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Randell Alexander, MD, PhD; Yutaka Sato, MD; Wilbur Smith, MD; Thomas Bennett, MD

Am J Dis Child. 1990;144(6):724-726.

Abstract
• Shaking as a mechanism of severe brain injury in infants has been challenged on a theoretical basis as insufficient to explain the magnitude of observed injuries. Computed tomography and magnetic resonance imaging, developed since shaken baby syndrome was first described, are helpful in establishing whether external trauma occurred for infants thought to have been shaken. We compiled data from 24 infants initially diagnosed as having shaken baby syndrome, including physical examination, roentgenograms, computed tomography or magnetic resonance imaging, and autopsy (when applicable). Half of the patients showed no evidence of direct impact, and evidence of external trauma was not predictive of a fatal outcome. These findings indicate that shaking by itself is sufficient to cause severe or fatal intracranial injury and that the shaken baby syndrome reflects a spectrum of such child abuse injuries that may include direct trauma or only shaking.

(AJDC. 1990;144:724-726)

Author Affiliations
From the Departments of Pediatrics (Drs Alexander and Smith) and Radiology (Drs Sato and Smith), The University of Iowa Hospitals and Clinics, Iowa City, and the Iowa State Medical Examiner's Office, Des Moines (Dr Bennett).

Footnotes
Accepted for publication January 9, 1990.

Read in part before the 18th Annual Child Abuse and Neglect Symposium, Keystone, Colo, May 24, 1989.

Reprint requests to The University of Iowa Hospitals and Clinics, 209 Hospital School, Iowa City, IA 52242 (Dr Alexander).

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