‘‘Shaken baby syndrome,’’ as it was once known, hasbecome a very contentious and hotly debated area in thefields of forensic pathology and medicine of infants andyoung children [1, 2]. Described by Caffey in the 1970s toencompass situations where intracranial injury was presentin the absence of external signs of head trauma, it wasbelieved to result from violent shaking of an infant [3].Infants and children under 2 years of age are thought to bethe most vulnerable as their heads are disproportionatelyheavy relative to their bodies, the neck muscles are weak,the brain is soft as many axons are unmyelinated, and thebase of the skull is flat [4, 5]. It has been asserted that thenature of the shaking is such that it should be recognized bythe perpetrator as likely to be harmful [5], i.e., it is notsomething that could happen during normal playfullyhandling.Classically infants may present with a hyperacuteencephalopathy (cervicomedullary syndrome) with acuterespiratory failure and severe cerebral edema due to brainstem injury, an acute encephalopathy with a depressedconscious state, fits, apnea, and hypotonia, with raisedintracranial pressure, bilateral subdural hemorrhages andretinal hemorrhages, a subacute non-encephalopathic statewith less severe brain injury and various combinations ofsubdural and retinal hemorrhages, rib fractures and bruising,or with a chronic state with isolated subdural hemorrhage,rapidly expanding head circumference, and signs of raisedintracranial pressure [6].In milder cases an infant or child may present withnonspecific features such as vomiting, poor feeding, leth-argy, and irritability. While some children will recover,survivors may have residual neurologic sequelae such asspasticity, seizures, cortical blindness, microencephaly,chronic subdural fluid collections, cerebral atrophy, andporencephalic cysts [5].In a lethal case argument exists as to whether the infantmay appear quite normal for a period of time (i.e., have a so-called ‘‘lucid interval’’), or may instead be immediatelysymptomatic [7]. Given the severity of the injury (i.e., theevent has resulted in death) and the rapidity with whichintracranialpressurehasbeenshowntoriseinanimalmodelsfollowing blunt trauma [8] the author considers it veryunlikely that an infant would be able to engage in normalactivities in an apparently unaffected manner after such aninsult. Death is believed to occur in approximately 15–38 %of cases and the findings at autopsy, as noted, include sub-dural hemorrhage that is usually bilateral, subarachnoidhemorrhage, and retinal hemorrhage. The subdural hemor-rhage tends to be maximal in the inter-hemispheric fissure,usually measures less than 5–10 ml on each side, and doesnot cause a mass effect [4, 5].However, the validity of the diagnostic criteria and theevidence for underlying mechanisms have been questioned[9–11]. A ‘‘unified hypothesis’’ was proposed in 2003 whichsuggested that subdural and retinal hemorrhages in infantswho had been shaken were due to hypoxia with brainswelling, rather than to blunt trauma [12]. This study has,however, been challenged [13] and it has been suggestedthat there were ‘‘serious flaws in the methodology’’ [14]. Aretrospective multicenter study of infants and young chil-dren with proven hypoxic brain injury in the absence oftrauma was certainly not able to demonstrate intracranialhemorrhage [15]. Similarly there has been little support for