Shaken baby syndrome: Difference between revisions
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==Overview== | ==Overview== | ||
'''Shaken baby syndrome''' ('''SBS''') is a form of [[child abuse]] that is thought to occur when an abuser violently shakes an infant or small child, creating a [[whiplash (medicine)|whiplash]]-type motion that causes acceleration-deceleration injuries. The injury is estimated to affect between 1,200 and 1,600 children every year in the USA.<!-- | '''Shaken baby syndrome''' ('''SBS''') is a form of [[child abuse]] that is thought to occur when an abuser violently shakes an infant or small child, creating a [[whiplash (medicine)|whiplash]]-type motion that causes acceleration-deceleration injuries. The injury is estimated to affect between 1,200 and 1,600 children every year in the USA.<!-- | ||
-- | --> A remarkable feature of SBS is the typical lack of external evidence of trauma. The combination of shaking with striking of the infant against a hard object is sometimes termed the '''shaken impact syndrome'''. | ||
The concept of SBS was initially described in the early 1970s, based on a theory and a wide variety of circumstances by Dr. John Caffey, a radiologist, as well as Dr. Norman Guthkelch, a neurosurgeon.<!-- | The concept of SBS was initially described in the early 1970s, based on a theory and a wide variety of circumstances by Dr. John Caffey, a radiologist, as well as Dr. Norman Guthkelch, a neurosurgeon.<!-- | ||
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SBS, a major cause of mortality in infants, is often fatal and can produce lifelong disability from [[brain damage|neurological damage]]. Up to 50% of deaths related to child abuse are reportedly due to shaken baby syndrome. | SBS, a major cause of mortality in infants, is often fatal and can produce lifelong disability from [[brain damage|neurological damage]]. Up to 50% of deaths related to child abuse are reportedly due to shaken baby syndrome. About 25% to 30% of infant victims with SBS die from their injuries.{{fact|date=Sepbember, 2007}} Nonfatal consequences of SBS include varying degrees of visual impairment (e.g., [[blindness]]), motor impairment (e.g. [[cerebral palsy]]) and [[cognitive deficit|cognitive impairment]]s. | ||
==Signs and symptoms== | ==Signs and symptoms== | ||
The signs associated with inflicted SBS include retinal hemorrhages, [[petechia]]e (small, pinpoint hemorrhages) on the body or face, multiple fractures of the long bones, and [[subdural hematoma]]s.<!-- | The signs associated with inflicted SBS include retinal hemorrhages, [[petechia]]e (small, pinpoint hemorrhages) on the body or face, multiple fractures of the long bones, and [[subdural hematoma]]s.<!-- | ||
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These signs have evolved through the years as the accepted and recognized signs of child abuse and the shaken baby syndrome. Additional effects of SBS are [[diffuse axonal injury]], [[hypoxia (medical)|oxygen deprivation]] and [[cerebral edema|swelling of the brain]], which can raise [[intracranial pressure]] and damage delicate brain tissue. | These signs have evolved through the years as the accepted and recognized signs of child abuse and the shaken baby syndrome. Additional effects of SBS are [[diffuse axonal injury]], [[hypoxia (medical)|oxygen deprivation]] and [[cerebral edema|swelling of the brain]], which can raise [[intracranial pressure]] and damage delicate brain tissue. | ||
Most victims of SBS are under one year old. Victims of SBS may display irritability, [[failure to thrive]], alterations in eating patterns, [[lethargy]], [[vomiting]], [[seizure]]s, bulging or tense [[fontanel]]s, increased size of the head, altered respirations, and dilated [[pupil]]s. | Most victims of SBS are under one year old. Victims of SBS may display irritability, [[failure to thrive]], alterations in eating patterns, [[lethargy]], [[vomiting]], [[seizure]]s, bulging or tense [[fontanel]]s, increased size of the head, altered respirations, and dilated [[pupil]]s. Medical professionals strongly suspect shaking as the cause of injuries when a baby or small child presents with retinal hemorrhage, [[bone fracture|fractures]], [[soft tissue]] injuries or subdural hematoma, that cannot be explained by accidental trauma or other medical conditions. No alternative condition mimics all of the symptoms of SBS exactly, but those that must be ruled out include [[hydrocephalus]], [[sudden infant death syndrome]] (SIDS), [[seizure disorder]]s, and [[infectious disease|infectious]] or [[congenital disease]]s like [[meningitis]] and [[metabolic disorder]]s.<!-- | ||
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[[Fracture]]s of the [[vertebrae]] and [[ribs]] may also be associated with SBS. Although several [[bone disorder]]s may also cause increased vulnerability to fractures, they can be distinguished from inflicted trauma by other characteristic alterations of the bones, by [[genetic testing|gene tests]], and by the absence of corroborative evidence of abuse. The principal disorders known to cause increased susceptibility to fracture without other obvious evidence of bone abnormality are the various moderate-severity forms of [[osteogenesis imperfecta]].<!-- | [[Fracture]]s of the [[vertebrae]] and [[ribs]] may also be associated with SBS. Although several [[bone disorder]]s may also cause increased vulnerability to fractures, they can be distinguished from inflicted trauma by other characteristic alterations of the bones, by [[genetic testing|gene tests]], and by the absence of corroborative evidence of abuse. The principal disorders known to cause increased susceptibility to fracture without other obvious evidence of bone abnormality are the various moderate-severity forms of [[osteogenesis imperfecta]].<!-- | ||
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Although bone disease of prematurity, [[rickets]] due to vitamin D deficiency,<!-- | Although bone disease of prematurity, [[rickets]] due to vitamin D deficiency,<!-- | ||
-- | --> [[Scurvy]] (vitamin C deficiency),<!-- | ||
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copper deficiency and [[Menkes disease]] can increase fracture susceptibility, the bone disease is accompanied by additional evidence allowing it to be easily distinguished from abuse in nearly all cases.<!-- | copper deficiency and [[Menkes disease]] can increase fracture susceptibility, the bone disease is accompanied by additional evidence allowing it to be easily distinguished from abuse in nearly all cases.<!-- | ||
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In addition to [[Barlow's Disease]]<!-- | In addition to [[Barlow's Disease]]<!-- | ||
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--> or scurvy,<!-- | |||
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a number of medical conditions,<!-- | a number of medical conditions,<!-- | ||
-- | --> including malformations,<!-- | ||
-- | --> premature infants,<!-- | ||
--> can mimic SBS, even before birth.<!-- | |||
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-- | --><ref name="“Williams" 2005”="">{{cite book | author=''Williams Obstetrics'' | title= Diseases and Injuries of the Fetus and Newborn| volume= 22 | chapter=Chapter 29 | date=2005 | pages=page 649-691 | publisher= McGraw-Hill Companies | id=ISBN 0-07-141315-4}}</ref><!-- | ||
--><ref name=“Williams 2005”>{{cite book | author=''Williams Obstetrics'' | title= Diseases and Injuries of the Fetus and Newborn| volume= 22 | chapter=Chapter 29 | date=2005 | pages=page 649-691 | publisher= McGraw-Hill Companies | id=ISBN 0-07-141315-4}}</ref><!-- | --><!-- | ||
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Examination by an experienced [[ophthalmologist]] is often critical in diagnosing shaken baby syndrome, as particular forms of ocular bleeding are quite characteristic of this condition.<!-- | Examination by an experienced [[ophthalmologist]] is often critical in diagnosing shaken baby syndrome, as particular forms of ocular bleeding are quite characteristic of this condition.<!-- | ||
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Some medical experts assert that "no case studies have ever been undertaken to probe even a partial list of possible confounding variables/phenomena, such as the presence of intracranial cysts or fluid collections, hydrocephalus, congenital and inherited diseases, infection, coagulation disorders and venous thrombosis, recent immunizations,"<!-- | Some medical experts assert that "no case studies have ever been undertaken to probe even a partial list of possible confounding variables/phenomena, such as the presence of intracranial cysts or fluid collections, hydrocephalus, congenital and inherited diseases, infection, coagulation disorders and venous thrombosis, recent immunizations,"<!-- | ||
-- | --> ''medications, birth-related brain injuries,''<!-- | ||
--> "or recent or remote head trauma. Until and unless these and probably many more factors are evaluated, it is inappropriate to select one mechanism only and ignore the rest of the potential causes."<!-- | |||
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In 2005, a review of several ophthalmology studies and their findings concerning "inflicted childhood neurotrauma" (SBS) was published in the UK, in the quarterly ophthalmology publication ''Focus.''<!-- | In 2005, a review of several ophthalmology studies and their findings concerning "inflicted childhood neurotrauma" (SBS) was published in the UK, in the quarterly ophthalmology publication ''Focus.''<!-- | ||
-- | --> One of the studies "found a correlation between intra-ocular bleeding, anterior optic nerve haemorrhage and subdural haematomas. Post mortem findings of vitreous traction at the apex of retinal folds and the edge of dome shaped haemorrhages and retinoschisis gives some supporting evidence that vitreous forces may cause this shearing damage. There is no adequate model to test this experimentally, so this remains hypothesis, not established fact."<!-- | ||
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The main scientific finding of two additional studies<!-- | The main scientific finding of two additional studies<!-- | ||
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-- | --> from the ''Focus'' article "was that in cases of retinal haemorrhages with thin film subdurals and in the absence of other injuries that the pathological finding is more commonly that of hypoxic ischaemic encephalopathy rather than diffuse axonal injury. Regardless of the recent debate the observational evidence to date remains that children with non accidental injury may have no visible retinal haemorrhages, whilst non accidental injury and birth are the only circumstances in which multiple retinal haemorrhages in differing layers of the retina have been accurately documented."<!-- | ||
--><ref name="Newman W"/> | --><ref name="Newman W" /> | ||
The following references documented cases of retinal hemorrhages from accidental head trauma<!-- | The following references documented cases of retinal hemorrhages from accidental head trauma<!-- | ||
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a videotaped minor fall,<!-- | a videotaped minor fall,<!-- | ||
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osteogenesis imperfecta<!-- | osteogenesis imperfecta<!-- | ||
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indicating that shaking is not the only possible cause of injury. According to one author, "the presence of retinal hemorrhages is neither necessary nor sufficient for the diagnosis of child abuse."<!-- | indicating that shaking is not the only possible cause of injury. According to one author, "the presence of retinal hemorrhages is neither necessary nor sufficient for the diagnosis of child abuse."<!-- | ||
-- | --> A postvaccinial ocular syndrome was reported as early as 1948, recent papers have been published concerning the occlusion of central retinal vein after hepatitis B vaccination,<!-- | ||
--> "The compounding effects of [[anoxia]] or [[hypoxia]], [[anemia]], [[thrombocytopenia]], mild [[coagulopathy]], obstruction of retinal venous flow, or possible age-related anatomic variations in the retinal vasculature are not well understood."<!-- | |||
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==Anatomy and pathophysiology== | ==Anatomy and pathophysiology== | ||
People under the age of three years are especially susceptible to brain damage from shaking.<ref name="Forbes"/> This is due to several anatomical factors. Their heads are bigger and weigh more with respect to their bodies than adults' heads, and their neck muscles are weak and cannot prevent violent motions. | People under the age of three years are especially susceptible to brain damage from shaking.<ref name="Forbes" /> This is due to several anatomical factors. Their heads are bigger and weigh more with respect to their bodies than adults' heads, and their neck muscles are weak and cannot prevent violent motions. Infants' brains are not [[myelin]]ated; myelin sheaths form in childhood and are complete in [[adolescence]]. The brain water content is reduced as [[neuron]]s gain myelin during development, so babies have a greater percentage of brain water than adults do. Because of this higher water content, children's brains are softer and are much more susceptible to acceleration-deceleration injuries and diffuse axonal injury.<ref name="Singh" /> | ||
Rotation injury is especially damaging and likely to occur in shaking trauma.<!-- | Rotation injury is especially damaging and likely to occur in shaking trauma.<!-- | ||
--><ref name="Oral"/> | --><ref name="Oral" /> | ||
The type of injuries caused by shaking injury are usually not caused by falls and impacts from normal play, which are mostly linear forces.<!-- | The type of injuries caused by shaking injury are usually not caused by falls and impacts from normal play, which are mostly linear forces.<!-- | ||
--><ref name="Oral"/> | --><ref name="Oral" /> | ||
Rotation injury is also referred to as diffuse axonal injury (DAI). A report in 2001, reviewed the brains of 37 infants aged 9 months or less, all of whom died from inflicted head injuries, and 14 control infants who died of other causes. Axonal damage was identified using immunohistochemistry for ß-amyloid precursor protein. The observation that the predominant histological abnormality in cases of inflicted head injury in the very young is diffuse hypoxic brain damage, not DAI, can be explained in one of two ways: either the unmyelinated axon of the immature cerebral hemispheres is relatively resistant to traumatic damage, or in shaking-type injuries the brain is not exposed to the forces necessary to produce DAI.''<!-- | Rotation injury is also referred to as diffuse axonal injury (DAI). A report in 2001, reviewed the brains of 37 infants aged 9 months or less, all of whom died from inflicted head injuries, and 14 control infants who died of other causes. Axonal damage was identified using immunohistochemistry for ß-amyloid precursor protein. The observation that the predominant histological abnormality in cases of inflicted head injury in the very young is diffuse hypoxic brain damage, not DAI, can be explained in one of two ways: either the unmyelinated axon of the immature cerebral hemispheres is relatively resistant to traumatic damage, or in shaking-type injuries the brain is not exposed to the forces necessary to produce DAI.''<!-- | ||
--><ref name="Geddes II"/> Apparently a critical point was missed or overlooked in a paper published in 1968<!-- | --><ref name="Geddes II" /> Apparently a critical point was missed or overlooked in a paper published in 1968<!-- | ||
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concerning the results of bioengineering study in conjunction with the U.S. Department of Transportation. This experiment showed, qualitatively, that rotation alone could indeed produce intracranial injury, though it was not shown quantitatively that human beings could generate the required rotational acceleration by manual shaking. This critical omission was not addressed until 19 years later, when it was shown quantitatively that impact was required to generate adequate force. Guthkelch, Caffey, and others either were not aware of, or disregarded, this critical missing piece of information. In the intervening years, and even up to the present, numerous references are made to infants sustaining inflicted brain injury by manual shaking. Yet no laboratory proof of this possibility has ever been put forth. In fact, the available experimental evidence began as far back as 1943, addressed directly in 1987<!-- | concerning the results of bioengineering study in conjunction with the U.S. Department of Transportation. This experiment showed, qualitatively, that rotation alone could indeed produce intracranial injury, though it was not shown quantitatively that human beings could generate the required rotational acceleration by manual shaking. This critical omission was not addressed until 19 years later, when it was shown quantitatively that impact was required to generate adequate force. Guthkelch, Caffey, and others either were not aware of, or disregarded, this critical missing piece of information. In the intervening years, and even up to the present, numerous references are made to infants sustaining inflicted brain injury by manual shaking. Yet no laboratory proof of this possibility has ever been put forth. In fact, the available experimental evidence began as far back as 1943, addressed directly in 1987<!-- | ||
-- | --> and reproduced in 2003,<!-- | ||
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seems to indicate the contrary.<!-- | seems to indicate the contrary.<!-- | ||
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"The assessment of the mechanical causation of injury requires training and experience in Injury Biomechanics, a distinct discipline not taught in medical school. Lack of education and experience in Injury Biomechanics, amongst other factors, has led in practice to the proliferation and propagation of inaccurate and sometimes erroneous information on SBS injury mechanisms in the literature." A recent biomechanical experiment in 2005, demonstrated that "forceful shaking can severely injure or kill an infant, this is because the cervical spine would be severely injured and not because subdural hematomas would be caused by high head rotational accelerations. Furthermore, shaking cervical spine injury can occur at much lower levels of head velocity and acceleration than those reported for the SBS. These findings are consistent with the physical laws of injury biomechanics as well as our collective understanding of the fragile infant cervical spine from (1) clinical obstetric experience, (2) automotive medicine and crash safety experience, and (3) common parental experience. We have determined that an infant head subjected to the levels of rotational velocity and acceleration called for in the SBS literature, would experience forces on the infant neck far exceeding the limits for structural failure of the cervical spine. Furthermore, shaking cervical spine injury can occur at much lower levels of head velocity and acceleration than those reported for the SBS.<!-- | "The assessment of the mechanical causation of injury requires training and experience in Injury Biomechanics, a distinct discipline not taught in medical school. Lack of education and experience in Injury Biomechanics, amongst other factors, has led in practice to the proliferation and propagation of inaccurate and sometimes erroneous information on SBS injury mechanisms in the literature." A recent biomechanical experiment in 2005, demonstrated that "forceful shaking can severely injure or kill an infant, this is because the cervical spine would be severely injured and not because subdural hematomas would be caused by high head rotational accelerations. Furthermore, shaking cervical spine injury can occur at much lower levels of head velocity and acceleration than those reported for the SBS. These findings are consistent with the physical laws of injury biomechanics as well as our collective understanding of the fragile infant cervical spine from (1) clinical obstetric experience, (2) automotive medicine and crash safety experience, and (3) common parental experience. We have determined that an infant head subjected to the levels of rotational velocity and acceleration called for in the SBS literature, would experience forces on the infant neck far exceeding the limits for structural failure of the cervical spine. Furthermore, shaking cervical spine injury can occur at much lower levels of head velocity and acceleration than those reported for the SBS.<!-- | ||
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In 2004, a Scottish database collected data for five years on cases of suspected non-accidental head injury diagnosed after a multiagency assessment and included cases with uncoerced confessions of perpetrators and criminal convictions. Several patterns appeared allowing the categorization of the cases into four predominant types: Hyperacute encephalopathy (6% of all cases); Acute encephalopathy (53% of cases (SBS)); Subacute non-encephalopathic presentation (19% of cases); Chronic extracerebral presentation (22% of cases). Infants can be traumatically injured in many ways, and many instances are unwitnessed. Thus the generic term non-accidental head injury or inflicted traumatic brain injury is occasionally used in preference to shaken baby syndrome, which implies a specific mechanism of injury.<!-- | In 2004, a Scottish database collected data for five years on cases of suspected non-accidental head injury diagnosed after a multiagency assessment and included cases with uncoerced confessions of perpetrators and criminal convictions. Several patterns appeared allowing the categorization of the cases into four predominant types: Hyperacute encephalopathy (6% of all cases); Acute encephalopathy (53% of cases (SBS)); Subacute non-encephalopathic presentation (19% of cases); Chronic extracerebral presentation (22% of cases). Infants can be traumatically injured in many ways, and many instances are unwitnessed. Thus the generic term non-accidental head injury or inflicted traumatic brain injury is occasionally used in preference to shaken baby syndrome, which implies a specific mechanism of injury.<!-- | ||
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An earlier detailed neuropathological study was publish in the UK in 2001, which included immunocytochemistry for microscopic damage.<!-- | An earlier detailed neuropathological study was publish in the UK in 2001, which included immunocytochemistry for microscopic damage.<!-- | ||
--><ref name="Geddes I ">{{cite journal | author = Geddes J, Hackshaw A, Vowles G, Nickols C, Whitwell H | title = Neuropathology of inflicted head injury in children. I. Patterns of brain damage. | journal = Brain | volume = 124 | issue = Pt 7 | pages = 1290-8 | year = 2001 | month=Jul | id = PMID 11408324 | url=http://brain.oxfordjournals.org/cgi/content/full/124/7/1290}}</ref> | --><ref name="Geddes I">{{cite journal | author = Geddes J, Hackshaw A, Vowles G, Nickols C, Whitwell H | title = Neuropathology of inflicted head injury in children. I. Patterns of brain damage. | journal = Brain | volume = 124 | issue = Pt 7 | pages = 1290-8 | year = 2001 | month=Jul | id = PMID 11408324 | url=http://brain.oxfordjournals.org/cgi/content/full/124/7/1290}}</ref> | ||
==Prognosis== | ==Prognosis== | ||
SBS kills about one third of its victims and permanently and severely disables another third.<!-- | SBS kills about one third of its victims and permanently and severely disables another third.<!-- | ||
--><ref name="Oral"/> | --><ref name="Oral" /> | ||
Problems resulting from SBS include learning disabilities, seizure disorders, speech disability, hydrocephalus, behavioral problems, [[cerebral palsy]], and visual disorders.<!-- | Problems resulting from SBS include learning disabilities, seizure disorders, speech disability, hydrocephalus, behavioral problems, [[cerebral palsy]], and visual disorders.<!-- | ||
--><ref name="Oral"/> | --><ref name="Oral" /> | ||
== Prevention == | ==Prevention== | ||
Prevention is similar to the prevention of [[child abuse]] in general. New parents, babysitters, and other caregivers should be warned about the dangers of shaking infants. Crying is a common trigger for creating irritation and frustration in the caregiver. Some experts have advised that caregivers need strategies to cope with their own frustrations; for example, they should be reminded that they are not always responsible when babies cry. | Prevention is similar to the prevention of [[child abuse]] in general. New parents, babysitters, and other caregivers should be warned about the dangers of shaking infants. Crying is a common trigger for creating irritation and frustration in the caregiver. Some experts have advised that caregivers need strategies to cope with their own frustrations; for example, they should be reminded that they are not always responsible when babies cry. | ||
== SBS as a medicolegal concept == | ==SBS as a medicolegal concept== | ||
The legal import of shaken baby syndrome varies according to circumstances, often involving child welfare and criminal investigations. Such investigations determine whether children are judged safe to remain in their parents / caregivers' care, and whether an individual may be charged with assault, child endangerment, or homicide. | The legal import of shaken baby syndrome varies according to circumstances, often involving child welfare and criminal investigations. Such investigations determine whether children are judged safe to remain in their parents / caregivers' care, and whether an individual may be charged with assault, child endangerment, or homicide. | ||
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The trial court's ruling is not considered binding legal precedent. The Commonwealth of Kentucky has appealed the ruling to the state's intermediate appellate court.<!-- | The trial court's ruling is not considered binding legal precedent. The Commonwealth of Kentucky has appealed the ruling to the state's intermediate appellate court.<!-- | ||
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In the Summer of 2006 a review of the Shaken Baby Syndrome and the Shaken Impact Syndrome was published in the ''Military Law Review''. This legal review contains an extensive examination of the divergent views of the scientific literature, in addition to examining the divergent views of the legal parameters involving a trial. <!-- | In the Summer of 2006 a review of the Shaken Baby Syndrome and the Shaken Impact Syndrome was published in the ''Military Law Review''. This legal review contains an extensive examination of the divergent views of the scientific literature, in addition to examining the divergent views of the legal parameters involving a trial. <!-- | ||
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In July of 2005, the Court of Appeals in the [[United Kingdom]] reversed or reduced three convictions of SBS, finding that the classic triad of retinal hemorrhage, subdural hematoma, and acute encephalopathy are not 100% diagnostic of SBS and that clinical history is also important.<!-- | In July of 2005, the Court of Appeals in the [[United Kingdom]] reversed or reduced three convictions of SBS, finding that the classic triad of retinal hemorrhage, subdural hematoma, and acute encephalopathy are not 100% diagnostic of SBS and that clinical history is also important.<!-- | ||
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In their ruling, they upheld the clinical concept of SBS but dismissed two cases and reduced the sentence on a third based on their individual merits. In their words: "Whilst a strong pointer to NAHI [non-accidental head injury] on its own we do not think it possible to find that it must automatically and necessarily lead to a diagnosis of NAHI. All the circumstances, including the clinical picture, must be taken into account." The term ''"non-accidental trauma'"'' was suggested instead of "SBS" in the March 27, 2004 edition of the ''[[British Medical Journal]]''<!-- | In their ruling, they upheld the clinical concept of SBS but dismissed two cases and reduced the sentence on a third based on their individual merits. In their words: "Whilst a strong pointer to NAHI [non-accidental head injury] on its own we do not think it possible to find that it must automatically and necessarily lead to a diagnosis of NAHI. All the circumstances, including the clinical picture, must be taken into account." The term ''"non-accidental trauma'"'' was suggested instead of "SBS" in the March 27, 2004 edition of the ''[[British Medical Journal]]''<!-- | ||
--><ref name="Minns">{{cite journal | author=Minns R, Busuttil A | title=Patterns of presentation of the shaken baby syndrome -- Four types of inflicted brain injury predominate | journal=BMJ | year=2004 | month=27 March | volume=328 | pages=766 | url=http://bmj.bmjjournals.com/cgi/content/full/328/7442/766 | doi=10.1136/bmj.328.7442.766}}- provides links to Editorials and a Clinical review</ref> | --><ref name="Minns">{{cite journal | author=Minns R, Busuttil A | title=Patterns of presentation of the shaken baby syndrome -- Four types of inflicted brain injury predominate | journal=BMJ | year=2004 | month=27 March | volume=328 | pages=766 | url=http://bmj.bmjjournals.com/cgi/content/full/328/7442/766 | doi=10.1136/bmj.328.7442.766}}- provides links to Editorials and a Clinical review</ref> | ||
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An additional, alternative explanation for some incidents contemplated as shaken baby syndrome has been proposed. This explanation suggests that a [[vitamin C]] deficiency may sometimes play a role in the pathogenesis of shaken baby syndrome,<!-- | An additional, alternative explanation for some incidents contemplated as shaken baby syndrome has been proposed. This explanation suggests that a [[vitamin C]] deficiency may sometimes play a role in the pathogenesis of shaken baby syndrome,<!-- | ||
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--><ref name="Scheibner V">{{cite journal | author = Scheibner V | title = Shaken Baby Syndrome Diagnosis on Shaky Ground." | journal = “Journal of the Australasian College of Nutritional and Environmental Medicine” | volume = 20 | issue = 2 | pages = 5-8,15 | | --><ref name="Scheibner V">{{cite journal | author = Scheibner V | title = Shaken Baby Syndrome Diagnosis on Shaky Ground." | journal = “Journal of the Australasian College of Nutritional and Environmental Medicine” | volume = 20 | issue = 2 | pages = 5-8,15 | | ||
url= http://www.acnem.org/journal/pdf_files/20-2_august_2001/20-2_shaken_baby_syndrome.pdf | format=PDF | year = 2001 | month=Aug }}</ref><!-- | url= http://www.acnem.org/journal/pdf_files/20-2_august_2001/20-2_shaken_baby_syndrome.pdf | format=PDF | year = 2001 | month=Aug }}</ref><!-- | ||
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--> citing that the current SBS pathology determination may be seriously flawed or incomplete<!-- | |||
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-- | --> This contested hypothesis is based upon a speculated marginal, near scorbutic condition or lack of essential nutrient(s) repletion and a potential elevated histamine level.<!-- | ||
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--><ref name="Clemetson2004">{{cite journal | author=Clemetson CAB | title=Was it "shaken baby" or a variant of Barlow's disease? | journal=J Am Phys Surg" | year=2004 | volume=9 | pages=78-80 | url=http://www.jpands.org/vol9no3/clemetson.pdf | format=PDF}}</ref><!-- | --><ref name="Clemetson2004">{{cite journal | author=Clemetson CAB | title=Was it "shaken baby" or a variant of Barlow's disease? | journal=J Am Phys Surg" | year=2004 | volume=9 | pages=78-80 | url=http://www.jpands.org/vol9no3/clemetson.pdf | format=PDF}}</ref><!-- | ||
--><ref name="Clemetson2006">{{cite journal | author=Clemetson CAB | title=Caffey Revisited: A Commentary on the Origin of "Shaken Baby Syndrome." | journal=J Am Phys Surg | year=2006 | month=Spring | volume=11 | issue=1 | pages=20-1 | url=http://www.jpands.org/vol11no1/clemetson.pdf | format=PDF}}</ref><!-- | --><ref name="Clemetson2006">{{cite journal | author=Clemetson CAB | title=Caffey Revisited: A Commentary on the Origin of "Shaken Baby Syndrome." | journal=J Am Phys Surg | year=2006 | month=Spring | volume=11 | issue=1 | pages=20-1 | url=http://www.jpands.org/vol11no1/clemetson.pdf | format=PDF}}</ref><!-- | ||
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The proponents of such hypotheses often question the adequacy of nutrient tissue levels, especially vitamin C,<!-- | The proponents of such hypotheses often question the adequacy of nutrient tissue levels, especially vitamin C,<!-- | ||
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-- | --> for those children currently or recently ill, bacterial infections, those with higher individual requirements, those suffering from environmental challenges (e.g. allergies), and perhaps transient vaccination related stresses.<!-- | ||
-- | --> However, no cases of [[scurvy]] mimicking SBS or [[crib death]] have been reported, and scurvy typically occurs later in infancy, rarely causes death or intracranial bleeding, and is accompanied by other changes of the bones and skin and invariably an unusually deficient dietary history. | ||
A number of medical personnel recommend that all SBS pathology determinations should include vitamin C repletion history and histamine/vitamin C levels. Additional medical recommendations for the use of vitamins and nutrients as a preventive measure, particularly vitamin C, should be used especially for children with known, projected or suspected stresses/conditions (vaccines) that may deplete certain nutrients.<!-- | A number of medical personnel recommend that all SBS pathology determinations should include vitamin C repletion history and histamine/vitamin C levels. Additional medical recommendations for the use of vitamins and nutrients as a preventive measure, particularly vitamin C, should be used especially for children with known, projected or suspected stresses/conditions (vaccines) that may deplete certain nutrients.<!-- | ||
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-- | --> | ||
Although a Barlow’s disease variant (infantile scurvy) may be the most common disease, other diagnoses such as fragile bone disease, hemorrhagic disease of the newborn (vitamin K deficiency) and glutaric aciduria type 1 must also be considered. Gestational problems affecting both mother and fetus, the birthing process, prematurity and nutritional deficits can accelerate skeletal and hemorrhagic pathologies that can also mimic SBS, even before birth.<!-- | Although a Barlow’s disease variant (infantile scurvy) may be the most common disease, other diagnoses such as fragile bone disease, hemorrhagic disease of the newborn (vitamin K deficiency) and glutaric aciduria type 1 must also be considered. Gestational problems affecting both mother and fetus, the birthing process, prematurity and nutritional deficits can accelerate skeletal and hemorrhagic pathologies that can also mimic SBS, even before birth.<!-- | ||
--><ref name="ClemetsonCAB">{{cite journal | author = Clemetson CAB | title = Capillary Fragility as a Cause of Substantial Hemorrhage in Infants." | journal = Medical Hypotheses And Research | volume = 1 | issue = 2/3 | pages = 121-129 | url= http://www.journal-mhr.com/PDF_Files/vol_1_2/1_2N3_PDFs/1_2N3_5.pdf| year = 2004 | month=Jul |format=PDF }}</ref><!-- | --><ref name="ClemetsonCAB">{{cite journal | author = Clemetson CAB | title = Capillary Fragility as a Cause of Substantial Hemorrhage in Infants." | journal = Medical Hypotheses And Research | volume = 1 | issue = 2/3 | pages = 121-129 | url= http://www.journal-mhr.com/PDF_Files/vol_1_2/1_2N3_PDFs/1_2N3_5.pdf| year = 2004 | month=Jul |format=PDF }}</ref><!-- | ||
--><ref name=“Cushing”>{{cite journal | author = Cushing H | title = Reprint of “Concerning Surgical Intervention for the Intracranial Hemorrhages of the New-born” (1905) | journal = Child's Nervous System | volume = 16 | issue= Classics in Pediatric Neurosurgery |pages = 484-492| year = 2000 | id = PMID 11007498 | url= http://www.springerlink.com/content/ue6mbcn20g5ae45j/ }}</ref><!-- | --><ref name="“Cushing”">{{cite journal | author = Cushing H | title = Reprint of “Concerning Surgical Intervention for the Intracranial Hemorrhages of the New-born” (1905) | journal = Child's Nervous System | volume = 16 | issue= Classics in Pediatric Neurosurgery |pages = 484-492| year = 2000 | id = PMID 11007498 | url= http://www.springerlink.com/content/ue6mbcn20g5ae45j/ }}</ref><!-- | ||
--><ref name=“Williams 1997”>{{cite book | author=''Williams Obstetrics'' | title= Diseases and Injuries of the Fetus and Newborn| volume= 20 | chapter=Chapter 20 | date=1997 | pages=page 997-998 | publisher= Appleton & Lange, Stamford, CT | id=ISBN 0-8365-9638-X}}</ref><!-- | --><ref name="“Williams" 1997”="">{{cite book | author=''Williams Obstetrics'' | title= Diseases and Injuries of the Fetus and Newborn| volume= 20 | chapter=Chapter 20 | date=1997 | pages=page 997-998 | publisher= Appleton & Lange, Stamford, CT | id=ISBN 0-8365-9638-X}}</ref><!-- | ||
--><ref name=“Williams 2005”>{{cite book | author=''Williams Obstetrics'' | title= Diseases and Injuries of the Fetus and Newborn| volume= 22 | chapter=Chapter 29 | date=2005 | pages=page 649-691 | publisher= McGraw-Hill Companies | id=ISBN 0-07-141315-4}}</ref><!-- | --><ref name="“Williams" 2005”="">{{cite book | author=''Williams Obstetrics'' | title= Diseases and Injuries of the Fetus and Newborn| volume= 22 | chapter=Chapter 29 | date=2005 | pages=page 649-691 | publisher= McGraw-Hill Companies | id=ISBN 0-07-141315-4}}</ref><!-- | ||
--><ref name=“Looney”>{{cite journal | author = Looney CB, et.al| title = Intracranial Hemorrhage in Asymptomatic Neonates: Prevalence on MR Images and Relationship to Obstetric and Neonatal Risk Factors | journal = Radiology | --><ref name="“Looney”">{{cite journal | author = Looney CB, et.al| title = Intracranial Hemorrhage in Asymptomatic Neonates: Prevalence on MR Images and Relationship to Obstetric and Neonatal Risk Factors | journal = Radiology | ||
| volume = 242 | pages = 535-541| year = 2007 | id = PMID 17179400 | url= http://radiology.rsnajnls.org/cgi/content/abstract/242/2/535 }}</ref> These views are not widely known, utilized or explored in conventional medicine. Nevertheless, favorable court rulings<!-- | | volume = 242 | pages = 535-541| year = 2007 | id = PMID 17179400 | url= http://radiology.rsnajnls.org/cgi/content/abstract/242/2/535 }}</ref> These views are not widely known, utilized or explored in conventional medicine. Nevertheless, favorable court rulings<!-- | ||
--><ref name="Commonwealth">Commonwealth Of Kentucky VS. Christopher A. Davis, Greenup Circuit Court [http://www.aapsonline.org/sbs/daubert.pdf CASE NO.04-CR 205]</ref> and evidentiary commentary on flawed SBS determinations have been demonstrated by biomechanical studies over the years.<!-- | --><ref name="Commonwealth">Commonwealth Of Kentucky VS. Christopher A. Davis, Greenup Circuit Court [http://www.aapsonline.org/sbs/daubert.pdf CASE NO.04-CR 205]</ref> and evidentiary commentary on flawed SBS determinations have been demonstrated by biomechanical studies over the years.<!-- | ||
| Line 220: | Line 191: | ||
--><ref name="Prange">{{cite journal | author = Prange M, Coats B, Duhaime A, Margulies S | title = Anthropomorphic simulations of falls, shakes, and inflicted impacts in infants. | journal = J Neurosurg | volume = 99 | issue = 1 | pages = 143-50 | year = 2003 | month=Mar | id = PMID 12854757 | url=http://scholar.google.com/scholar?hl=en&lr=&q=cache:IVXo29ZXQdkJ:www.thejns-net.org/jns/issues/v99n1/pdf/n0990143.pdf+author:%22Prange%22+intitle:%22Anthropomorphic+simulations+of+falls,+shakes,+and+...%22}}</ref><!-- | --><ref name="Prange">{{cite journal | author = Prange M, Coats B, Duhaime A, Margulies S | title = Anthropomorphic simulations of falls, shakes, and inflicted impacts in infants. | journal = J Neurosurg | volume = 99 | issue = 1 | pages = 143-50 | year = 2003 | month=Mar | id = PMID 12854757 | url=http://scholar.google.com/scholar?hl=en&lr=&q=cache:IVXo29ZXQdkJ:www.thejns-net.org/jns/issues/v99n1/pdf/n0990143.pdf+author:%22Prange%22+intitle:%22Anthropomorphic+simulations+of+falls,+shakes,+and+...%22}}</ref><!-- | ||
--><ref name="Uscinski">{{cite journal | author=Uscinski R | title=The Shaken Baby Syndrome | journal=J Am Phys Surg | year=2004 | month=Fall | volume=9 | issue=3 | pages=76-7 | url=http://www.jpands.org/vol9no3/uscinski.pdf | format=PDF}}</ref><!-- | --><ref name="Uscinski">{{cite journal | author=Uscinski R | title=The Shaken Baby Syndrome | journal=J Am Phys Surg | year=2004 | month=Fall | volume=9 | issue=3 | pages=76-7 | url=http://www.jpands.org/vol9no3/uscinski.pdf | format=PDF}}</ref><!-- | ||
-- | --><!-- | ||
--><ref name="Bandak">{{cite journal | author = Bandak F | title = Shaken baby syndrome: a biomechanics analysis of injury mechanisms. | journal = Forensic Sci Int | volume = 151 | issue = 1 | pages = 71-9 | year = 2005 | month=June 30 | id = PMID 15885948}}</ref><!-- | --><ref name="Bandak">{{cite journal | author = Bandak F | title = Shaken baby syndrome: a biomechanics analysis of injury mechanisms. | journal = Forensic Sci Int | volume = 151 | issue = 1 | pages = 71-9 | year = 2005 | month=June 30 | id = PMID 15885948}}</ref><!-- | ||
-- | --> | ||
In addition, it has been suggested that severe adverse reactions to vaccinations may be an alternative cause of SBS. <!-- | In addition, it has been suggested that severe adverse reactions to vaccinations may be an alternative cause of SBS. <!-- | ||
-- | --><!-- | ||
-- | --> | ||
==See also== | ==See also== | ||
* Louise Woodward - was famously convicted of killing Matthew Eappen in 1997 by shaking baby syndrome. | |||
* Alan Yurko - sentenced to life in prison + 10 years (1998) without parole for the murder of his son, supposedly due to shaking baby syndrome. "Bad Science" from the ''"Orlando Weekly"'' (2003) [http://www.truthinjustice.org/yurko.htm]. Case was vacated on second appeal and Alan Yurko was subsequently released from prison on August 27, 2004 [http://www.accessmylibrary.com/premium/0286/0286-8540218.html]. Information on Case of Alan Yurko - Shaken Baby Syndrome [http://www.aapsonline.org/judicial/yurko.htm] | *Louise Woodward - was famously convicted of killing Matthew Eappen in 1997 by shaking baby syndrome. | ||
* [[C. Alan B. Clemetson]] | *Alan Yurko - sentenced to life in prison + 10 years (1998) without parole for the murder of his son, supposedly due to shaking baby syndrome. "Bad Science" from the ''"Orlando Weekly"'' (2003) [http://www.truthinjustice.org/yurko.htm]. Case was vacated on second appeal and Alan Yurko was subsequently released from prison on August 27, 2004 [http://www.accessmylibrary.com/premium/0286/0286-8540218.html]. Information on Case of Alan Yurko - Shaken Baby Syndrome [http://www.aapsonline.org/judicial/yurko.htm] | ||
* [[Child abuse]] | *[[C. Alan B. Clemetson]] | ||
*[[Child abuse]] | |||
==Footnotes== | ==Footnotes== | ||
<div class="references-small"><references/></div> | <div class="references-small"> | ||
<references /></div> | |||
===Video=== | ===Video=== | ||
* [http://www.expertdigital.com/shakenbaby.html ExpertDigital.com] - Graphic Demonstration (Windows Media) | |||
*[http://www.expertdigital.com/shakenbaby.html ExpertDigital.com] - Graphic Demonstration (Windows Media) | |||
==Overview== | ==Overview== | ||
| Line 258: | Line 232: | ||
==Classification== | ==Classification== | ||
The modified grading system of abusive head trauma (AHT) is as the following: | |||
{| class="wikitable" | |||
|+ | |||
! colspan="3" |Modified Grading System of Abusive Head Trauma (AHT) | |||
(Modified Table from Khan et al.:Pediatric abusive head trauma and stroke. | |||
J Neurosurg Pediatr 2017;20:183e90. ) | |||
|- | |||
|'''Grade''' | |||
|'''Description''' | |||
|'''Brain Infarction seen on CT or MRI''' | |||
|- | |||
|'''1''' | |||
|Skull fracture alone +/- associated craniofacial soft-tissue injury | |||
| - | |||
|- | |||
|'''2a''' | |||
| | |||
* Intracranial hemorrhage not requiring surgical intervention | |||
or | |||
* Cerebral edema not requiring surgical intervention | |||
|No | |||
|- | |||
|'''2b''' | |||
| | |||
* Intracranial hemorrhage not requiring surgical intervention | |||
or | |||
* Cerebral edema not requiring surgical intervention. | |||
|Yes | |||
|- | |||
|'''3a''' | |||
| | |||
* Intracranial hemorrhage requiring surgery or procedure | |||
or | |||
* Cerebral edema requiring surgery or procedure | |||
or | |||
* Death due to intracranial injuries. | |||
|No | |||
|- | |||
|'''3b''' | |||
| | |||
* Intracranial hemorrhage requiring surgery or procedure | |||
or | |||
* Cerebral edema requiring surgery or procedure | |||
or | |||
* Death due to intracranial injuries. | |||
|Yes | |||
|} | |||
==Pathophysiology== | ==Pathophysiology== | ||
| Line 333: | Line 339: | ||
Shaken baby syndrome must be differentiated from the following conditions:<ref name="pmid23530171">{{cite journal| author=Carpenter SL, Abshire TC, Anderst JD, Section on Hematology/Oncology and Committee on Child Abuse and Neglect of the American Academy of Pediatrics| title=Evaluating for suspected child abuse: conditions that predispose to bleeding. | journal=Pediatrics | year= 2013 | volume= 131 | issue= 4 | pages= e1357-73 | pmid=23530171 | doi=10.1542/peds.2013-0196 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23530171 }} </ref><ref name="pmid7660304">{{cite journal| author=Weissgold DJ, Budenz DL, Hood I, Rorke LB| title=Ruptured vascular malformation masquerading as battered/shaken baby syndrome: a nearly tragic mistake. | journal=Surv Ophthalmol | year= 1995 | volume= 39 | issue= 6 | pages= 509-12 | pmid=7660304 | doi=10.1016/s0039-6257(05)80058-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7660304 }} </ref><ref name="pmid22614777">{{cite journal| author=Agrawal S, Peters MJ, Adams GG, Pierce CM| title=Prevalence of retinal hemorrhages in critically ill children. | journal=Pediatrics | year= 2012 | volume= 129 | issue= 6 | pages= e1388-96 | pmid=22614777 | doi=10.1542/peds.2011-2772 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22614777 }} </ref><ref name="pmid12483361">{{cite journal| author=Nassogne MC, Sharrard M, Hertz-Pannier L, Armengaud D, Touati G, Delonlay-Debeney P | display-authors=etal| title=Massive subdural haematomas in Menkes disease mimicking shaken baby syndrome. | journal=Childs Nerv Syst | year= 2002 | volume= 18 | issue= 12 | pages= 729-31 | pmid=12483361 | doi=10.1007/s00381-002-0630-z | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12483361 }} </ref><ref name="pmid15234150">{{cite journal| author=Ganesh A, Jenny C, Geyer J, Shouldice M, Levin AV| title=Retinal hemorrhages in type I osteogenesis imperfecta after minor trauma. | journal=Ophthalmology | year= 2004 | volume= 111 | issue= 7 | pages= 1428-31 | pmid=15234150 | doi=10.1016/j.ophtha.2003.10.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15234150 }} </ref><ref name="pmid17465389">{{cite journal| author=Bishop FS, Liu JK, McCall TD, Brockmeyer DL| title=Glutaric aciduria type 1 presenting as bilateral subdural hematomas mimicking nonaccidental trauma. Case report and review of the literature. | journal=J Neurosurg | year= 2007 | volume= 106 | issue= 3 Suppl | pages= 222-6 | pmid=17465389 | doi=10.3171/ped.2007.106.3.222 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17465389 }} </ref><ref name="pmid16183447">{{cite journal| author=Brousseau TJ, Kissoon N, McIntosh B| title=Vitamin K deficiency mimicking child abuse. | journal=J Emerg Med | year= 2005 | volume= 29 | issue= 3 | pages= 283-8 | pmid=16183447 | doi=10.1016/j.jemermed.2005.02.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16183447 }} </ref> | Shaken baby syndrome must be differentiated from the following conditions:<ref name="pmid23530171">{{cite journal| author=Carpenter SL, Abshire TC, Anderst JD, Section on Hematology/Oncology and Committee on Child Abuse and Neglect of the American Academy of Pediatrics| title=Evaluating for suspected child abuse: conditions that predispose to bleeding. | journal=Pediatrics | year= 2013 | volume= 131 | issue= 4 | pages= e1357-73 | pmid=23530171 | doi=10.1542/peds.2013-0196 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23530171 }} </ref><ref name="pmid7660304">{{cite journal| author=Weissgold DJ, Budenz DL, Hood I, Rorke LB| title=Ruptured vascular malformation masquerading as battered/shaken baby syndrome: a nearly tragic mistake. | journal=Surv Ophthalmol | year= 1995 | volume= 39 | issue= 6 | pages= 509-12 | pmid=7660304 | doi=10.1016/s0039-6257(05)80058-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7660304 }} </ref><ref name="pmid22614777">{{cite journal| author=Agrawal S, Peters MJ, Adams GG, Pierce CM| title=Prevalence of retinal hemorrhages in critically ill children. | journal=Pediatrics | year= 2012 | volume= 129 | issue= 6 | pages= e1388-96 | pmid=22614777 | doi=10.1542/peds.2011-2772 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22614777 }} </ref><ref name="pmid12483361">{{cite journal| author=Nassogne MC, Sharrard M, Hertz-Pannier L, Armengaud D, Touati G, Delonlay-Debeney P | display-authors=etal| title=Massive subdural haematomas in Menkes disease mimicking shaken baby syndrome. | journal=Childs Nerv Syst | year= 2002 | volume= 18 | issue= 12 | pages= 729-31 | pmid=12483361 | doi=10.1007/s00381-002-0630-z | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12483361 }} </ref><ref name="pmid15234150">{{cite journal| author=Ganesh A, Jenny C, Geyer J, Shouldice M, Levin AV| title=Retinal hemorrhages in type I osteogenesis imperfecta after minor trauma. | journal=Ophthalmology | year= 2004 | volume= 111 | issue= 7 | pages= 1428-31 | pmid=15234150 | doi=10.1016/j.ophtha.2003.10.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15234150 }} </ref><ref name="pmid17465389">{{cite journal| author=Bishop FS, Liu JK, McCall TD, Brockmeyer DL| title=Glutaric aciduria type 1 presenting as bilateral subdural hematomas mimicking nonaccidental trauma. Case report and review of the literature. | journal=J Neurosurg | year= 2007 | volume= 106 | issue= 3 Suppl | pages= 222-6 | pmid=17465389 | doi=10.3171/ped.2007.106.3.222 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17465389 }} </ref><ref name="pmid16183447">{{cite journal| author=Brousseau TJ, Kissoon N, McIntosh B| title=Vitamin K deficiency mimicking child abuse. | journal=J Emerg Med | year= 2005 | volume= 29 | issue= 3 | pages= 283-8 | pmid=16183447 | doi=10.1016/j.jemermed.2005.02.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16183447 }} </ref> | ||
* Accidental [[head trauma]] that may cause: | *Accidental [[head trauma]] that may cause: | ||
** [[Epidural hemorrhage]] | **[[Epidural hemorrhage]] | ||
** [[Subdural hemorrhage]] | **[[Subdural hemorrhage]] | ||
** [[Subarachnoid hemorrhage]] | **[[Subarachnoid hemorrhage]] | ||
** [[Cerebellar]] hemorrhage | **[[Cerebellar]] hemorrhage | ||
** [[Parenchymal]] hemorrhage | **[[Parenchymal]] hemorrhage | ||
* [[Bleeding diathesis]] | *[[Bleeding diathesis]] | ||
* [[Arteriovenous malformation]] | *[[Arteriovenous malformation]] | ||
* [[Stroke]] | *[[Stroke]] | ||
* [[Neoplastic]] conditions | *[[Neoplastic]] conditions | ||
* [[Metabolic disorders]] | *[[Metabolic disorders]] | ||
* [[Glutaric aciduria]] | *[[Glutaric aciduria]] | ||
* [[Vitamin K deficiency]] | *[[Vitamin K deficiency]] | ||
* [[Connective tissue diseases]] | *[[Connective tissue diseases]] | ||
* [[Osteogenesis imperfecta]] | *[[Osteogenesis imperfecta]] | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
* The exact [[incidence]] of shaken baby syndrome/abusive head trauma (AHT) is unknown.<ref name="pmid32330675">{{cite journal| author=Hung KL| title=Pediatric abusive head trauma. | journal=Biomed J | year= 2020 | volume= 43 | issue= 3 | pages= 240-250 | pmid=32330675 | doi=10.1016/j.bj.2020.03.008 | pmc=7424091 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32330675 }} </ref> | |||
* In a population-based study, the [[incidence]] of AHT was reported to be 29.7 cases per 100,000 children younger than one year in the United States.<ref name="pmid12902365">{{cite journal| author=Keenan HT, Runyan DK, Marshall SW, Nocera MA, Merten DF, Sinal SH| title=A population-based study of inflicted traumatic brain injury in young children. | journal=JAMA | year= 2003 | volume= 290 | issue= 5 | pages= 621-6 | pmid=12902365 | doi=10.1001/jama.290.5.621 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12902365 }} </ref> | *The exact [[incidence]] of shaken baby syndrome/abusive head trauma (AHT) is unknown.<ref name="pmid32330675">{{cite journal| author=Hung KL| title=Pediatric abusive head trauma. | journal=Biomed J | year= 2020 | volume= 43 | issue= 3 | pages= 240-250 | pmid=32330675 | doi=10.1016/j.bj.2020.03.008 | pmc=7424091 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32330675 }} </ref> | ||
* In another study, the [[incidence]] of AHT was reported to be 24.6 cases per 100,000 children younger than one year in Scotland.<ref name="pmid11075773">{{cite journal| author=Barlow KM, Minns RA| title=Annual incidence of shaken impact syndrome in young children. | journal=Lancet | year= 2000 | volume= 356 | issue= 9241 | pages= 1571-2 | pmid=11075773 | doi=10.1016/S0140-6736(00)03130-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11075773 }} </ref> | *In a population-based study, the [[incidence]] of AHT was reported to be 29.7 cases per 100,000 children younger than one year in the United States.<ref name="pmid12902365">{{cite journal| author=Keenan HT, Runyan DK, Marshall SW, Nocera MA, Merten DF, Sinal SH| title=A population-based study of inflicted traumatic brain injury in young children. | journal=JAMA | year= 2003 | volume= 290 | issue= 5 | pages= 621-6 | pmid=12902365 | doi=10.1001/jama.290.5.621 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12902365 }} </ref> | ||
* Shaken baby syndrome/AHT is the leading cause of death due to [[Head injury|head injuries]] in children younger than 2 years, worldwide.<ref name="pmid32330675">{{cite journal| author=Hung KL| title=Pediatric abusive head trauma. | journal=Biomed J | year= 2020 | volume= 43 | issue= 3 | pages= 240-250 | pmid=32330675 | doi=10.1016/j.bj.2020.03.008 | pmc=7424091 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32330675 }} </ref> | *In another study, the [[incidence]] of AHT was reported to be 24.6 cases per 100,000 children younger than one year in Scotland.<ref name="pmid11075773">{{cite journal| author=Barlow KM, Minns RA| title=Annual incidence of shaken impact syndrome in young children. | journal=Lancet | year= 2000 | volume= 356 | issue= 9241 | pages= 1571-2 | pmid=11075773 | doi=10.1016/S0140-6736(00)03130-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11075773 }} </ref> | ||
*Shaken baby syndrome/AHT is the leading cause of death due to [[Head injury|head injuries]] in children younger than 2 years, worldwide.<ref name="pmid32330675">{{cite journal| author=Hung KL| title=Pediatric abusive head trauma. | journal=Biomed J | year= 2020 | volume= 43 | issue= 3 | pages= 240-250 | pmid=32330675 | doi=10.1016/j.bj.2020.03.008 | pmc=7424091 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32330675 }} </ref> | |||
==Risk Factors== | ==Risk Factors== | ||
Common [[risk factors]] in the development of shaken baby syndrome/AHT include factors that increase the risk of [[child abuse]] and may include:<ref name="pmid1959075">{{cite journal| author=Smith JA, Adler RG| title=Children hospitalized with child abuse and neglect: a case-control study. | journal=Child Abuse Negl | year= 1991 | volume= 15 | issue= 4 | pages= 437-45 | pmid=1959075 | doi=10.1016/0145-2134(91)90027-b | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1959075 }} </ref><ref name="pmid19034044">{{cite journal| author=Catherine NL, Ko JJ, Barr RG| title=Getting the word out: advice on crying and colic in popular parenting magazines. | journal=J Dev Behav Pediatr | year= 2008 | volume= 29 | issue= 6 | pages= 508-11 | pmid=19034044 | doi=10.1097/DBP.0b013e31818d0c0c | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19034044 }} </ref><ref name="pmid23535075">{{cite journal| author=Niederkrotenthaler T, Xu L, Parks SE, Sugerman DE| title=Descriptive factors of abusive head trauma in young children--United States, 2000-2009. | journal=Child Abuse Negl | year= 2013 | volume= 37 | issue= 7 | pages= 446-55 | pmid=23535075 | doi=10.1016/j.chiabu.2013.02.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23535075 }} </ref><ref name="pmid53080">{{cite journal| author=Smith SM, Hanson R| title=Interpersonal relationships and child-rearing practices in 214 parents of battered children. | journal=Br J Psychiatry | year= 1975 | volume= 127 | issue= | pages= 513-25 | pmid=53080 | doi=10.1192/bjp.127.6.513 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=53080 }} </ref><ref name="pmid4075043">{{cite journal| author=Oliver JE| title=Successive generations of child maltreatment: social and medical disorders in the parents. | journal=Br J Psychiatry | year= 1985 | volume= 147 | issue= | pages= 484-90 | pmid=4075043 | doi=10.1192/bjp.147.5.484 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4075043 }} </ref><ref name="pmid4005662">{{cite journal| author=Benedict MI, White RB, Cornely DA| title=Maternal perinatal risk factors and child abuse. | journal=Child Abuse Negl | year= 1985 | volume= 9 | issue= 2 | pages= 217-24 | pmid=4005662 | doi=10.1016/0145-2134(85)90014-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4005662 }} </ref><ref name="pmid710189">{{cite journal| author=Garbarino J, Crouter A| title=Defining the comminity context for parent-child relations: the correlates of child maltreatment. | journal=Child Dev | year= 1978 | volume= 49 | issue= 3 | pages= 604-16 | pmid=710189 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=710189 }} </ref><ref name="pmid8591089">{{cite journal| author=Muller RT, Hunter JE, Stollak G| title=The intergenerational transmission of corporal punishment: a comparison of social learning and temperament models. | journal=Child Abuse Negl | year= 1995 | volume= 19 | issue= 11 | pages= 1323-35 | pmid=8591089 | doi=10.1016/0145-2134(95)00103-f | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8591089 }} </ref> | Common [[risk factors]] in the development of shaken baby syndrome/AHT include factors that increase the risk of [[child abuse]] and may include:<ref name="pmid1959075">{{cite journal| author=Smith JA, Adler RG| title=Children hospitalized with child abuse and neglect: a case-control study. | journal=Child Abuse Negl | year= 1991 | volume= 15 | issue= 4 | pages= 437-45 | pmid=1959075 | doi=10.1016/0145-2134(91)90027-b | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1959075 }} </ref><ref name="pmid19034044">{{cite journal| author=Catherine NL, Ko JJ, Barr RG| title=Getting the word out: advice on crying and colic in popular parenting magazines. | journal=J Dev Behav Pediatr | year= 2008 | volume= 29 | issue= 6 | pages= 508-11 | pmid=19034044 | doi=10.1097/DBP.0b013e31818d0c0c | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19034044 }} </ref><ref name="pmid23535075">{{cite journal| author=Niederkrotenthaler T, Xu L, Parks SE, Sugerman DE| title=Descriptive factors of abusive head trauma in young children--United States, 2000-2009. | journal=Child Abuse Negl | year= 2013 | volume= 37 | issue= 7 | pages= 446-55 | pmid=23535075 | doi=10.1016/j.chiabu.2013.02.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23535075 }} </ref><ref name="pmid53080">{{cite journal| author=Smith SM, Hanson R| title=Interpersonal relationships and child-rearing practices in 214 parents of battered children. | journal=Br J Psychiatry | year= 1975 | volume= 127 | issue= | pages= 513-25 | pmid=53080 | doi=10.1192/bjp.127.6.513 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=53080 }} </ref><ref name="pmid4075043">{{cite journal| author=Oliver JE| title=Successive generations of child maltreatment: social and medical disorders in the parents. | journal=Br J Psychiatry | year= 1985 | volume= 147 | issue= | pages= 484-90 | pmid=4075043 | doi=10.1192/bjp.147.5.484 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4075043 }} </ref><ref name="pmid4005662">{{cite journal| author=Benedict MI, White RB, Cornely DA| title=Maternal perinatal risk factors and child abuse. | journal=Child Abuse Negl | year= 1985 | volume= 9 | issue= 2 | pages= 217-24 | pmid=4005662 | doi=10.1016/0145-2134(85)90014-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4005662 }} </ref><ref name="pmid710189">{{cite journal| author=Garbarino J, Crouter A| title=Defining the comminity context for parent-child relations: the correlates of child maltreatment. | journal=Child Dev | year= 1978 | volume= 49 | issue= 3 | pages= 604-16 | pmid=710189 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=710189 }} </ref><ref name="pmid8591089">{{cite journal| author=Muller RT, Hunter JE, Stollak G| title=The intergenerational transmission of corporal punishment: a comparison of social learning and temperament models. | journal=Child Abuse Negl | year= 1995 | volume= 19 | issue= 11 | pages= 1323-35 | pmid=8591089 | doi=10.1016/0145-2134(95)00103-f | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8591089 }} </ref> | ||
* Infantile colic | |||
* Inconsolable cry | *Infantile colic | ||
* Child [[Disability]] | *Inconsolable cry | ||
* Lack of parental frustration tolerance | *Child [[Disability]] | ||
* Lack of prenatal and childcare experience | *Lack of parental frustration tolerance | ||
* Low education level | *Lack of prenatal and childcare experience | ||
* Low socioeconomic status | *Low education level | ||
* Single-parent families | *Low socioeconomic status | ||
* Young parents without support | *Single-parent families | ||
* Community isolation | *Young parents without support | ||
* Limited recreational facilities | *Community isolation | ||
* Poverty | *Limited recreational facilities | ||
*Poverty | |||
==Screening== | ==Screening== | ||
| Line 395: | Line 403: | ||
===Clinical Evaluation=== | ===Clinical Evaluation=== | ||
The clinical work-up of shaken baby syndrome should include:<ref name="pmid32330675">{{cite journal| author=Hung KL| title=Pediatric abusive head trauma. | journal=Biomed J | year= 2020 | volume= 43 | issue= 3 | pages= 240-250 | pmid=32330675 | doi=10.1016/j.bj.2020.03.008 | pmc=7424091 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32330675 }} </ref> | The clinical work-up of shaken baby syndrome should include:<ref name="pmid32330675">{{cite journal| author=Hung KL| title=Pediatric abusive head trauma. | journal=Biomed J | year= 2020 | volume= 43 | issue= 3 | pages= 240-250 | pmid=32330675 | doi=10.1016/j.bj.2020.03.008 | pmc=7424091 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32330675 }} </ref> | ||
* Comprehensive history | |||
* [[Physical examination]] | *Comprehensive history | ||
* [[Laboratory]] tests | *[[Physical examination]] | ||
* [[Imaging]] | *[[Laboratory]] tests | ||
* [[Consultation]] with specialists | *[[Imaging]] | ||
*[[Consultation]] with specialists | |||
===History and Symptoms=== | ===History and Symptoms=== | ||
| Line 406: | Line 415: | ||
The following should be considered in the history of shaken baby syndrome/AHT:<ref name="pmid32330675">{{cite journal| author=Hung KL| title=Pediatric abusive head trauma. | journal=Biomed J | year= 2020 | volume= 43 | issue= 3 | pages= 240-250 | pmid=32330675 | doi=10.1016/j.bj.2020.03.008 | pmc=7424091 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32330675 }} </ref> | The following should be considered in the history of shaken baby syndrome/AHT:<ref name="pmid32330675">{{cite journal| author=Hung KL| title=Pediatric abusive head trauma. | journal=Biomed J | year= 2020 | volume= 43 | issue= 3 | pages= 240-250 | pmid=32330675 | doi=10.1016/j.bj.2020.03.008 | pmc=7424091 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32330675 }} </ref> | ||
* Open-ended questions should be asked by [[physicians]] | |||
* Caretakers should be interviewed separately | *Open-ended questions should be asked by [[physicians]] | ||
* An inconsistent or changing history may suggest AHT or [[child abuse]] | *Caretakers should be interviewed separately | ||
* The most common history suggestive of abusive head trauma (AHT) are: | *An inconsistent or changing history may suggest AHT or [[child abuse]] | ||
** History of non-accidental [[trauma]] | *The most common history suggestive of abusive head trauma (AHT) are: | ||
** History of falling from a low height | **History of non-accidental [[trauma]] | ||
**History of falling from a low height | |||
'''Symptoms''' | '''Symptoms''' | ||
Symptoms of shaken baby syndrome/AHT may include:<ref name="pmid32330675">{{cite journal| author=Hung KL| title=Pediatric abusive head trauma. | journal=Biomed J | year= 2020 | volume= 43 | issue= 3 | pages= 240-250 | pmid=32330675 | doi=10.1016/j.bj.2020.03.008 | pmc=7424091 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32330675 }} </ref> | Symptoms of shaken baby syndrome/AHT may include:<ref name="pmid32330675">{{cite journal| author=Hung KL| title=Pediatric abusive head trauma. | journal=Biomed J | year= 2020 | volume= 43 | issue= 3 | pages= 240-250 | pmid=32330675 | doi=10.1016/j.bj.2020.03.008 | pmc=7424091 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32330675 }} </ref> | ||
* [[Vomiting]] | |||
* [[Poor feeding]] | *[[Vomiting]] | ||
* Decreased interaction | *[[Poor feeding]] | ||
* [[Irritability]] | *Decreased interaction | ||
* [[Sleepiness]] and [[lethargy]] | *[[Irritability]] | ||
* [[Hypothermia]] | *[[Sleepiness]] and [[lethargy]] | ||
* [[Bradycardia]] | *[[Hypothermia]] | ||
* [[Respiratory distress]] | *[[Bradycardia]] | ||
* [[Apnea]] | *[[Respiratory distress]] | ||
* [[Seizures]] | *[[Apnea]] | ||
*[[Seizures]] | |||
===Physical Examination=== | ===Physical Examination=== | ||
The following [[signs]] should be considered on the [[physical examination]] of shaken baby syndrome/AHT:<ref name="pmid32330675">{{cite journal| author=Hung KL| title=Pediatric abusive head trauma. | journal=Biomed J | year= 2020 | volume= 43 | issue= 3 | pages= 240-250 | pmid=32330675 | doi=10.1016/j.bj.2020.03.008 | pmc=7424091 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32330675 }} </ref> | The following [[signs]] should be considered on the [[physical examination]] of shaken baby syndrome/AHT:<ref name="pmid32330675">{{cite journal| author=Hung KL| title=Pediatric abusive head trauma. | journal=Biomed J | year= 2020 | volume= 43 | issue= 3 | pages= 240-250 | pmid=32330675 | doi=10.1016/j.bj.2020.03.008 | pmc=7424091 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32330675 }} </ref> | ||
* Decreased level of [[consciousness]] | *Decreased level of [[consciousness]] | ||
* [[Cardiovascular collapse]] | *[[Cardiovascular collapse]] | ||
* Bulging [[fontanel]] | *Bulging [[fontanel]] | ||
* [[Hydrocephalus]] | *[[Hydrocephalus]] | ||
* [[Microcephaly]] | *[[Microcephaly]] | ||
* [[Subdural hematoma]] | *[[Subdural hematoma]] | ||
* [[Retinal]] hemorrhages | *[[Retinal]] hemorrhages | ||
* [[Fractures]] in [[long bone]], [[metaphysis]], and [[rib]] | *[[Fractures]] in [[long bone]], [[metaphysis]], and [[rib]] | ||
* Lack of external [[injury]] | *Lack of external [[injury]] | ||
* Bruises ([[ears]], [[neck]], or [[trunk]]) | *Bruises ([[ears]], [[neck]], or [[trunk]]) | ||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
| Line 445: | Line 456: | ||
Laboratory tests for shaken baby syndrome should include:<ref name="pmid32330675">{{cite journal| author=Hung KL| title=Pediatric abusive head trauma. | journal=Biomed J | year= 2020 | volume= 43 | issue= 3 | pages= 240-250 | pmid=32330675 | doi=10.1016/j.bj.2020.03.008 | pmc=7424091 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32330675 }} </ref> | Laboratory tests for shaken baby syndrome should include:<ref name="pmid32330675">{{cite journal| author=Hung KL| title=Pediatric abusive head trauma. | journal=Biomed J | year= 2020 | volume= 43 | issue= 3 | pages= 240-250 | pmid=32330675 | doi=10.1016/j.bj.2020.03.008 | pmc=7424091 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32330675 }} </ref> | ||
* [[Complete blood cell count|Complete blood cell count (CBC)]] with [[platelet]] count | *[[Complete blood cell count|Complete blood cell count (CBC)]] with [[platelet]] count | ||
* [[Prothrombin time (PT)]] | *[[Prothrombin time (PT)]] | ||
* [[Partial thromboplastin time|Partial thromboplastin time (PTT)]] | *[[Partial thromboplastin time|Partial thromboplastin time (PTT)]] | ||
* Chemistry panel | *Chemistry panel | ||
* [[Aspartate aminotransferase|Aspartate aminotransferase (AST)]] | *[[Aspartate aminotransferase|Aspartate aminotransferase (AST)]] | ||
* [[Alanine aminotransferase |Alanine aminotransferase (ALT)]] | *[[Alanine aminotransferase |Alanine aminotransferase (ALT)]] | ||
* [[Amylase]] | *[[Amylase]] | ||
* [[Lipase]] | *[[Lipase]] | ||
* [[Urinalysis]] | *[[Urinalysis]] | ||
===Electrocardiogram=== | ===Electrocardiogram=== | ||
| Line 460: | Line 471: | ||
===X-ray=== | ===X-ray=== | ||
There are no specific [[x-ray]] findings associated with shaken baby syndrome, however, in order to identify [[child abuse]] in children aged less than two years with unexplained [[trauma]], a [[skeletal]] survey should be performed with [[Radiograph|radiographs]] of the:<ref name="pmid32330675">{{cite journal| author=Hung KL| title=Pediatric abusive head trauma. | journal=Biomed J | year= 2020 | volume= 43 | issue= 3 | pages= 240-250 | pmid=32330675 | doi=10.1016/j.bj.2020.03.008 | pmc=7424091 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32330675 }} </ref> | There are no specific [[x-ray]] findings associated with shaken baby syndrome, however, in order to identify [[child abuse]] in children aged less than two years with unexplained [[trauma]], a [[skeletal]] survey should be performed with [[Radiograph|radiographs]] of the:<ref name="pmid32330675">{{cite journal| author=Hung KL| title=Pediatric abusive head trauma. | journal=Biomed J | year= 2020 | volume= 43 | issue= 3 | pages= 240-250 | pmid=32330675 | doi=10.1016/j.bj.2020.03.008 | pmc=7424091 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32330675 }} </ref> | ||
* [[Skull]] | |||
* [[Spine]] | *[[Skull]] | ||
* [[Ribs]] | *[[Spine]] | ||
* [[Long bones]] | *[[Ribs]] | ||
*[[Long bones]] | |||
===Echocardiography or Ultrasound=== | ===Echocardiography or Ultrasound=== | ||
| Line 470: | Line 482: | ||
===CT scan=== | ===CT scan=== | ||
Noncontrast [[head]] [[CT]] is the initial radiologic workup for evaluating [[intracranial injury]] due to abusive head trauma (AHT).<ref name="pmid32330675">{{cite journal| author=Hung KL| title=Pediatric abusive head trauma. | journal=Biomed J | year= 2020 | volume= 43 | issue= 3 | pages= 240-250 | pmid=32330675 | doi=10.1016/j.bj.2020.03.008 | pmc=7424091 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32330675 }} </ref><ref name="pmid16882816">{{cite journal| author=Tung GA, Kumar M, Richardson RC, Jenny C, Brown WD| title=Comparison of accidental and nonaccidental traumatic head injury in children on noncontrast computed tomography. | journal=Pediatrics | year= 2006 | volume= 118 | issue= 2 | pages= 626-33 | pmid=16882816 | doi=10.1542/peds.2006-0130 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16882816 }} </ref> [[CT]] is helpful in detecting:<ref name="pmid16882816">{{cite journal| author=Tung GA, Kumar M, Richardson RC, Jenny C, Brown WD| title=Comparison of accidental and nonaccidental traumatic head injury in children on noncontrast computed tomography. | journal=Pediatrics | year= 2006 | volume= 118 | issue= 2 | pages= 626-33 | pmid=16882816 | doi=10.1542/peds.2006-0130 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16882816 }} </ref> | Noncontrast [[head]] [[CT]] is the initial radiologic workup for evaluating [[intracranial injury]] due to abusive head trauma (AHT).<ref name="pmid32330675">{{cite journal| author=Hung KL| title=Pediatric abusive head trauma. | journal=Biomed J | year= 2020 | volume= 43 | issue= 3 | pages= 240-250 | pmid=32330675 | doi=10.1016/j.bj.2020.03.008 | pmc=7424091 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32330675 }} </ref><ref name="pmid16882816">{{cite journal| author=Tung GA, Kumar M, Richardson RC, Jenny C, Brown WD| title=Comparison of accidental and nonaccidental traumatic head injury in children on noncontrast computed tomography. | journal=Pediatrics | year= 2006 | volume= 118 | issue= 2 | pages= 626-33 | pmid=16882816 | doi=10.1542/peds.2006-0130 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16882816 }} </ref> [[CT]] is helpful in detecting:<ref name="pmid16882816">{{cite journal| author=Tung GA, Kumar M, Richardson RC, Jenny C, Brown WD| title=Comparison of accidental and nonaccidental traumatic head injury in children on noncontrast computed tomography. | journal=Pediatrics | year= 2006 | volume= 118 | issue= 2 | pages= 626-33 | pmid=16882816 | doi=10.1542/peds.2006-0130 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16882816 }} </ref> | ||
* [[Skull fracture]] | |||
* [[Intracranial hemorrhage]] | *[[Skull fracture]] | ||
* [[Ischemic]] changes | *[[Intracranial hemorrhage]] | ||
* [[Brain edema]] | *[[Ischemic]] changes | ||
*[[Brain edema]] | |||
===MRI=== | ===MRI=== | ||
[[MRI]] may be helpful in:<ref name="pmid10447132">{{cite journal| author=Barlow KM, Gibson RJ, McPhillips M, Minns RA| title=Magnetic resonance imaging in acute non-accidental head injury. | journal=Acta Paediatr | year= 1999 | volume= 88 | issue= 7 | pages= 734-40 | pmid=10447132 | doi=10.1080/08035259950169017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10447132 }} </ref> | [[MRI]] may be helpful in:<ref name="pmid10447132">{{cite journal| author=Barlow KM, Gibson RJ, McPhillips M, Minns RA| title=Magnetic resonance imaging in acute non-accidental head injury. | journal=Acta Paediatr | year= 1999 | volume= 88 | issue= 7 | pages= 734-40 | pmid=10447132 | doi=10.1080/08035259950169017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10447132 }} </ref> | ||
* Detecting [[subacute]] and [[chronic]] subdural bleeding | |||
* Evaluating the extent of [[injuries]] in the [[parenchyma]] | *Detecting [[subacute]] and [[chronic]] subdural bleeding | ||
* Differentiating [[chronic]] subdural from [[subarachnoid]] collections | *Evaluating the extent of [[injuries]] in the [[parenchyma]] | ||
*Differentiating [[chronic]] subdural from [[subarachnoid]] collections | |||
===Other Imaging Findings=== | ===Other Imaging Findings=== | ||
Revision as of 12:08, 10 September 2020
For patient information click here
| Shaken baby syndrome | |
| ICD-9 | 995.55 |
|---|---|
| MedlinePlus | 000004 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Shaken baby syndrome (SBS) is a form of child abuse that is thought to occur when an abuser violently shakes an infant or small child, creating a whiplash-type motion that causes acceleration-deceleration injuries. The injury is estimated to affect between 1,200 and 1,600 children every year in the USA. A remarkable feature of SBS is the typical lack of external evidence of trauma. The combination of shaking with striking of the infant against a hard object is sometimes termed the shaken impact syndrome.
The concept of SBS was initially described in the early 1970s, based on a theory and a wide variety of circumstances by Dr. John Caffey, a radiologist, as well as Dr. Norman Guthkelch, a neurosurgeon.
SBS, a major cause of mortality in infants, is often fatal and can produce lifelong disability from neurological damage. Up to 50% of deaths related to child abuse are reportedly due to shaken baby syndrome. About 25% to 30% of infant victims with SBS die from their injuries.[citation needed] Nonfatal consequences of SBS include varying degrees of visual impairment (e.g., blindness), motor impairment (e.g. cerebral palsy) and cognitive impairments.
Signs and symptoms
The signs associated with inflicted SBS include retinal hemorrhages, petechiae (small, pinpoint hemorrhages) on the body or face, multiple fractures of the long bones, and subdural hematomas. These signs have evolved through the years as the accepted and recognized signs of child abuse and the shaken baby syndrome. Additional effects of SBS are diffuse axonal injury, oxygen deprivation and swelling of the brain, which can raise intracranial pressure and damage delicate brain tissue.
Most victims of SBS are under one year old. Victims of SBS may display irritability, failure to thrive, alterations in eating patterns, lethargy, vomiting, seizures, bulging or tense fontanels, increased size of the head, altered respirations, and dilated pupils. Medical professionals strongly suspect shaking as the cause of injuries when a baby or small child presents with retinal hemorrhage, fractures, soft tissue injuries or subdural hematoma, that cannot be explained by accidental trauma or other medical conditions. No alternative condition mimics all of the symptoms of SBS exactly, but those that must be ruled out include hydrocephalus, sudden infant death syndrome (SIDS), seizure disorders, and infectious or congenital diseases like meningitis and metabolic disorders.
Fractures of the vertebrae and ribs may also be associated with SBS. Although several bone disorders may also cause increased vulnerability to fractures, they can be distinguished from inflicted trauma by other characteristic alterations of the bones, by gene tests, and by the absence of corroborative evidence of abuse. The principal disorders known to cause increased susceptibility to fracture without other obvious evidence of bone abnormality are the various moderate-severity forms of osteogenesis imperfecta. Although bone disease of prematurity, rickets due to vitamin D deficiency, Scurvy (vitamin C deficiency), copper deficiency and Menkes disease can increase fracture susceptibility, the bone disease is accompanied by additional evidence allowing it to be easily distinguished from abuse in nearly all cases. In addition to Barlow's Disease or scurvy, a number of medical conditions, including malformations, premature infants, can mimic SBS, even before birth.[1]
Examination by an experienced ophthalmologist is often critical in diagnosing shaken baby syndrome, as particular forms of ocular bleeding are quite characteristic of this condition.
Some medical experts assert that "no case studies have ever been undertaken to probe even a partial list of possible confounding variables/phenomena, such as the presence of intracranial cysts or fluid collections, hydrocephalus, congenital and inherited diseases, infection, coagulation disorders and venous thrombosis, recent immunizations," medications, birth-related brain injuries, "or recent or remote head trauma. Until and unless these and probably many more factors are evaluated, it is inappropriate to select one mechanism only and ignore the rest of the potential causes."
In 2005, a review of several ophthalmology studies and their findings concerning "inflicted childhood neurotrauma" (SBS) was published in the UK, in the quarterly ophthalmology publication Focus. One of the studies "found a correlation between intra-ocular bleeding, anterior optic nerve haemorrhage and subdural haematomas. Post mortem findings of vitreous traction at the apex of retinal folds and the edge of dome shaped haemorrhages and retinoschisis gives some supporting evidence that vitreous forces may cause this shearing damage. There is no adequate model to test this experimentally, so this remains hypothesis, not established fact."
The main scientific finding of two additional studies from the Focus article "was that in cases of retinal haemorrhages with thin film subdurals and in the absence of other injuries that the pathological finding is more commonly that of hypoxic ischaemic encephalopathy rather than diffuse axonal injury. Regardless of the recent debate the observational evidence to date remains that children with non accidental injury may have no visible retinal haemorrhages, whilst non accidental injury and birth are the only circumstances in which multiple retinal haemorrhages in differing layers of the retina have been accurately documented."[2]
The following references documented cases of retinal hemorrhages from accidental head trauma a videotaped minor fall, osteogenesis imperfecta indicating that shaking is not the only possible cause of injury. According to one author, "the presence of retinal hemorrhages is neither necessary nor sufficient for the diagnosis of child abuse." A postvaccinial ocular syndrome was reported as early as 1948, recent papers have been published concerning the occlusion of central retinal vein after hepatitis B vaccination, "The compounding effects of anoxia or hypoxia, anemia, thrombocytopenia, mild coagulopathy, obstruction of retinal venous flow, or possible age-related anatomic variations in the retinal vasculature are not well understood."
Anatomy and pathophysiology
People under the age of three years are especially susceptible to brain damage from shaking.[3] This is due to several anatomical factors. Their heads are bigger and weigh more with respect to their bodies than adults' heads, and their neck muscles are weak and cannot prevent violent motions. Infants' brains are not myelinated; myelin sheaths form in childhood and are complete in adolescence. The brain water content is reduced as neurons gain myelin during development, so babies have a greater percentage of brain water than adults do. Because of this higher water content, children's brains are softer and are much more susceptible to acceleration-deceleration injuries and diffuse axonal injury.[4]
Rotation injury is especially damaging and likely to occur in shaking trauma.[5] The type of injuries caused by shaking injury are usually not caused by falls and impacts from normal play, which are mostly linear forces.[5]
Rotation injury is also referred to as diffuse axonal injury (DAI). A report in 2001, reviewed the brains of 37 infants aged 9 months or less, all of whom died from inflicted head injuries, and 14 control infants who died of other causes. Axonal damage was identified using immunohistochemistry for ß-amyloid precursor protein. The observation that the predominant histological abnormality in cases of inflicted head injury in the very young is diffuse hypoxic brain damage, not DAI, can be explained in one of two ways: either the unmyelinated axon of the immature cerebral hemispheres is relatively resistant to traumatic damage, or in shaking-type injuries the brain is not exposed to the forces necessary to produce DAI.[6] Apparently a critical point was missed or overlooked in a paper published in 1968 concerning the results of bioengineering study in conjunction with the U.S. Department of Transportation. This experiment showed, qualitatively, that rotation alone could indeed produce intracranial injury, though it was not shown quantitatively that human beings could generate the required rotational acceleration by manual shaking. This critical omission was not addressed until 19 years later, when it was shown quantitatively that impact was required to generate adequate force. Guthkelch, Caffey, and others either were not aware of, or disregarded, this critical missing piece of information. In the intervening years, and even up to the present, numerous references are made to infants sustaining inflicted brain injury by manual shaking. Yet no laboratory proof of this possibility has ever been put forth. In fact, the available experimental evidence began as far back as 1943, addressed directly in 1987 and reproduced in 2003, seems to indicate the contrary.
"The assessment of the mechanical causation of injury requires training and experience in Injury Biomechanics, a distinct discipline not taught in medical school. Lack of education and experience in Injury Biomechanics, amongst other factors, has led in practice to the proliferation and propagation of inaccurate and sometimes erroneous information on SBS injury mechanisms in the literature." A recent biomechanical experiment in 2005, demonstrated that "forceful shaking can severely injure or kill an infant, this is because the cervical spine would be severely injured and not because subdural hematomas would be caused by high head rotational accelerations. Furthermore, shaking cervical spine injury can occur at much lower levels of head velocity and acceleration than those reported for the SBS. These findings are consistent with the physical laws of injury biomechanics as well as our collective understanding of the fragile infant cervical spine from (1) clinical obstetric experience, (2) automotive medicine and crash safety experience, and (3) common parental experience. We have determined that an infant head subjected to the levels of rotational velocity and acceleration called for in the SBS literature, would experience forces on the infant neck far exceeding the limits for structural failure of the cervical spine. Furthermore, shaking cervical spine injury can occur at much lower levels of head velocity and acceleration than those reported for the SBS.
In 2004, a Scottish database collected data for five years on cases of suspected non-accidental head injury diagnosed after a multiagency assessment and included cases with uncoerced confessions of perpetrators and criminal convictions. Several patterns appeared allowing the categorization of the cases into four predominant types: Hyperacute encephalopathy (6% of all cases); Acute encephalopathy (53% of cases (SBS)); Subacute non-encephalopathic presentation (19% of cases); Chronic extracerebral presentation (22% of cases). Infants can be traumatically injured in many ways, and many instances are unwitnessed. Thus the generic term non-accidental head injury or inflicted traumatic brain injury is occasionally used in preference to shaken baby syndrome, which implies a specific mechanism of injury. An earlier detailed neuropathological study was publish in the UK in 2001, which included immunocytochemistry for microscopic damage.[7]
Prognosis
SBS kills about one third of its victims and permanently and severely disables another third.[5] Problems resulting from SBS include learning disabilities, seizure disorders, speech disability, hydrocephalus, behavioral problems, cerebral palsy, and visual disorders.[5]
Prevention
Prevention is similar to the prevention of child abuse in general. New parents, babysitters, and other caregivers should be warned about the dangers of shaking infants. Crying is a common trigger for creating irritation and frustration in the caregiver. Some experts have advised that caregivers need strategies to cope with their own frustrations; for example, they should be reminded that they are not always responsible when babies cry.
SBS as a medicolegal concept
The legal import of shaken baby syndrome varies according to circumstances, often involving child welfare and criminal investigations. Such investigations determine whether children are judged safe to remain in their parents / caregivers' care, and whether an individual may be charged with assault, child endangerment, or homicide.
Since the inception of "whiplash shaking" evolving into SBS, the concept has been the subject of criticism by some scientists and jurists for years.
In April 2006, a Daubert hearing (a mini-trial within a trial, conducted before the judge only, not the jury, over the validity and admissibility of expert opinion testimony) was conducted concerning the admissibility of proposed medical and scientific evidence in a Kentucky Circuit Court case.[8] A Grand Jury had indicted the defendant of first-degree criminal abuse by violently shaking a child. The Defendant alleges that the child's medical records indicate that the only significant injury for the victim was a subdural hematoma and retinal hemorrhaging and there was no significant bruising, fractures, or evidence of impact. The Commonwealth's case was based upon the theory of shaken baby syndrome.
The Court after hearing expert testimony and reviewing the evidence, issued the following conclusion and opinion: "The Court can further conclude that based on the medical signs and symptoms, the clinical medical and scientific research communities are in disagreement as to whether it is possible to determine if a given head injury is due to an accident or abuse. Therefore, the Court finds that because the Daubert test has not been met, neither party can call a witness to give an expert opinion as to whether a child's head injury is due to a shaken baby syndrome when only the child exhibits a subdural hematoma and bilateral ocular bleeding. Either party can call a witness to give an expert opinion as to the cause of the injury being due to shaken baby syndrome, if and only, the child exhibits a subdural hematoma and bilateral ocular bleeding, and any other indicia of abuse present such as long-bone injuries, a fractured skull, bruising, or other indications that abuse has occurred."
The trial court's ruling is not considered binding legal precedent. The Commonwealth of Kentucky has appealed the ruling to the state's intermediate appellate court..
In the Summer of 2006 a review of the Shaken Baby Syndrome and the Shaken Impact Syndrome was published in the Military Law Review. This legal review contains an extensive examination of the divergent views of the scientific literature, in addition to examining the divergent views of the legal parameters involving a trial.
In July of 2005, the Court of Appeals in the United Kingdom reversed or reduced three convictions of SBS, finding that the classic triad of retinal hemorrhage, subdural hematoma, and acute encephalopathy are not 100% diagnostic of SBS and that clinical history is also important. In their ruling, they upheld the clinical concept of SBS but dismissed two cases and reduced the sentence on a third based on their individual merits. In their words: "Whilst a strong pointer to NAHI [non-accidental head injury] on its own we do not think it possible to find that it must automatically and necessarily lead to a diagnosis of NAHI. All the circumstances, including the clinical picture, must be taken into account." The term "non-accidental trauma'" was suggested instead of "SBS" in the March 27, 2004 edition of the British Medical Journal[9]
Alternative hypotheses
An additional, alternative explanation for some incidents contemplated as shaken baby syndrome has been proposed. This explanation suggests that a vitamin C deficiency may sometimes play a role in the pathogenesis of shaken baby syndrome,[10] citing that the current SBS pathology determination may be seriously flawed or incomplete[11] This contested hypothesis is based upon a speculated marginal, near scorbutic condition or lack of essential nutrient(s) repletion and a potential elevated histamine level.[12][13]
The proponents of such hypotheses often question the adequacy of nutrient tissue levels, especially vitamin C, for those children currently or recently ill, bacterial infections, those with higher individual requirements, those suffering from environmental challenges (e.g. allergies), and perhaps transient vaccination related stresses. However, no cases of scurvy mimicking SBS or crib death have been reported, and scurvy typically occurs later in infancy, rarely causes death or intracranial bleeding, and is accompanied by other changes of the bones and skin and invariably an unusually deficient dietary history.
A number of medical personnel recommend that all SBS pathology determinations should include vitamin C repletion history and histamine/vitamin C levels. Additional medical recommendations for the use of vitamins and nutrients as a preventive measure, particularly vitamin C, should be used especially for children with known, projected or suspected stresses/conditions (vaccines) that may deplete certain nutrients.
Although a Barlow’s disease variant (infantile scurvy) may be the most common disease, other diagnoses such as fragile bone disease, hemorrhagic disease of the newborn (vitamin K deficiency) and glutaric aciduria type 1 must also be considered. Gestational problems affecting both mother and fetus, the birthing process, prematurity and nutritional deficits can accelerate skeletal and hemorrhagic pathologies that can also mimic SBS, even before birth.[14][15][1][1][16] These views are not widely known, utilized or explored in conventional medicine. Nevertheless, favorable court rulings[8] and evidentiary commentary on flawed SBS determinations have been demonstrated by biomechanical studies over the years.[17][18][19][20][21]
In addition, it has been suggested that severe adverse reactions to vaccinations may be an alternative cause of SBS.
See also
- Louise Woodward - was famously convicted of killing Matthew Eappen in 1997 by shaking baby syndrome.
- Alan Yurko - sentenced to life in prison + 10 years (1998) without parole for the murder of his son, supposedly due to shaking baby syndrome. "Bad Science" from the "Orlando Weekly" (2003) [2]. Case was vacated on second appeal and Alan Yurko was subsequently released from prison on August 27, 2004 [3]. Information on Case of Alan Yurko - Shaken Baby Syndrome [4]
- C. Alan B. Clemetson
- Child abuse
Footnotes
- ↑ 1.0 1.1 1.2 Williams Obstetrics (2005). "Chapter 29". Diseases and Injuries of the Fetus and Newborn. 22. McGraw-Hill Companies. pp. page 649-691. ISBN 0-07-141315-4.
- ↑
- ↑
- ↑
- ↑ 5.0 5.1 5.2 5.3
- ↑
- ↑ Geddes J, Hackshaw A, Vowles G, Nickols C, Whitwell H (2001). "Neuropathology of inflicted head injury in children. I. Patterns of brain damage". Brain. 124 (Pt 7): 1290–8. PMID 11408324. Unknown parameter
|month=ignored (help) - ↑ 8.0 8.1 Commonwealth Of Kentucky VS. Christopher A. Davis, Greenup Circuit Court CASE NO.04-CR 205
- ↑ Minns R, Busuttil A (2004). "Patterns of presentation of the shaken baby syndrome -- Four types of inflicted brain injury predominate". BMJ. 328: 766. doi:10.1136/bmj.328.7442.766. Unknown parameter
|month=ignored (help)- provides links to Editorials and a Clinical review - ↑ Scheibner V (2001). "Shaken Baby Syndrome Diagnosis on Shaky Ground."" (PDF). “Journal of the Australasian College of Nutritional and Environmental Medicine”. 20 (2): 5–8, 15. Unknown parameter
|month=ignored (help) - ↑
- ↑ Clemetson CAB (2004). "Was it "shaken baby" or a variant of Barlow's disease?" (PDF). J Am Phys Surg". 9: 78–80.
- ↑ Clemetson CAB (2006). "Caffey Revisited: A Commentary on the Origin of "Shaken Baby Syndrome."" (PDF). J Am Phys Surg. 11 (1): 20–1. Unknown parameter
|month=ignored (help) - ↑ Clemetson CAB (2004). "Capillary Fragility as a Cause of Substantial Hemorrhage in Infants."" (PDF). Medical Hypotheses And Research. 1 (2/3): 121–129. Unknown parameter
|month=ignored (help) - ↑ Cushing H (2000). "Reprint of "Concerning Surgical Intervention for the Intracranial Hemorrhages of the New-born" (1905)". Child's Nervous System. 16 (Classics in Pediatric Neurosurgery): 484–492. PMID 11007498.
- ↑ Looney CB, et.al (2007). "Intracranial Hemorrhage in Asymptomatic Neonates: Prevalence on MR Images and Relationship to Obstetric and Neonatal Risk Factors". Radiology. 242: 535–541. PMID 17179400.
- ↑ Ommaya AK, Faas F, Yarnell P (1968). "Whiplash injury and brain damage: an experimental study". JAMA. 22 (204(4)): 285–9. PMID 4967499.
- ↑ Duhaime A, Gennarelli T, Thibault L, Bruce D, Margulies S, Wiser R (1987). "The shaken baby syndrome. A clinical, pathological, and biomechanical study". J Neurosurg. 66 (3): 409–15. PMID 3819836.
- ↑ Prange M, Coats B, Duhaime A, Margulies S (2003). "Anthropomorphic simulations of falls, shakes, and inflicted impacts in infants". J Neurosurg. 99 (1): 143–50. PMID 12854757. Unknown parameter
|month=ignored (help) - ↑ Uscinski R (2004). "The Shaken Baby Syndrome" (PDF). J Am Phys Surg. 9 (3): 76–7. Unknown parameter
|month=ignored (help) - ↑ Bandak F (2005). "Shaken baby syndrome: a biomechanics analysis of injury mechanisms". Forensic Sci Int. 151 (1): 71–9. PMID 15885948. Unknown parameter
|month=ignored (help)
Video
- ExpertDigital.com - Graphic Demonstration (Windows Media)
Overview
Historical Perspective
[Disease name] was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].
The association between [important risk factor/cause] and [disease name] was made in/during [year/event].
In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].
In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].
There have been several outbreaks of [disease name], including -----.
In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].
Classification
The modified grading system of abusive head trauma (AHT) is as the following:
| Modified Grading System of Abusive Head Trauma (AHT)
(Modified Table from Khan et al.:Pediatric abusive head trauma and stroke. J Neurosurg Pediatr 2017;20:183e90. ) | ||
|---|---|---|
| Grade | Description | Brain Infarction seen on CT or MRI |
| 1 | Skull fracture alone +/- associated craniofacial soft-tissue injury | - |
| 2a |
or
|
No |
| 2b |
or
|
Yes |
| 3a |
or
or
|
No |
| 3b |
or
or
|
Yes |
Pathophysiology
The exact pathogenesis of [disease name] is not fully understood.
OR
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
OR
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
OR
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
OR
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
OR
The progression to [disease name] usually involves the [molecular pathway].
OR
The pathophysiology of [disease/malignancy] depends on the histological subtype.
Causes
Disease name] may be caused by [cause1], [cause2], or [cause3].
OR
Common causes of [disease] include [cause1], [cause2], and [cause3].
OR
The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
OR
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click here.
Differentiating Shaken Baby Syndrome from Other Diseases
Shaken baby syndrome must be differentiated from the following conditions:[1][2][3][4][5][6][7]
- Accidental head trauma that may cause:
- Epidural hemorrhage
- Subdural hemorrhage
- Subarachnoid hemorrhage
- Cerebellar hemorrhage
- Parenchymal hemorrhage
- Bleeding diathesis
- Arteriovenous malformation
- Stroke
- Neoplastic conditions
- Metabolic disorders
- Glutaric aciduria
- Vitamin K deficiency
- Connective tissue diseases
- Osteogenesis imperfecta
Epidemiology and Demographics
- The exact incidence of shaken baby syndrome/abusive head trauma (AHT) is unknown.[8]
- In a population-based study, the incidence of AHT was reported to be 29.7 cases per 100,000 children younger than one year in the United States.[9]
- In another study, the incidence of AHT was reported to be 24.6 cases per 100,000 children younger than one year in Scotland.[10]
- Shaken baby syndrome/AHT is the leading cause of death due to head injuries in children younger than 2 years, worldwide.[8]
Risk Factors
Common risk factors in the development of shaken baby syndrome/AHT include factors that increase the risk of child abuse and may include:[11][12][13][14][15][16][17][18]
- Infantile colic
- Inconsolable cry
- Child Disability
- Lack of parental frustration tolerance
- Lack of prenatal and childcare experience
- Low education level
- Low socioeconomic status
- Single-parent families
- Young parents without support
- Community isolation
- Limited recreational facilities
- Poverty
Screening
There is insufficient evidence to recommend routine screening for [disease/malignancy].
OR
According to the [guideline name], screening for [disease name] is not recommended.
OR
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].
Natural History, Complications, and Prognosis
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
OR
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
OR
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
Diagnosis
Clinical Evaluation
The clinical work-up of shaken baby syndrome should include:[8]
- Comprehensive history
- Physical examination
- Laboratory tests
- Imaging
- Consultation with specialists
History and Symptoms
History
The following should be considered in the history of shaken baby syndrome/AHT:[8]
- Open-ended questions should be asked by physicians
- Caretakers should be interviewed separately
- An inconsistent or changing history may suggest AHT or child abuse
- The most common history suggestive of abusive head trauma (AHT) are:
- History of non-accidental trauma
- History of falling from a low height
Symptoms
Symptoms of shaken baby syndrome/AHT may include:[8]
- Vomiting
- Poor feeding
- Decreased interaction
- Irritability
- Sleepiness and lethargy
- Hypothermia
- Bradycardia
- Respiratory distress
- Apnea
- Seizures
Physical Examination
The following signs should be considered on the physical examination of shaken baby syndrome/AHT:[8]
- Decreased level of consciousness
- Cardiovascular collapse
- Bulging fontanel
- Hydrocephalus
- Microcephaly
- Subdural hematoma
- Retinal hemorrhages
- Fractures in long bone, metaphysis, and rib
- Lack of external injury
- Bruises (ears, neck, or trunk)
Laboratory Findings
Laboratory tests for shaken baby syndrome should include:[8]
- Complete blood cell count (CBC) with platelet count
- Prothrombin time (PT)
- Partial thromboplastin time (PTT)
- Chemistry panel
- Aspartate aminotransferase (AST)
- Alanine aminotransferase (ALT)
- Amylase
- Lipase
- Urinalysis
Electrocardiogram
There are no ECG findings associated with shaken baby syndrome.
X-ray
There are no specific x-ray findings associated with shaken baby syndrome, however, in order to identify child abuse in children aged less than two years with unexplained trauma, a skeletal survey should be performed with radiographs of the:[8]
Echocardiography or Ultrasound
There are no echocardiography or ultrasound findings associated with shaken baby syndrome.
CT scan
Noncontrast head CT is the initial radiologic workup for evaluating intracranial injury due to abusive head trauma (AHT).[8][19] CT is helpful in detecting:[19]
MRI
- Detecting subacute and chronic subdural bleeding
- Evaluating the extent of injuries in the parenchyma
- Differentiating chronic subdural from subarachnoid collections
Other Imaging Findings
There are no other imaging findings associated with shaken baby syndrome.
Other Diagnostic Studies
There are no other diagnostic studies associated with shaken baby syndrome.
Treatment
Medical Therapy
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
OR
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
OR
The majority of cases of [disease name] are self-limited and require only supportive care.
OR
[Disease name] is a medical emergency and requires prompt treatment.
OR
The mainstay of treatment for [disease name] is [therapy].
OR The optimal therapy for [malignancy name] depends on the stage at diagnosis.
OR
[Therapy] is recommended among all patients who develop [disease name].
OR
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
OR
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
OR
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
OR
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
Surgery
Surgical intervention is not recommended for the management of [disease name].
OR
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
OR
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
OR
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
OR
Surgery is the mainstay of treatment for [disease or malignancy].
Primary Prevention
There are no established measures for the primary prevention of [disease name].
OR
There are no available vaccines against [disease name].
OR
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
OR
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].
Secondary Prevention
There are no established measures for the secondary prevention of [disease name].
OR
Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].
References
- ↑ Carpenter SL, Abshire TC, Anderst JD, Section on Hematology/Oncology and Committee on Child Abuse and Neglect of the American Academy of Pediatrics (2013). "Evaluating for suspected child abuse: conditions that predispose to bleeding". Pediatrics. 131 (4): e1357–73. doi:10.1542/peds.2013-0196. PMID 23530171.
- ↑ Weissgold DJ, Budenz DL, Hood I, Rorke LB (1995). "Ruptured vascular malformation masquerading as battered/shaken baby syndrome: a nearly tragic mistake". Surv Ophthalmol. 39 (6): 509–12. doi:10.1016/s0039-6257(05)80058-x. PMID 7660304.
- ↑ Agrawal S, Peters MJ, Adams GG, Pierce CM (2012). "Prevalence of retinal hemorrhages in critically ill children". Pediatrics. 129 (6): e1388–96. doi:10.1542/peds.2011-2772. PMID 22614777.
- ↑ Nassogne MC, Sharrard M, Hertz-Pannier L, Armengaud D, Touati G, Delonlay-Debeney P; et al. (2002). "Massive subdural haematomas in Menkes disease mimicking shaken baby syndrome". Childs Nerv Syst. 18 (12): 729–31. doi:10.1007/s00381-002-0630-z. PMID 12483361.
- ↑ Ganesh A, Jenny C, Geyer J, Shouldice M, Levin AV (2004). "Retinal hemorrhages in type I osteogenesis imperfecta after minor trauma". Ophthalmology. 111 (7): 1428–31. doi:10.1016/j.ophtha.2003.10.028. PMID 15234150.
- ↑ Bishop FS, Liu JK, McCall TD, Brockmeyer DL (2007). "Glutaric aciduria type 1 presenting as bilateral subdural hematomas mimicking nonaccidental trauma. Case report and review of the literature". J Neurosurg. 106 (3 Suppl): 222–6. doi:10.3171/ped.2007.106.3.222. PMID 17465389.
- ↑ Brousseau TJ, Kissoon N, McIntosh B (2005). "Vitamin K deficiency mimicking child abuse". J Emerg Med. 29 (3): 283–8. doi:10.1016/j.jemermed.2005.02.009. PMID 16183447.
- ↑ 8.0 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 Hung KL (2020). "Pediatric abusive head trauma". Biomed J. 43 (3): 240–250. doi:10.1016/j.bj.2020.03.008. PMC 7424091 Check
|pmc=value (help). PMID 32330675 Check|pmid=value (help). - ↑ Keenan HT, Runyan DK, Marshall SW, Nocera MA, Merten DF, Sinal SH (2003). "A population-based study of inflicted traumatic brain injury in young children". JAMA. 290 (5): 621–6. doi:10.1001/jama.290.5.621. PMID 12902365.
- ↑ Barlow KM, Minns RA (2000). "Annual incidence of shaken impact syndrome in young children". Lancet. 356 (9241): 1571–2. doi:10.1016/S0140-6736(00)03130-5. PMID 11075773.
- ↑ Smith JA, Adler RG (1991). "Children hospitalized with child abuse and neglect: a case-control study". Child Abuse Negl. 15 (4): 437–45. doi:10.1016/0145-2134(91)90027-b. PMID 1959075.
- ↑ Catherine NL, Ko JJ, Barr RG (2008). "Getting the word out: advice on crying and colic in popular parenting magazines". J Dev Behav Pediatr. 29 (6): 508–11. doi:10.1097/DBP.0b013e31818d0c0c. PMID 19034044.
- ↑ Niederkrotenthaler T, Xu L, Parks SE, Sugerman DE (2013). "Descriptive factors of abusive head trauma in young children--United States, 2000-2009". Child Abuse Negl. 37 (7): 446–55. doi:10.1016/j.chiabu.2013.02.002. PMID 23535075.
- ↑ Smith SM, Hanson R (1975). "Interpersonal relationships and child-rearing practices in 214 parents of battered children". Br J Psychiatry. 127: 513–25. doi:10.1192/bjp.127.6.513. PMID 53080.
- ↑ Oliver JE (1985). "Successive generations of child maltreatment: social and medical disorders in the parents". Br J Psychiatry. 147: 484–90. doi:10.1192/bjp.147.5.484. PMID 4075043.
- ↑ Benedict MI, White RB, Cornely DA (1985). "Maternal perinatal risk factors and child abuse". Child Abuse Negl. 9 (2): 217–24. doi:10.1016/0145-2134(85)90014-6. PMID 4005662.
- ↑ Garbarino J, Crouter A (1978). "Defining the comminity context for parent-child relations: the correlates of child maltreatment". Child Dev. 49 (3): 604–16. PMID 710189.
- ↑ Muller RT, Hunter JE, Stollak G (1995). "The intergenerational transmission of corporal punishment: a comparison of social learning and temperament models". Child Abuse Negl. 19 (11): 1323–35. doi:10.1016/0145-2134(95)00103-f. PMID 8591089.
- ↑ 19.0 19.1 Tung GA, Kumar M, Richardson RC, Jenny C, Brown WD (2006). "Comparison of accidental and nonaccidental traumatic head injury in children on noncontrast computed tomography". Pediatrics. 118 (2): 626–33. doi:10.1542/peds.2006-0130. PMID 16882816.
- ↑ Barlow KM, Gibson RJ, McPhillips M, Minns RA (1999). "Magnetic resonance imaging in acute non-accidental head injury". Acta Paediatr. 88 (7): 734–40. doi:10.1080/08035259950169017. PMID 10447132.
da:Shaken baby syndrom de:Schütteltrauma it:Sindrome del bambino scosso nl:Shaken baby-syndroom fi:Ravistellun vauvan oireyhtymä sv:Shaken baby syndrome
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