The shaken baby syndrome

A clinical, pathological, and biomechanical study

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✓ 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.

Article Information

Address reprint requests to: Ann-Christine Duhaime, M.D., Division of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania 19014.

© AANS, except where prohibited by US copyright law.

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    Representative tangential acceleration traces for infant models undergoing shake (upper) and impact (lower) manipulations. While manipulations of the infant models were performed as described, with a series of shakes followed by an impact, the magnitude of the impact accelerations was so much greater than that associated with the shakes that different scales are used to display the respective acceleration traces.

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    Angular acceleration versus angular velocity for shakes and impacts, with injury thresholds from primate experiments scaled to 500-gm brain weight. DAI = diffuse axonal injury; SDH = subdural hematoma.

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