Reflections on the syndrome of the "shaken baby"

A full appreciation of the development of current concepts concerning the "shaken baby syndrome" requires a systematic review of historic and more recent interpretations of scientific data that form the bases for diagnosis in these cases. This discussion relates to the dilemma in determining the cause of shaking injuries in this age group that are not obviously accidental or inflicted. The cases in question can present with similar clinical and pathological findings and possibly result from innocent activity. Shaking of infants and children for any reason should be avoided. Debates related to the circumstances and forces required for the development of intracranial and ophthalmic pathology as a result of shaking are discussed. References to the application of "markers of abuse" and other criteria in determining guilt or innocence in these specific situations are presented and evaluated.