Shaken Baby Syndrome: A South African Medico-Legal Perspective

  • Andra Le Roux-Kemp University Of The Witswatersrand
  • Elsie Burger Stellenbosch University and Western Cape Forensic Pathology Service
Keywords: Shaken Baby Syndrome, abusive head trauma, child abuse, medico-legal practice, evidence-based medicine, triad of injuries, expert witnesses, exoneration


Shaken Baby Syndrome refers to the violent and repetitive shaking of an infant, and is a form of abusive head trauma. It was first described in 1974, and has since been the topic of intensive study and discussion. The syndrome has classically been diagnosed with a triad of injuries, namely subdural haemorrhage, retinal haemorrhage and encephalopathy (brain abnormalities). However, recent publications have led to some doubt regarding the causation and diagnostic significance of the triad. It is now generally accepted that other conditions, even natural diseases, may cause the findings listed in the so-called "triad". To date, no reported case law is available on Shaken Baby Syndrome in South Africa; therefore this article focuses on cases in the United States and United Kingdom to delineate some of the issues associated with litigating the condition. This includes the obligation of expert witnesses to give independent, factual evidence about their areas of expertise. It is recommended that medical and legal professionals involved in cases of alleged child abuse should collect as much information as possible about the context of the case. Confessions by parents or caregivers should be treated with circumspection. Awareness campaigns should be aimed at informing the public of the dangers of shaking an infant. And with regards to Shaken Baby Syndrome an increased focus on evidence-based medicine is necessary to dissipate the uncertainty around the condition.





Albert, Blanchard and Knox 2012 JAMA

Albert D, Blanchard JW and Knox BL "Ensuring Appropriate Expert Testimony for Cases Involving the 'Shaken Baby''' 2012 JAMA 39-40

Bandak 2005 Forensic Sci Int

Bandak FA "Biomechanics Analysis of Injury Mechanisms" 2005 Forensic Sci Int 71-79

Barr and Runyan 2008 Am J Prev Med

Barr RG and Runyan DK "Inflicted Childhood Neurotrauma: The Problem Set and Challenges to Measuring Incidence" 2008 Am J Prev Med S106-S111

Biron and Shelton 2005 Child Abuse and Neglect

Biron D and Shelton D "Perpetrator Accounts in Infant Abusive Head Trauma Brought About by a Shaking Event" 2005 Child Abuse and Neglect 1347-1358

Bechtel and Berger 2006 Pediatric Emergency Medicine

Bechtel K and Berger R "Inflicted Traumatic Brain Injury: Making the Diagnosis in the Emergency Department" 2006 Pediatric Emergency Medicine 138-142

Berger, Kochanek and Pierce 2004 Child Abuse and Neglect

Berger RP, Kochanek PM and Pierce MC "Biochemical Markers of Brain Injury: Could They be Used as Diagnostic Adjuncts in Cases of Inflicted Brain Injury?" 2004 Child Abuse and Neglect 739-754

Caffey 1946 AJR

Caffey J "Multiple Fractures in the Long Bones of Infants Suffering from Chronic Subdural Hematoma" 1946 AJR 163-173

Caffey 1972 Am J Dis Child

Caffey J "On the Theory and Practice of Shaking Infants" 1972 Am J Dis Child 161-169

Caffey 1974 Pediatrics

Caffey J "The Whiplash Shaken Infant Syndrome: Manual Shaking by the Extremities with Whiplash-induced Intracranial And Intraocular Bleedings, Linked with Residual Permanent Brain Damage and Mental Retardation" 1974 Pediatrics 396-403

Case 2007 Legal Medicine

Case ME "Abusive Head Injuries in Infants and Young Children" 2007 Legal Medicine 83-87

Couser 2013 J Pediatr Health Care

Couser S "Patient Education Review" 2013 Sep-Oct J Pediatr Health Care 238-239

Donohoe 2003 Am J Forensic Med Pathol

Donohoe M "Evidence-based Medicine and Shaken Baby Syndrome: Part I – Literature Review, 1966-1998" 2003 Am J Forensic Med Pathol 239-242

Duhaime et al 1987 Journal of Neurosurgery

Duhaime AC et al "The Shaken Baby Syndrome: A Clinical, Pathological and Biomechanical Study" 1987 Journal of Neurosurgery 409-415

Dykes 1986 Child Abuse and Neglect

Dykes LJ "The Whiplash Shaken Infant Syndrome: What has been Learned?" 1986 Child Abuse and Neglect 211-221

Editorial 1998 The Lancet

Editorial "Shaken Babies" 1998 1 Aug The Lancet 335

Findley et al 2012 Hous J Health L & Pol'y

Findley KA et al "Shaken Baby Syndrome, Abusive Head Trauma, and Actual Innocence: Getting it Right" 2012 Hous J Health L & Pol'y 209-312

Fortin and Stipanicic 2010 Ann Phys Rehabil Med

Fortin G and Stipanicic A "How to Recognise and Diagnose Abusive Head Trauma in Infants" 2010 Ann Phys Rehabil Med 693-710

Geddes et al 2001 Brain

Geddes JF et al "Neuropathology of Inflicted Head Injury in Children. I. Patterns of Brain Damage" 2001 Brain 1290-1298

Geddes and Whitwell 2004 Forensic Sci Int

Geddes JF and Whitwell HL "Inflicted Head Injury in Infants" 2004 Forensic Sci Int 83-88

Goldsmith and Plunkett 2004 Am J Forensic Med Pathol

Goldsmith W and Plunkett J "A Biomechanical Analysis of the Causes of Traumatic Brain Injury in Infants and Children" 2004 Am J Forensic Med Pathol 89-100

Gould 2001 Curr Diagn Path

Gould SJ "Sudden Unexpected Death in Infancy" 2001 Curr Diagn Path 69-75

Graham and Gennarelli "Trauma"

Graham DI and Gennarelli TA "Trauma" in Graham DI and Lantos PL (eds) Greenfield's Neuropathology 6th ed (Arnold London 1997) 234-262

Guthkelch 1971 BMJ

Guthkelch AN "Infantile Subdural Haematoma and Its Relationship to Whiplash Injuries" 1971 BMJ 430-431

Guthkelch 2012 Hous J Health L & Pol'y

Guthkelch AN "Problems of Infant Retino-dural Haemorrhage with Minimal External Injury" 2012 Hous J Health L & Pol'y 201-208

Hadley et al 2000 Neurosurgery

Hadley MN et al "The Infant Whiplash-shake Injury Syndrome: A Clinical and Pathological Study" 2000 Neurosurgery 536-540

Holford and de Villiers 1998 SAMJ

Holford L and de Villiers F "Landmark Decision in Child Abuse Court Case" 1998 Oct SAMJ 1326-1327

Jenny "Theory and Practice of Shaking Infants"

Jenny C "On the Theory and Practice of Shaking Infants: Where have we Come in the 30 Years Since Shaken Baby Syndrome was First Identified?" Oral keynote presentation delivered at the Fourth National Conference on Shaken Baby Syndrome (12 September 2002 Salt Lake City, Utah)

Keenan et al 2003 JAMA

Keenan HT et al "A Population-based Study of Inflicted Traumatic Brain Injury in Young Children" 2003 JAMA 621-626

Kelly, MacCormick and Strange 2009 Child Abuse and Neglect

Kelly P, MacCormick J and Strange R "Non-accidental Head Injury in New Zealand: The Outcome of Referral to Statutory Authorities" 2009 Child Abuse and Neglect 393-401

Kempe et al 1962 JAMA

Kempe CH et al "The Battered Child Syndrome" 1962 JAMA 17-24

Kivlin et al 2000 Opthalmology

Kivlin J et al "Shaken Baby Syndrome" 2000 Ophthalmology 1246-1254

Laurent-Vannier et al 2009 Ann Phys Rehabil Med

Laurent-Vannier A et al "Long-term Outcome of the Shaken Baby Syndrome and Medicolegal Consequences: A Case Report" 2009 Ann Phys Rehabil Med 436-447

Laurent-Vannier et al 2011 Ann Phys Rehabil Med

Laurent-Vannier A et al "A Public Hearing. Shaken Baby Syndrome: Guidelines on Establishing a Robust Diagnosis and the Procedures to be Adopted by Healthcare and Social Services Staff" 2011 Ann Phys Rehabil Med 533-599

Lopes, Eisenstein and Williams 2013 Journal de Pediatria

Lopes NRL, Eisenstein E and Williams LCA "Abusive Head Trauma in Children: A Literature Review" 2013 Journal de Pediatria 426-433

Mehl 1990 Child Abuse and Neglect

Mehl AL "Shaken Impact Syndrome: Letters to the Editor" 1990 Child Abuse and Neglect 603-605

Niederkrontenthaler et al 2013 Child Abuse and Neglect

Niederkrontenthaler T et al "Descriptive Factors of Abusive Head Trauma in Young Children – United States, 2000-2009" 2013 Child Abuse and Neglect 446-455

Ommaya, Goldsmith and Thibault 2002 Brit J Neurosurg

Ommaya AK, Goldsmith W and Thibault L "Biomechanics and Neuropathology of Adult and Paediatric Head Injury" 2002 Brit J Neurosurg 220-242

Ricci et al 2003 Child Abuse and Neglect

Ricci L et al " Abuse Head Trauma in Maine Infants: Medical, Child Protective and Law Enforcement Analysis" 2003 Child Abuse and Neglect 271-283

Richards et al 2006 Arch Dis Child

Richards PG et al "Shaken Baby Syndrome" 2006 Arch Dis Child 205-206

Runyan 2008 Am J Prev Med

Runyan DK "The Challenges of Assessing the Incidence of Inflicted Traumatic Brain Injury" 2008 Am J Prev Med S112-S115

Russell 2013 Child Abuse and Neglect

Russell BS "Revisiting the Measurement of Shaken Baby Syndrome Awareness" 2013 Child Abuse and Neglect 671-676

Saternus, Kernbach-Wighton and Oehmichen 2000 Forensic Sci Int

Saternus KS, Kernbach-Wighton G and Oehmichen M "The Shaking Trauma in Infants – Kinetic Chains" 2000 Forensic Sci Int 203-213

Starling et al 2004 Arch Pediatr Adolesc Med

Starling SP et al "Analysis of Perpetrator Admissions to Inflicted Traumatic Brain Injury in Children" 2004 Arch Pediatr Adolesc Med 454-458

Squier 2011 Acta Neuropathologica

Squier W "The 'Shaken Baby' Syndrome: Pathology and Mechanisms" 2011 Acta Neuropathologica 519-542

Togioka 2008 J Emerg Med

Togioka BM "Retinal Haemorrhages and Shaken Baby Syndrome: An Evidence-based Review" 2008 J Emerg Med 98-106

Tuerkheimer 2010-2011 Ala L Rev

Tuerkheimer D "Science-dependent Prosecution and the Problem of Epistemic Contingency: A Study of Shaken Baby Syndrome" 2010-2011 Ala L Rev 513-569

Weaver 2010 Chi-Kent L Rev

Weaver RL "Reliability, Justice and Confessions: The Essential Paradox" 2010 Chi-Kent L Rev 179-188

Case law

Case of Allen v The United Kingdom 25424/09, 12 July 2013 ECHR

Cavazos v Smith 132 S Ct 2 (31 October 2011) (per curiam)

Commonwealth v Woodward 694 NE 2d 1277, 1281 (1998)

Michael v Linksfield Park Clinic (Pty) Ltd (1) [2001] ZASCA 12

R v Harris [2005] EWCA Crim 1980 (21 July 2005)

SA Willers & AM Willers (No 14/5829/95)

S v Campos 2002 1 SACR 233 (SCA)

S v Rudman 2013 JDR 0712 (GNP)

Smith v Mitchell Case No CV 01-4484-ABC (CD Cal, Mar 22, 2004)

Smith v Mitchell 437 F 3d 884 (2006)


Children's Act 38 of 2005

Internet sources

Hall 1999

Hall S 1999 Nanny Admits Killing Baby

uk/1999/jan/19/sarahhall accessed 3 September 2013

How to Cite
Le Roux-Kemp, A., & Burger, E. (2017). Shaken Baby Syndrome: A South African Medico-Legal Perspective. Potchefstroom Electronic Law Journal, 17(4), 1286-1316.