B, et al: Cerebral injury in child abuse: a changing profile. Childs Brain 7:225–235, 1980

    • Search Google Scholar
    • Export Citation
  • 14.

    Merten DF, & Osborne DRS: Craniocerebral trauma in the child abuse syndrome. Pediatr Ann 12:882–887, 1983 Merten DF, Osborne DRS: Craniocerebral trauma in the child abuse syndrome. Pediatr Ann 12:882–887, 1983

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Sarsfield JK: The neurological sequelae of non-accidental injury. Dev Med Child Neurol 16:826–827, 1974 Sarsfield JK: The neurological sequelae of non-accidental injury. Dev Med Child Neurol 16:826–827, 1974

    • Search Google Scholar
    • Export Citation
  • 16.

    Thibault LE, & Gennarelli TA: Biomechanics of diffuse brain injuries, in: Proceedings of the Fourth Experimental Safety Vehicle Conference. New York: American Association of Automotive Engineers, 1985 Thibault LE, Gennarelli TA: Biomechanics of diffuse brain injuries, in: Proceedings of the Fourth Experimental Safety Vehicle Conference. New York: American Association of Automotive Engineers, 1985

    • Search Google Scholar
    • Export Citation
  • 17.

    Zimmerman RA, , Bilaniuk LT, & Bruce D, et al: Computed tomography of craniocerebral injury in the abused child. Radiology 130:687–690, 1979 Zimmerman RA, Bilaniuk LT, Bruce D, et al: Computed tomography of craniocerebral injury in the abused child. Radiology 130:687–690, 1979

    • Crossref
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 7392 1590 66
Full Text Views 1206 77 5
PDF Downloads 635 103 9
EPUB Downloads 0 0 0