Trauma in a shaken infant? A case study

Abstract

Abusive Head Trauma (AHT) due to shaking is one of the most serious types of child abuse. An inflicted blunt force trauma or repetitive accelerationdeceleration trauma in infants can cause brain injury. Objective: Head acceleration was measured during manual shaking and a free fall from a height of 1 m (3 ft). An experiment employing Inertial Measurement Units (IMUs) was carried out to determine the values of acceleration to which individual body parts were exposed. In the article we report the case of a two-month-old female infant with suspected Shaken Baby Syndrome (SBS). Subdural bilateral haemorrhages were detected. An ophthalmological examination confirmed diffuse bilateral retinal damage with retinal ecchymoses. The infant was disqualified from neurosurgery and instead received treatment in the intensive care unit, which included antioedematous therapy and respiratory support. The girl died after one month in the intensive care unit (ICU). A forensic autopsy revealed no congenital abnormalities or signs of preexisting diseases. Ischaemic damage to the brain tissue was discovered. Based on autopsy findings, it was established that the death of the child most likely resulted from intracranial inertial injury. Acceleration values can reach up to 142 m/s2 in the forehead region during AHT. With a free fall from a height of 1 m to soft ground, the value was 165 m/s2. Testing has shown humans can generate only about 10–15 Gs of acceleration of the brain with the most forceful shaking. In our experiment the maximum shaking force was 14.5 G. In a free fall the g-force value was 16.8 G. The recorded impact duration was 20 ms and 26 ms, respectively. The fall dynamics are influenced by fall height, initial velocity or force, and body mass. The speed on contact with the ground depends on the height of the fall and the initial velocity. Based on the results of the experiment, the authors conclude that it cannot be categorically stated that pure shaking cannot cause fatal head injuries in an infant. In this case, the statement of SBS is not unequivocal. • Ischaemic damage to the brain tissue was discovered. • Acceleration values can reach up to 142 m/s 2 in the forehead region during AHT. • With a free fall from a height of 1 m to soft ground, the value was 165 m/s 2 . • That it cannot be categorically stated that pure shaking cannot cause fatal head injuries in an infant. • Humans can generate only about 10–15 Gs of acceleration of the brain with the most forceful shaking.