Abusive head trauma follows witnessed infant shaking

Abuse is a frequent cause of infant subdural haemorrhages, retinal haemorrhages and neurological dysfunction. Confessed shaking, without impact, is one reported injury cause. However, this remains legally controversial. We evaluated whether witnessed shaking alone can cause typical abusive head trauma (AHT). Cases were collected by Helfer Society list-serve solicitation for infants who developed signs and symptoms of AHT after independently witnessed shaking. We also reviewed a cross-sectional observational, multi-centre study (Examining Siblings to Recognize Abuse (ExSTRA)) of 2890 children evaluated for abuse between January 2010 and April 2011 who experienced independently witnessed shaking. Four children identified by the Helfer Society experienced witnessed shaking and developed clinical and radiological evidence of AHT, including subdural and retinal haemorrhages. Another two had neurological symptoms, but normal imaging. Nineteen (0.7%) ExSTRA subjects experienced witnessed shaking without impact injuries. Among them, one (5.9%) of the 17 subjects who were neuroimaged had AHT findings and additional abusive injuries. Three had neurologic symptoms but normal neuroimaging. Although shaking is rarely witnessed, these cases support that shaking alone can cause typical AHT injuries, including, but not limited to, acute neurological impairment, subdural haemorrhages and retinal haemorrhages. This information is important to the legal management of abused children. Key Practitioner Messages: Confessions document that infant shaking can cause abusive head trauma (AHT); however, this is disputed in courtrooms and by some physicians. Ten infants developed clinical neurologic symptoms with or without radiologic findings of AHT after independently witnessed shaking. None had a history of cranial impacts, and all lacked physical findings suggesting impacts. They provide support for isolated shaking as a cause of AHT.