A generation of doctors has been taught that Shaken Baby Syndrome (SBS) can be diagnosed definitively by a triad of [1] retinal hemorrhage, [2] meningeal hemorrhage (subdural or subarachnoid) and [3] encephalopathy. SBS, not really syndromic, is unravelling, and has been supplanted by Abusive Head Trauma (AHT) by its proponents. Yet fundamental problems remain with the idea. The physics of angular acceleration provides only 11-12% of that necessary to cause destructive shear force within the brain. The fulcrum around which the brain would rotate is not the center of the head (as in boxing), but inferiorly in the neck, which has been injured in no case of presumptive SBS/AHT. Commonly, there is little to no differential diagnosis by child abuse specialists in court asserting there is only one possible diagnosis: abuse. There are a multitude of causes of the triad. Reperfusion hemorrhage after resuscitation following cardiac arrest accounts for many cases, due to reperfusion of previously hypoxic or ischemic endothelium. SBS and SIDS show a remarkable graphic superposition in month-over-month incidence plots, suggesting resuscitation in SIDS may turn it into SBS if reperfusion hemorrhage occurs. Another mimic of what passes for SBS/AHT is a short fall. Usually innocuous, short falls have a strike velocity of >5 mph from a 12” fall, and 10 mph from a 44” fall and can give rise to fractures and/or subdural hematomas, if the head strikes first. Lucid intervals can occur in young children, but are discounted in SBS/AHT circles. Retinal hemorrhages result from ↑ICP via the valveless venous system transmitting the pressure from the cerebral venous system to retinal veins. Differential diagnosis in law is termed due process, often lacking in SBS/AT cases at trial. The problem is confounded further by false confessions. Research on normal subjects shows that, if given cogent background data and a medical certainty they were guilty, people will admit to a factitious crime they never committed. These multiple, system-wide errors converge to cause incarceration of parents, day care workers and grandparents, presently numbering over 1000 imprisonments. Prosecutions based on the triad continue.
Conflictsof Interest:
None.
