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'{{Infobox disease | Name = Shaken baby syndrome | Image = | Caption = | DiseasesDB = | <!-- no direct topic --> ICD10 = | <!-- no ICD10 code {{ICD10|ICD10Group|Major|minor|Linkcode|Minorlink}} --> ICD9 = {{ICD9|995.55}} | ICDO = | OMIM = | MedlinePlus = 000004 | eMedicineSubj = search | eMedicineTopic = shaken%20infant%20syndrome | MeshID = }} '''Shaken baby syndrome''' ('''SBS''') is a triad of medical symptoms: [[subdural hematoma]], [[retinal hemorrhage]], and [[cerebral edema]] from which some doctors, consistent with current medical understanding, infer [[child abuse]] caused by intentional shaking. In a majority of cases there is no visible sign of external trauma. SBS is often fatal and can cause severe [[brain damage]], resulting in lifelong disability. Estimated death rates ([[mortality rate|mortality]]) among infants with SBS range from 15% to 38%; the median is 20%–25%. Up to half of deaths related to child abuse are reportedly due to shaken baby syndrome.<ref>{{Cite book| author= Montelenone JA, Brodeur AE. | title= Child Maltreatment: A Clinical Guide and Reference | year=1994 | publisher= GW Medical Publishing |location= St Louis}}{{Page needed|date=September 2010}}</ref>{{Failed verification|date=March 2011}} Nonfatal consequences of SBS include varying degrees of visual impairment (including [[blindness]]), motor impairment (e.g. [[cerebral palsy]]) and [[cognitive deficit|cognitive impairment]]s. {{Citation needed|date=June 2009}} ==Signs and symptoms== [[File:Trauma subdural arrow.jpg|right|thumb|[[Subdural hematoma]] (arrow), bleeding between the [[dura mater]] and the brain, commonly occurs in SBS.]] Characteristic injuries associated with SBS include [[retinal hemorrhage]]s, multiple fractures of the long bones, and [[subdural hematoma]]s (bleeding in the brain).<ref name="NINDS_info">{{Cite web|url=http://www.ninds.nih.gov/disorders/shakenbaby/shakenbaby.htm |title=NINDS Shaken Baby Syndrome Information Page |accessdate=2008-06-23 |date=2007-02-14 |publisher=[[National Institute of Neurological Disorders and Stroke]] }}</ref> These signs have evolved through the years as the accepted and recognized signs of child abuse and the shaken baby syndrome. 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. About three quarters of cases involve retinal hemorrhaging.<ref name="Miehl">{{Cite web|url=http://www.medscape.com/viewarticle/515880|title=Shaken Baby Syndrome | accessdate=2011-04-27 | publisher=[[Journal of Forensic Nursing]] }}</ref> Additional effects of SBS are [[diffuse axonal injury]], [[hypoxia (medical)|oxygen deprivation]] and [[cerebral edema|swelling of the brain]],<ref name="Miehl"/> which can raise [[intracranial pressure]] and damage delicate brain tissue. A recent study found the prevalence of retinal hemorrhages in abusive head trauma was 78%, but only 5.3% in nonabusive pediatric head trauma.<ref>[http://www.medscape.com/viewarticle/721141 Medscape] </ref> Victims of SBS may display irritability, [[failure to thrive]], alterations in eating patterns, [[lethargy]], [[vomiting]], [[seizure]]s, bulging or tense [[fontanel]]s (the soft spots on an infant's head), increased size of the head, altered breathing, and dilated [[pupil]]s.<ref name="biausa">[http://www.biausa.org/Pages/types_of_brain_injury.html#shaken Types of brain injury: Shaken baby syndrome]. Brain Injury Association of America. Retrieved on September 24, 2007.</ref> [[Fracture]]s of the [[vertebrae]], [[long bones]], and [[ribs]] may also be associated with SBS.<ref>{{Cite journal|author=Kempe CH, Silverman FN, Steele BF, Droegemueller W, Silver HK |title=The battered-child syndrome |journal=JAMA |volume=181 |issue= |pages=17–24 |year=1962 |month=July |pmid=14455086 |doi=10.1001/jama.1962.03050270019004}}</ref> Dr. John Caffey reported in 1972 that metaphyseal avulsions (small fragments of bone had been torn off where the periosteum covering the bone and the [[cortical bone]] are tightly bound together) and "bones on both the proximal and distal sides of a single joint are affected, especially at the knee".<ref name="Caffey J 1972 161–9"/> ==Mechanism== Rotational injury is especially damaging and likely to occur in shaking trauma.<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.<ref name="Oral"/> It has been suggested that the mechanism of ocular abnormalities is related to vitreoretinal traction, with movement of the [[Vitreous humour|vitreous]] contributing to development of the characteristic retinal hemorrhages. These ocular findings correlate well with intracranial abnormalities.<ref>[http://www.ajo.com/article/S0002-9394(02)01628-8/abstract] Post Mortem Findings </ref> ==Prevention== Prevention is similar to the prevention of [[child abuse]] in general. lol ==Diagnosis== [[File:Hydrocephalus.jpg|thumb|right|[[Hydrocephalus]], an accumulation of [[cerebrospinal fluid]], can accompany SBS.<ref name="Miehl"/> CT scanning is one technique used to diagnose the condition.]] SBS may be misdiagnosed and underdiagnosed, and caregivers may lie or be unaware of the mechanism of injury.<ref name=pmid11433079>{{Cite journal|author= |title=Shaken baby syndrome: rotational cranial injuries-technical report |journal=Pediatrics |volume=108 |issue=1 |pages=206–10 |year=2001 |month=July |pmid=11433079 |doi=10.1542/peds.108.1.206 |author1= American Academy of Pediatrics: Committee on Child Abuse and Neglect}}</ref>{{Failed verification|date=March 2011}} Commonly, there are no externally visible signs of the condition,<ref name=pmid11433079/>{{Failed verification|date=March 2011}}. Examination by an experienced [[ophthalmologist]] is often critical in diagnosing shaken baby syndrome, as particular forms of ocular bleeding are quite characteristic.<!-- --><ref>{{Cite web| author= | title= Shaken Baby Syndrome Resources | url= http://www.aao.org/education/library/statements/shaken_baby.cfm#ocular | work=| publisher= American Academy of Ophthalmology }}</ref> 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.<ref>{{cite journal | author = Togioka BM, Arnold MA, Bathurst MA ''et al.'' | year = 2009 | title = Retinal hemorrhages and shaken baby syndrome: an evidence-based review | url = | journal = J Emerg Med | volume = 37 | issue = | pages = 98–106 }}</ref><!-- --><ref name="Oral">{{Cite web| author=Oral R | title=Intentional head trauma in infants: Shaken baby syndrome | publisher=Virtual Children's Hospital | month=August | year=2003 | url=http://www.vh.org/pediatric/provider/pediatrics/shakenimpactsyndrome/ | archiveurl=http://web.archive.org/web/20050214084615/http://www.vh.org/pediatric/provider/pediatrics/shakenimpactsyndrome/ | archivedate=2005-02-14 | format=Archived | accessdate=2006-10-09}}</ref> [[CT scan]]ning and [[magnetic resonance imaging]] are used to diagnose the condition.<ref name=pmid11433079/>{{Failed verification|date=March 2011}} Conditions that may accompany SBS include [[bone fracture]]s, injury to the [[cervical spine]] (in the neck), hemorrhaging of the [[retina]] (in the eye), [[cerebral hemorrhage]] or [[atrophy]], [[hydrocephalus]], and [[papilledema]] (swelling of the [[optic disc]]).<ref name="Miehl"/> ==Treatment== Treatment involves monitoring of [[intracranial pressure]] (the pressure within the skull), draining of fluid from the [[cerebral ventricles]], and, if an [[intracranial hematoma]] is present, draining of the hematoma.<ref name="Miehl"/> ==Prognosis== Prognosis depends on severity and can range from total recovery to severe disability to death when the injury is severe.<ref name="Miehl"/> One third of these patients die, one third survives with a major neurological condition, and only one third survives in good condition. The most frequent neurological impairments are learning disabilities, seizure disorders, speech disabilities, [[hydrocephalus]], [[cerebral palsy]], and visual disorders.<ref name="Oral"/> ==Epidemiology== Small children are at particularly high risk for the abuse that causes SBS given the large difference in size between the small child and an adult.<ref name=pmid11433079/>{{Failed verification|date=February 2011}} SBS usually occurs in children under the age of two but may occur in those up to age five.<ref name=pmid11433079/>{{Failed verification|date=March 2011}} ==Risk factors== Caregivers that are at risk for becoming abusive often have unrealistic expectations of the child and may display "role reversal", expecting the child to fulfill the needs of the caregiver.<ref name=pmid11433079/>{{Failed verification|date=March 2011}} [[Substance abuse]] and emotional stress, resulting for example from financial troubles, are other risk factors for aggression and impulsiveness in caregivers.<ref name=pmid11433079/>{{Failed verification|date=March 2011}} Both males and females can inflict SBS, but the abusers are more often male.<ref name=pmid11433079/>{{Failed verification|date=March 2011}} Although it had been previously speculated that SBS was an isolated event, a history of prior child abuse is a common finding in cases of SBS.<ref name=pmid11433079/>{{Failed verification|date=March 2011}} In an estimated 33–40% of cases, evidence of prior head injuries, such as old intracranial bleeds, is present.<ref name=pmid11433079/>{{Failed verification|date=March 2011}} ==History== In 1946, the concept of SBS and the term "whiplash shaken infant syndrome" was introduced by Dr. John Caffey, a pediatric radiologist.<ref>http://pediatrics.aappublications.org/cgi/content/abstract/54/4/396</ref> The term described a set of symptoms found with little or no external evidence of head trauma, including retinal hemorrhages and intracranial hemorrhages with subdural or [[Subarachnoid hemorrhage|subarachnoid bleeding]] or both.<ref name="Caffey J 1972 161–9">{{Cite journal|author=Caffey J |title=On the theory and practice of shaking infants. Its potential residual effects of permanent brain damage and mental retardation |journal=American Journal of Diseases of Children |volume=124 |issue=2 |pages=161–9 |year=1972 |month=August |pmid=4559532}}</ref> In 1971, Dr. Norman Guthkelch proposed that [[whiplash injury]] caused subdural hemorrhage in infants by tearing the veins in the subdural space.<ref>{{Cite journal|author=David TJ |title=Shaken baby (shaken impact) syndrome: non-accidental head injury in infancy |journal=Journal of the Royal Society of Medicine |volume=92 |issue=11 |pages=556–61 |year=1999 |month=November |pmid=10703491 |pmc=1297429}}</ref> Development of [[computed tomography]] and [[magnetic resonance imaging]] techniques in the 1970s and 1980s advanced the ability to diagnose the syndrome.<ref name=pmid11433079/>{{Failed verification|date=March 2011}} ===Concerns raised by SBS pioneer=== Dr. Norman Guthkelch stated in 2011,"I don't think that the famous triad, however well some people think it's defined, can ever be so well-defined that you can say that and nothing else cause it — that meaning shaking." He is also concerned by the number of cases similar to one he reviewed in Arizona that he concluded that child likely died of natural causes not SBS stating, "I think I used the expression in my report, 'I wouldn't hang a cat on the evidence of shaking, as presented.' "<ref>http://www.npr.org/2011/06/29/137471992/rethinking-shaken-baby-syndrome</ref> In 2012, Guthkelch went further, publishing an article "after 40 years of consideration," which is harshly critical of shaken baby prosecutions based solely on the triad of injuries.<ref>http://globalwrong.files.wordpress.com/2013/01/guthkelch-an-preface-to-narang-hous-j-health-law-poly-2012.pdf</ref> ==Legal issues== In July 2005, the Court of Appeals in the [[United Kingdom]] heard four appeals of SBS convictions: one case was dropped, the sentence was reduced for one, and two convictions were upheld.<ref name="Leeuw07">{{Cite journal|author=De Leeuw M, Jacobs W |title=Shaken baby syndrome: The classical clinical triad is still valid in recent court rulings |journal=Critical Care |volume= 11|issue=Supplement 2 |page=416 |year= 2007|pmid=<!--none found--> |doi= 10.1186/cc5576|url=http://ccforum.com/content/11/S2/P416}}</ref> The court found 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 the Court's ruling, they upheld the clinical concept of SBS but dismissed one case and reduced another from murder to manslaughter.<ref name="Leeuw07"/> 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."<ref>{{Cite news| author= | title=Shaken baby convictions overturned | url=http://www.guardian.co.uk/child/story/0,,1533200,00.html | work=Special Reports | date=Thursday July 21, 2005 | publisher=Guardian Unlimited | accessdate=2006-10-15}}</ref> The court invalidated the "unified hypothesis", proposed by British physician J. F. Geddes and colleagues, as an alternative mechanism for the subdural and retinal hemorrhage found in suspected cases of SBS.<ref name="Leeuw07"/> The unified hypothesis proposed that the hemorrhage was not caused by shearing of subdural and retinal veins but rather by cerebral [[hypoxia (medical)|hypoxia]], increased [[intracranial pressure]], and increased pressure in the brain's blood vessels.<ref name="Leeuw07"/> The court reported that "the unified hypothesis [could] no longer be regarded as a credible or alternative cause of the triad of injuries": subdural haemorrhage, retinal bleeding and [[encephalopathy]] due to [[hypoxemia]] (low blood oxygen) found in suspected SBS.<ref name="Leeuw07"/> On January 31, 2008, the Wisconsin Court of Appeals granted Audrey A. Edmonds a new trial based on "competing credible medical opinions in determining whether there is a reasonable doubt as to Edmunds's guilt." Specifically, the appeals court found that "Edmunds presented evidence that was not discovered until after her conviction, in the form of expert medical testimony, that a significant and legitimate debate in the medical community has developed in the past ten years over whether infants can be fatally injured through shaking alone, whether an infant may suffer head trauma and yet experience a significant lucid interval prior to death, and whether other causes may mimic the symptoms traditionally viewed as indicating shaken baby or shaken impact syndrome."<ref>{{Cite news| author= | title=Court of Appeals decision - State of Wisconsin v. Audrey A. Edmonds | url=http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=wi&vol=2008%5C31696&invol=2 | work=Wisconsin Court Opinions | date=January 31, 2008 | publisher=Findlaw | accessdate=2009-09-25}}</ref> The terms ''non-accidental head injury'' or ''inflicted traumatic brain injury'' have been suggested instead of "SBS".<ref name="Minns">{{Cite journal|author=Minns RA, Busuttil A |title=Patterns of presentation of the shaken baby syndrome: Four types of inflicted brain injury predominate |journal=BMJ |volume=328 |issue=7442 |pages=766 |year=2004 |month=March |pmid=15044297 |pmc=381336 |doi=10.1136/bmj.328.7442.766}}</ref> ==Controversies and alternative hypotheses== ===Vitamin C deficiency=== Some authors have suggested that certain cases of suspected shaken baby syndrome may result from [[vitamin C]] deficiency.<!-- --><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=July |format=PDF |accessdate=2009-05-19 }}</ref><!-- --><ref>{{Cite book| author= Johnston, C.S. | title= Ascorbic Acid; Biochemistry and Biomedical Cell Biology | volume=25 | chapter=Chapter 10) The Antihistamine Action of Ascorbic Acid | year=1996 | page=189 | publisher= Plenum Press | isbn=978-0-306-45148-5}}</ref><!-- --><ref>{{Cite journal|author=Majno G, Palade GE, Schoefl GI |title=STUDIES ON INFLAMMATION : II. The Site of Action of Histamine and Serotonin along the Vascular Tree: A Topographic Study |journal=The Journal of Biophysical and Biochemical Cytology |volume=11 |issue= 3|pages=607–26 |year=1961 |month=December |pmid=14468625 |pmc=2225127 |doi=10.1083/jcb.11.3.607}}</ref><!-- --><ref>{{Cite journal|author=Gore I, Fujinami T, Shirahama T |title=Endothelial changes produced by ascorbic acid deficiency in guinea pigs |journal=Archives of Pathology |volume=80 |issue=4 |pages=371–6 |year=1965 |month=October |pmid=5319838}}</ref> 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. However symptoms consistent with increased [[histamine]] levels, such as low blood pressure and allergic symptoms, are not commonly associated with [[scurvy]] as clinically significant vitamin C deficiency. A literature review of this hypothesis in the journal ''[[Pediatrics International]]'' "From the available information in the literature, concluded that there was no convincing evidence to conclude that vitamin C deficiency can be considered to be a cause of shaken baby syndrome."<ref>{{Cite journal|author=Fung EL, Nelson EA |title=Could Vitamin C deficiency have a role in shaken baby syndrome? |journal=[[Pediatrics International]] |volume=46 |issue=6 |pages=753–5 |year=2004 |month=December |pmid=15660885 |doi=10.1111/j.1442-200x.2004.01977.x}}</ref> The proponents of such hypotheses often question the adequacy of nutrient tissue levels, especially vitamin C,<!-- --><ref>{{Cite journal|author=Dettman G |title=Factor "X", sub-clinical scurvy and S.I.D.S. Historical. Part 1 |journal=The Australasian Nurses Journal |volume=7 |issue=7 |pages=2–5 |year=1978 |month=March |pmid=418769}}</ref><!-- --><ref>{{Cite journal|author=Kalokerinos A, Dettman G |title=Sudden death in infancy syndrome in Western Australia |journal=The Medical Journal of Australia |volume=2 |issue=1 |pages=31–2 |year=1976 |month=July |pmid=979792}}</ref> 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.<!-- --><ref>{{Cite book| author=Institute of Medicine (IOM) | title= Adverse Effects of Pertussis and Rubella Vaccines | chapter=Chapter 6) Evidence Concerning Pertussis Vaccines and Other Illnesses and Conditions -- Protracted Inconsolable Crying and Screaming | chapterurl=http://newton.nap.edu/books/0309044995/html/165.html | year=1991 | page=165 | publisher=The National Academies Press | isbn=0-309-04499-5}}</ref> Given that patients presenting with suspected SBS would constitute only the most severely affected group of children with nutritionally deficiencies, one would expect a larger number of individuals seen with milder symptoms. At the time of this writing, infantile scurvy in the United states is practically nonexistent.<ref>{{Cite journal|author=Lee RV|title=Scurvy: a contemporary historical perspective |journal=Connecticut Medicine |volume=47|issue=10 |pages=629–32, 703–4 |year=1983 |pmid=6354581}}</ref> No cases of [[scurvy]] mimicking SBS or [[Sudden Infant Death Syndrome]] 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.<ref>{{Cite journal|author=Weinstein M, Babyn Phil, Zlotkin S |title=An Orange a Day Keeps the Doctor Away: Scurvy in the Year 2000 |journal=Pediatrics |volume=108 |issue=3 |pages=e55 |year=2001 |pmid=11533373 |doi=10.1542/peds.108.3.e55}}</ref><!-- --><ref>{{Cite journal|author=Rajakumar K|title=Infantile Scurvy: A Historical Perspective |journal=Pediatrics |volume=108 |issue=4 |pages=e76 |year=2001 |pmid=11581484|doi=10.1542/peds.108.4.e76}}</ref> ===Gestational problems=== 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="Cushing">{{Cite journal|author=Cushing H, Goodrich JT |title=Reprint of "Concerning Surgical Intervention for the Intracranial Hemorrhages of the New-born" by Harvey Cushing, M.D. 1905 |journal=Child's Nervous System |volume=16 |issue=8 |pages=484–92 |year=2000 |month=August |pmid=11007498 |doi=10.1007/s003810000255}}</ref><!-- --><ref name="Williams 1997">{{Cite book| author=Williams Obstetrics | title= Diseases and Injuries of the Fetus and Newborn| volume= 20 | chapter=Chapter 20 | year=1997 | pages=997–998 | publisher= Appleton & Lange, Stamford, CT | isbn=0-8365-9638-X{{Please check ISBN|reason=Check digit (X) does not correspond to calculated figure.}}}}</ref><!-- --><ref name="Williams 2005">{{Cite book| author=Williams Obstetrics | title= Diseases and Injuries of the Fetus and Newborn| volume= 22 | chapter=Chapter 29 | year=2005 | pages=649–691 | publisher= McGraw-Hill Companies | isbn=0-07-141315-4}}</ref><!-- --><ref name="Looney">{{Cite journal|author=Looney CB |title=Intracranial hemorrhage in asymptomatic neonates: prevalence on MR images and relationship to obstetric and neonatal risk factors |journal=Radiology |volume=242 |issue=2 |pages=535–41 |year=2007 |month=February |pmid=17179400 |doi=10.1148/radiol.2422060133|author-separator=,|author2=Smith JK|author3=Merck LH|display-authors=3|last4=Wolfe|first4=H. M.|last5=Chescheir|first5=N. C.|last6=Hamer|first6=R. M.|last7=Gilmore|first7=J. H.}}</ref> Because the age of suspected SBS victims is usually older than those patients suffering from birth-related problems, the distinction is usually not problematic.{{Citation needed|date=March 2011}} ===Diffuse injury=== A 2001 study reported that the predominant [[histology|histological]] abnormality in cases of inflicted head injury in the very young is [[focal and diffuse brain injury|diffuse]] hypoxic brain damage, not [[diffuse axonal injury]] (DAI),<!-- --><ref name=pmid11408324>{{Cite journal|author=Geddes JF, Hackshaw AK, Vowles GH, Nickols CD, Whitwell HL |title=Neuropathology of inflicted head injury in children. I. Patterns of brain damage |journal=Brain |volume=124 |issue=7 |pages=1290–8 |year=2001 |month=July |pmid=11408324 |doi=10.1093/brain/124.7.1290}}</ref> and suggested two possible explanations: 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=pmid11408325>{{Cite journal|author=Geddes JF, Vowles GH, Hackshaw AK, Nickols CD, Scott IS, Whitwell HL |title=Neuropathology of inflicted head injury in children. II. Microscopic brain injury in infants |journal=Brain |volume=124 |issue=7 |pages=1299–306 |year=2001 |month=July |pmid=11408325 |doi=10.1093/brain/124.7.1299}}</ref> ===Force=== There has been controversy regarding the amount of force required to produce the brain damage seen in shaken baby syndrome. A 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... 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 SBS."<ref name="Bandak">{{Cite journal|author=Margulies S |title=Shaken baby syndrome: a flawed biomechanical analysis |journal=Forensic Science International |volume=164 |issue=2–3 |pages=278–9; author reply 282–3 |year=2006 |month=December |pmid=16436323 |doi=10.1016/j.forsciint.2005.12.018|author-separator=,|author2=Prange M|author3=Myers BS|display-authors=3|last4=Maltese|first4=Matthew R.|last5=Ji|first5=Songbai|last6=Ning|first6=Xinguo|last7=Fisher|first7=Jacob|last8=Arbogast|first8=Kristy|last9=Christian|first9=Cindy}}</ref><ref>{{Cite journal|author=Rangarajan N, Shams T |title=Re: shaken baby syndrome: a biomechanics analysis of injury mechanisms |journal=Forensic Science International |volume=164 |issue=2–3 |pages=280–1; author reply 282–3 |year=2006 |month=December |pmid=16497461 |doi=10.1016/j.forsciint.2005.12.017}}</ref> A detailed explanation of the calculations was provided in a [[letter to the editor]] published in ''Forensic Science International'' in February 2006.<ref name="Bandak F">{{Cite journal| author=Bandak F | title=Response to the Letter to the Editor | journal=Forensic Science International | volume=157 | issue=1 | month=December |year=2006 | doi=10.1016/j.forsciint.2006.01.001 | pages=282–3}} which refers to<br>{{Cite journal|author=Margulies S |title=Shaken baby syndrome: a flawed biomechanical analysis |journal=Forensic Science International |volume=164 |issue=2–3 |pages=278–9; author reply 282–3 |year=2006 |month=December |pmid=16436323 |doi=10.1016/j.forsciint.2005.12.018|author-separator=,|author2=Prange M|author3=Myers BS|display-authors=3|last4=Maltese|first4=Matthew R.|last5=Ji|first5=Songbai|last6=Ning|first6=Xinguo|last7=Fisher|first7=Jacob|last8=Arbogast|first8=Kristy|last9=Christian|first9=Cindy}}</ref> The BBC has made a documentary in 3 parts that covers arguments for and against the diagnosis of SBS.<ref name="Panorama Shaken Babies (BBC 1) (Part 1 of 3)">{{cite episode | network=BBC | series=Panorama | title=Panorama Shaken Babies (BBC 1) (Part 1 of 3) | date = 10 March 2008| url=http://news.bbc.co.uk/2/hi/programmes/panorama/7312438.stm | accessdate=2010-01-04}}</ref><ref name="Panorama Shaken Babies (BBC 1) (Part 2 of 3)">{{cite episode | network=BBC | series=Panorama | title=Panorama Shaken Babies (BBC 1) (Part 2 of 3) | url= }}</ref><ref name="Panorama Shaken Babies (BBC 1) (Part 3 of 3)">{{cite episode | network=BBC | series=Panorama | title=Panorama Shaken Babies (BBC 1) (Part 3 of 3) | url= }}</ref> ==See also== * [[Approval_of_iOS_apps#Baby_Shaker|Baby Shaker]] - An application removed by Apple that allowed the user to shake their phone until an image of a cartoon baby on the screen died. * [[Charles Randal Smith]] - Canadian Pathologist who conducted flawed autopsies and whose expert testimony in Shaken Baby Syndrome cases resulted in several wrongful convictions.<ref>http://www.nationalpost.com/news/Medical+panel+condemns+disgraced+pathologist+abominable+failures/4503500/story.html</ref> * [[Louise Woodward case]] - English au pair convicted of involuntary manslaughter in the 1997 death of Matthew Eappen. ==Further reading== *{{Cite journal| author = Lt. Colonel MD Ramsey | title = A Nuts And Bolts Approach To Litigating The Shaken Baby Or Shaken Impact Syndrome | journal = Military Law Review - US Department of Army Pamphlet | volume = 27-100-188 | issue = | pages = 1–37 | year = 2006 | month = Summer | issn= 0026-4040 | url= http://www.loc.gov/rr/frd/Military_Law/Military_Law_Review/pdf-files/188-summer-2006.pdf | format=PDF }} This American 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. * {{PDF|[http://www.phac-aspc.gc.ca/ncfv-cnivf/pdfs/fv-85-224-XIE2004000_e.pdf Family Violence In Canada - A Statistical Profile 2004]|523&nbsp;KB}} * Journal Issue: Western Journal of Emergency Medicine, 12(2) Title: "Challenging the Pathophysiologic Connection between Subdural Hematoma, Retinal Hemorrhage and Shaken Baby Syndrome" | Author: Steven C. Gabaeff, MD, FAAEM, FACEP <ref> http://escholarship.org/uc/item/7z55j01t#page-1 </ref> | Publication Date: 2011 | Publication Info: <ref> http://escholarship.org/uc/uciem_westjem?volume=12;issue=2 </ref> Western Journal of Emergency Medicine, Department of Emergency Medicine (UCI), UC Irvine * US National Library of Medicine, National Institutes of Health Title: "The evidence base for shaken baby syndrome - We need to question the diagnostic criteria" <ref>{{cite journal | pmc = 381308 | pmid=15044267 | doi=10.1136/bmj.328.7442.719 | volume=328 | issue=7442 | title=The evidence base for shaken baby syndrome | year=2004 | month=March | author=Geddes JF, Plunkett J | journal=BMJ | pages=719–20}}</ref> ==External links== * [http://lawreview.wustl.edu/inprint/87/1/dtuerkheimer.pdf] ''The Next Innocence Project: Shaken Baby Syndrome and the Criminal Courts.'' Deborah Tuerkheimer. Washington University Law Review. Volume 87 Number 1,2009 * [http://www.falseallegation.org National Child Abuse Defense & Resource Center.org] - National Child Abuse Defense & Resource Center *[http://www.bmj.com/cgi/content/full/328/7442/719] British Medical Journal 2004:328:719-720 (27 March) * [http://journals.lww.com/topicsinmri/Abstract/2007/02000/Imaging_of_the_Central_Nervous_System_in_Suspected.4.aspx] Imaging of the Central Nervous System in Suspected or Alleged Nonaccidental Injury, Including the Mimics.Barnes, Patrick D. MD; Krasnokutsky, Michael MD. ''Topics in Magnetic Resonance Imaging'': February 2007 - Volume 18 - Issue 1 - pp 53–74 * [http://www.dontshake.org National Center on Shaken Baby Syndrome] National Center on Shaken Baby Syndrome (NCSBS) * [http://www.childabuselaw.info/lawnews/Lyons_G_SBS_Utah_Law_Review_2003.pdf] Shaken Baby Syndrome: A Questionable Scientific Syndrome and a Dangerous Legal Concept. Utah Law Review * [http://www.madisonmagazine.com/Madison-Magazine/July-2009/Oh-Baby/] Madison magazine. article: ''Oh baby'' by Melanie Radzicki McManus * [http://www.madisonmagazine.com/Madison-Magazine/July-2009/Oh-Baby/Motion_to_Dismiss_Audrey_Edmunds.pdf] State's motion to dismiss prosecution in ''shaken baby syndrome'' case. *{{Cite journal|author=Keller KA, Barnes PD |title=Rickets vs. abuse: a national and international epidemic |journal=Pediatric Radiology |volume=38 |issue=11 |pages=1210–6 |year=2008 |month=November |pmid=18810424 |doi=10.1007/s00247-008-1001-z}} * [http://epresence.med.utoronto.ca/1/watch/516.aspx] Centre for Forensic Science and Medicine Seminar''Child Abuse - Nonaccidental Injury (NAI)'' presenter(s) Patrick D. Barnes Power Point Presentation. Lecture notes and references. * [http://www.jameslefanu.com/research/wrongful-diagnosis-of-child-abuse-a-master-theory] '' Wrongful Diagnosis of Child Abuse - A Master Theory. '' Journal of the Royal Society of Medicine. VOLUME 98, NUMBER 6, 2005 * [http://www.cbc.ca/fifth/2011-2012/diagnosismurder/] '' Diagnosis Murder '' CBC documentary investigates the topic and re-examines the crucial question: Is Shaken Baby Syndrome conclusive evidence of murder or is it what it is an unproven scientific hypothesis believed to be a scientific fact, 2012 ==Footnotes== {{Reflist|colwidth=30em}} {{Neurotrauma}} {{DEFAULTSORT:Shaken Baby Syndrome}} [[Category:Neurotrauma]] [[Category:Child abuse]] [[Category:Infancy]] [[da:Shaken baby syndrom]] [[de:Schütteltrauma]] [[es:Síndrome del niño sacudido]] [[eo:Sindromo de skuita bebo]] [[it:Sindrome del bambino scosso]] [[lt:Sukrėsto vaiko sindromas]] [[ms:Sindrom mengoncang bayi]] [[nl:Shaken-babysyndroom]] [[ja:揺さぶられっ子症候群]] [[pl:Zespół dziecka potrząsanego]] [[ro:Sindromul copilului scuturat]] [[ru:Синдром детского сотрясения]] [[fi:Ravistellun vauvan oireyhtymä]] [[sv:Shaken baby syndrome]] [[zh:搖晃嬰兒綜合症]]'