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Controversy # 1:

Shaking Alone Without Impact, Can Cause Subdural
Hematomas and Retinal Hemorrhages in Previously Healthy Babies

In many cases with allegations of non-accidental trauma, the child has a subdural hematoma and the requisite retinal hemorrhages without any appreciable damage to the outside of the head. In these cases the child often lacks an impact site (contusions or fractures). This pattern of injuries can be diagnostically puzzling for physicians. State's experts have traditionally regarded these as "Pure Shaking" cases. If the child has an old subdural hematoma or a pre-existing injury, then shaking alone is likely enough force to create a rebleed or spontaneous bleed, but the question remains whether shaking alone, of a previously healthy infant, can cause SDH and retinal hemorrhages, and if so, how does that kind of force compare to a short fall?

Prosecution experts testify that shaking alone of an otherwise healthy infant, can cause the symptoms seen in these cases, but that the impact of a short fall cannot. In 1987 Duhaime, Genarelli, Thibault, Bruce, Marguiles, and Wiser(1) conducted an experiment where an accelerometer was placed on a model of an infant and triatheletes experimented with shaking versus impact injuries. The study found that angular accelerations for shaking was less than that for impact by a factor of 50. Duhaime et al. determined that shaking alone of an otherwise healthy infant could not cause the constellation of injuries generally associated with SBS. They determined that impact was needed. This study has been replicated several times with similar results.

A recent study by Ommaya, Goldsmith and Thibault shows that impact loading creates a force 50-100 times greater than what can be created by human shaking. The article shows that deformation of an infant's skull makes him or her much more vulnerable to head injuries than adults and that a short fall can produce the requisite force to create a subdural hematoma and subsequent retinal hemorrhages(2).

Citations

1. Duhaime, A.C., Gennarelli, T., Tibualt, L.E. Bruce, D.A., Margulies, S.S., and Wiser R. (1987). The Shaken Baby Syndrome: A clinical, pathological, and biomechanical study. Journal of Neurosurgery 66:409-415.

2. Ommaya, Goldsmith, and Thibault. Biomechanics and neuropathology of adult and pediatric head injury. British Journal of Neurosurgery 2002;16(3): 220-242.

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