Application of Hill’s criteria of causation to shaken baby syndrome: Further evidence that questions the existence of shaken baby syndrome

Abstract

Background: Controversy about the existence of shaken baby syndrome persists. This diagnosis was once routinelyaccepted in the infant who presents with the triad - unexplained subdural hematoma, retinal hemorrhages, and neurologicdysfunction. However, a critical examination of the relevant biomechanical, biologic, and clinical findings in the infantwith the triad now suggests shaken baby syndrome may not exist, and medical mimics of this entity may have been missed.

Methods: The author performed a Hill’s analysis of causation using 9 criteria typically evaluated in such an assessmentusing a Google Scholar search of the medical literature for relevant information on shaken baby syndrome.

Results: None of the 9 criteria were fulfilled in the analysis.

Conclusion: Using a well-accepted analysis for evaluating whether a specific event (shaking) leads to a specific outcome(the triad), there was no compelling evidence that shaking causes the triad.