August 01, 2016

Shaken Baby Syndrome and Abusive Head Trauma Accepted as Valid Diagnoses by Most Physicians

The views expressed herein have not been approved by the House of Delegates or the Board of Governors of the American Bar Association, and accordingly, should not be construed as representing the policy of the American Bar Association.

Survey data reveals a high degree of medical consensus that shaking a young child is capable of producing subdural hematoma (a life-threatening pooling of blood outside the brain), severe retinal hemorrhage, coma, or death, according to a study published in The Journal of Pediatrics. 

Recent media reports and judicial decisions have called into question the general acceptance among physicians of shaken baby syndrome and abusive head trauma. General acceptance of concepts in the medical community is a critical factor for admitting medical expert testimony in courts. In cases of child maltreatment, courts often rely on medical expert testimony to establish the most likely cause of a child’s injuries. 

“Claims of substantial controversy within the medical community about shaken baby syndrome and abusive head trauma have created a chilling effect on child protection hearings and criminal prosecutions,” says Sandeep Narang, MD, JD, lead author on the study, Division Head of Child Abuse Pediatrics at Ann & Robert H. Lurie Children’s Hospital of Chicago, and Associate Professor of Pediatrics-Child Abuse at Northwestern University Feinberg School of Medicine. 

“Our study is the first to provide the much needed empiric confirmation that multidisciplinary physicians throughout the country overwhelmingly accept the validity of these diagnoses, and refutes the recent contention that there is this emerging ‘groundswell’ of physician opinion against the diagnoses.”

The study examined survey responses from 628 physicians frequently involved in evaluation of injured children at 10 leading children’s hospitals in the U.S. The represented specialties included emergency medicine, critical care, child abuse pediatrics, pediatric ophthalmology, pediatric radiology, pediatric neurosurgery, pediatric neurology and forensic pathology. Eighty-eight percent of respondents stated that shaken baby syndrome is a valid diagnosis, while 93% affirmed the diagnosis of abusive head trauma. 

When asked to attribute a cause of subdural hematoma, severe retinal hemorrhage, coma or death in a child less than three years of age, more than 80 percent of physicians responded that shaking with or without impact was likely or highly likely to produce subdural hematoma, 90 percent reported that it was likely or highly likely to lead to severe retinal hemorrhage, and 78 percent felt that it was likely or highly likely to result in a coma or death. None of the other potential causes, except high velocity motor vehicle collision, was thought to result in these three clinical findings by a large majority of respondents. Very few physicians selected a short fall as an explanation for each clinical finding. 

“Our data show that shaking a young child is generally accepted by physicians to be a dangerous form of abuse,” says Narang.

Research at Ann & Robert H. Lurie Children’s Hospital of Chicago is conducted through the Stanley Manne Children’s Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge.

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