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Forensic Science, Medicine, and Pathology

, Volume 10, Issue 2, pp 248–250 | Cite as

“Shaken baby syndrome” and forensic pathology

  • Waney Squier
Commentary

I welcome the creation of a forum to air opposing views in this “very contentious and hotly debated area” [1]. The critical issue is why, after more than 40 years, shaken baby syndrome/abusive head trauma (SBS/AHT) remains controversial.

Contrary to Byard’s suggestion, the SBS/AHT controversy is not about whether infants can be damaged or killed by violent shaking or abuse; of course they can. The real controversy is over whether shaking or abuse may reliably be inferred from specific findings, classically, subdural and retinal hemorrhage with encephalopathy (the triad).

Although SBS/AHT is a neuropathological and biomechanical hypothesis, we have learned in recent decades that it does not comport with the neuropathology of the infant brain or the biomechanics of head injury. The SBS/AHT hypothesis assumed that the triad was caused by the physical rupture of bridging veins, retinal vessels, and axons within the brain, requiring forces often described as equivalent to a multi-story fall...

Keywords

Retinal Hemorrhage Forensic Pathology Criminal Conviction Subdural Hemorrhage Infant Brain 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Byard R. “Shaken baby syndrome” and forensic pathology: an uneasy interface. Forensic Sci Med Pathol. 2013;. doi: 10.1007/s12024-013-9514-7.Google Scholar
  2. 2.
    Duhaime AC, Gennarelli TA, Thibault LE, Bruce DA, Margulies SS, Wiser R. The shaken baby syndrome. A clinical, pathological, and biomechanical study. J Neurosurg. 1987;66(3):409–15.PubMedCrossRefGoogle Scholar
  3. 3.
    Geddes JF, Hackshaw AK, Vowles GH, Nickols CD, Whitwell HL. Neuropathology of inflicted head injury in children. I. Patterns of brain damage. Brain. 2001;124(Pt 7):1290–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Geddes JF, Vowles GH, Hackshaw AK, Nickols CD, Scott IS, Whitwell HL. Neuropathology of inflicted head injury in children. II. Microscopic brain injury in infants. Brain. 2001;124(Pt 7):1299–306.PubMedCrossRefGoogle Scholar
  5. 5.
    Squier W, Mack J. The neuropathology of infant subdural haemorrhage. Forensic Sci Int. 2009;187(1–3):6–13.PubMedCrossRefGoogle Scholar
  6. 6.
    Frasier L, et al. In: Frasier L, editor. Abusive head trauma in infants and children. St. Louis: G W Medical; 2006.Google Scholar
  7. 7.
    Piteau SJ, Ward MG, Barrowman NJ, Plint AC. Clinical and radiographic characteristics associated with abusive and nonabusive head trauma: a systematic review. Pediatrics. 2012;130(2):315–23.PubMedCrossRefGoogle Scholar
  8. 8.
    Dias MS. The case for shaking. In: Jenny C, editor. Child abuse and neglect. Philadelphia: Elsevier Saunders; 2010.Google Scholar
  9. 9.
    Jenny C. The mechanics: distinguishing AHT/SBS from accidents and other medical conditions. New York City Abusive Head Trauma/Shaken Baby Syndrome Training Conference; 2011.Google Scholar
  10. 10.
    Greeley CS. Physical abuse of the young child: medical controversies in the criminal justice system. Physical abuse of young children. Brottsoffermyndigheten in cooperation Uppsala University Hospital and the Swedish Children Medical Association, Upsalla Sweden; 2013.Google Scholar
  11. 11.
    Richards P. JS (a minor), Re [2012] EWHC 1370 (Fam) (29 March 2012); 2012.Google Scholar
  12. 12.
    Squier W. Retino-dural haemorrhage of infancy. In: Jamieson A, Moenssens A, editors. Wiley Encyclopedia of Forensic Science. New York: John Wiley and Sons; 2013. http://onlinelibrary.wiley.com/book/10.1002/9780470061589.
  13. 13.
    Guthkelch AN. Infantile subdural haematoma and its relationship to whiplash injuries. Br Med J. 1971;2(759):430–1.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Guthkelch AN. Problems of infant retino-dural hemorrhage with minimal external injury. Hous J Health L Policy. 2012;12.Google Scholar
  15. 15.
    Gage LJ. R-v-Harris and others. [2005] EWCA Crim 1980; 2005.Google Scholar
  16. 16.
    Rooks VJ, Eaton JP, Ruess L, Petermann GW, Keck-Wherley J, Pedersen RC. Prevalence and evolution of intracranial hemorrhage in asymptomatic term infants. AJNR. 2008;29(6):1082–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Forbes BJ, Rubin SE, Margolin E, Levin AV. Evaluation and management of retinal hemorrhages in infants with and without abusive head trauma. J Aapos. 2010;14(3):267–73.PubMedCrossRefGoogle Scholar
  18. 18.
    Mack J, Squier W, Eastman JT. Anatomy and development of the meninges: implications for subdural collections and CSF circulation. Pediatr Radiol. 2009;39(3):200–10.PubMedCrossRefGoogle Scholar
  19. 19.
    Squier W, Lindberg E, Mack J, Darby S. Demonstration of fluid channels in human dura and their relationship to age and intradural bleeding. Childs Nerv Syst. 2009;25(8):925–31.PubMedCrossRefGoogle Scholar
  20. 20.
    Scheimberg I, Cohen MC, Zapata Vazquez RE, et al. Non-traumatic intradural and subdural hemorrhage and hypoxic ischaemic encephalopathy in fetuses, infants and children up to 3 years of age: analysis of two audits of 636 cases from two referral centers in the UK. Pediatr Dev Pathol. 2013;16(3):149–59.Google Scholar
  21. 21.
    Marmarou A. A review of progress in understanding the pathophysiology and treatment of brain edema. Neurosurg Focus. 2007;22(5):E1.CrossRefGoogle Scholar
  22. 22.
    Ebbs JD. Report to the attorney general: shaken baby death review. Ontario; 2011.Google Scholar
  23. 23.
    Geddes JF, Tasker RC, Hackshaw AK, et al. Dural haemorrhage in non-traumatic infant deaths: does it explain the bleeding in ‘shaken baby syndrome’? Neuropathol Appl Neurobiol. 2003;29(1):14–22.PubMedCrossRefGoogle Scholar
  24. 24.
    Matshes E. Retinal and optic nerve sheath haemorrhages are not pathognomonic of abusive head injury. In: Paper presented at American Academy of Forensic Sciences; 2010.Google Scholar
  25. 25.
    Finnie JW, Blumbergs PC, Manavis J, et al. Neuropathological changes in a lamb model of non-accidental head injury (the shaken baby syndrome). J Clin Neurosci. 2012;19(8):1159–64.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of Neuropathology, West Wing, John Radcliffe HospitalOxford UniversityOxfordUK

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