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9 Efforts to better understand the mechanisms and causations of injury have improved the gathering of objective data in the clinical realm. 7, 8 In reality, all models and theories have known limitations, and many clinicians and researchers acknowledge that precise mechanisms for all abusive injuries remain incompletely understood.
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Biomechanical modeling has since been used to both support and refute the contributions of shaking or impact to abusive head trauma (AHT). The relative importance of impact as a contributor to the head injury sustained by abused children became a source of controversy. The importance of impact in acceleration/deceleration injury was supported by their basic biomechanical models, and they concluded that most serious abusive head injuries required an impact to the head. In 1987, Duhaime et al 6 reported that victims of fatal shaken baby syndrome, and many of those who survived their trauma, showed evidence of blunt impact to the head at the time of diagnosis. Ludwig and Warman 5 first published the term “shaken baby syndrome” in their review of 20 infants and young toddlers injured by shaking, none of whom showed evidence of impact injury to the head. Pediatrician and radiologist John Caffey 3, 4 first described the association of chronic subdural hemorrhages and long-bone fractures in 1946, but it was not until 1972 that he published a seminal paper describing the radiologic and clinical features attributed to shaking injuries. More than 80 years later, American physicians began describing the clinical and radiologic manifestations of child abuse. The recognition of child abuse in modern medicine began in the 19th century, with the work of the French forensic physician Ambroise Tardieu, 1, 2 who described a wide array of physical and sexual injuries to children, including meningeal hemorrhage and brain injuries in fatally abused infants. The American Academy of Pediatrics recommends that pediatricians develop skills in the recognition of signs and symptoms of abusive head injury, including those caused by both shaking and blunt impact, consult with pediatric subspecialists when necessary, and embrace a less mechanistic term, abusive head trauma, when describing an inflicted injury to the head and its contents.
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The use of broad medical terminology that is inclusive of all mechanisms of injury, including shaking, is required. Spinal cord injury and secondary hypoxic ischemic injury can contribute to poor outcomes of victims. Although shaking an infant has the potential to cause neurologic injury, blunt impact or a combination of shaking and blunt impact cause injury as well. Although the term is well known and has been used for a number of decades, advances in the understanding of the mechanisms and clinical spectrum of injury associated with abusive head trauma compel us to modify our terminology to keep pace with our understanding of pathologic mechanisms. Shaken baby syndrome is a term often used by physicians and the public to describe abusive head trauma inflicted on infants and young children.