The shaken infant syndrome

In children less than 1 year, non-accidental injury is the commonest cause of serious head injury1—much of it resulting from shaking and impact. Last week saw the launch of a leaflet, “Handle with Care,” produced by the National Society for the Prevention of Cruelty to Children and the Department of Health, in response to increasing professional concern over the dangers of shaking babies. John Caffey first drew attention to the association of fractures of the long bones and subdural haematomas, and he implicated whiplash injury as the cause of the intracranial trauma.2 It is accepted that shaking alone can cause the brain damage,3 and it is now recognised that the infant's head also undergoes rotational forces as well as whiplashing during shaking.4 Injuries may result from single or multiple episodes of shaking. The severity of the shaking force is such that shaking injuries cannot occur in any form of playful activity (as Caffey originally suggested2). A recent description of the act of shaking states that it is so violent that neutral observers would recognise it as dangerous.5 The clinical presentation of a shaking …