[back] Shaken Baby Syndrome

Shaken Baby Syndrome: Pitfalls in Diagnosis and Demographics

By F. Edward Yazbak, MD, FAAP

The JAMA study findings
The inclusion criteria
The confession
The medical and child protective agency determination
Neck tissues injury
Associated injuries
North Carolina Vaccination Policies
The issue of vaccinations and SBS

"They will have successfully demolished my explanation if they can document a single case of Shaken Baby Syndrome or “inflicted shaking/impact injury” (as they prefer to call it), which occurred outside the 21-day period and in which a disorder of haemostasis, nutrition, or liver disease was convincingly excluded.
    I repeat, the diagnosis of Shaken Baby Syndrome or inflicted shaking/impact injury is a proven figment of the imagination of some in the medical profession and should be relegated to the scrap heap of history before it causes any more shame to the profession and disaster to innocent families."---
Michael Innis

…So ended a Rapid Response to the electronic British Medical Journal (BMJ) on April 27, 2004.

Some of us have been wondering about the existence of the so-called Shaken Baby Syndrome (SBS) and its relationship to recent vaccinations. It took a gutsy Australian to state it publicly. Michael Innis, MBBS, DTM&H, FRCPA, FRCPath, is a noted hematologist-pathologist and has reviewed multiple cases of SBS in the past few years.

Innis’ statement above was made just a few months after the publication of a University of North Carolina (UNC) study of SBS. The August 5, 2003 press release on that study was titled: “Estimated 300 children died in the U.S. from shaken baby syndrome last year.”

It began, “If the rest of the country reflected what happened in North Carolina recently, an estimated 1,300 U.S. children experienced severe or fatal head trauma from child abuse during the past year, a new study concludes. Of those, 1,200 were in the first year of their lives.”

It went on to quote lead investigator Heather T. Keenan, research assistant professor of social medicine at the UNC School of Medicine: "We did this research because inflicted head trauma, also called shaken baby syndrome, is one of the leading causes of death due to child abuse. Since there were no population-based estimates of how many children were being hurt, we conducted a population-based study to try and find out what the incidence of inflicted traumatic brain injury was.” (1)

In other words:

Their figures 300, 1,300 and 1,200 were estimates and projections

The study was designed to find out how many cases of inflicted traumatic brain injuries (TBI) were “diagnosed” in North Carolina in 2000 and 2001 and what were the characteristics of the children “who were getting hurt” and of the adults who were “presumed” to have hurt them

The lead author believes that all “inflicted head trauma” is due to “shaking.”

The study — “A Population-Based Study of Inflicted Traumatic Brain Injury in young Children” — was co-authored by D. K. Runyan, S. W. Marshall, M. A. Nocera, D. F. Merten and S. H. Sinal. (2) It was funded by the National Center for Injury Prevention and Control (NCIPC) of the Centers for Disease Control and Prevention (CDC) through a grant to UNC’s Injury Prevention Research Center and it was published in the Aug. 6, 2003 issue of the Journal of the American Medical Association (JAMA).

In 2000, North Carolina’s Population was 8.049.313 or 2.86 percent of the U.S. population.

The authors reported that 30 per 100,000 infants experienced a severe or fatal brain injury and that 80 children in the state incurred inflicted traumatic brain injuries over the two years (2000 and 2001). Eighteen of them died.

The question is obviously: Could the North Carolina figures be projected nationally?

In its “Child Maltreatment: Fact Sheet,” the NCIPC not only stated that the state figures could be projected but also firmed the study’s estimates into facts and increased them a little: “Shaken-baby syndrome (SBS) is a form of child abuse affecting between 1,200 and 1,600 children every year. SBS is a collection of signs and symptoms resulting from violently shaking an infant or child.” (3)

The population of North Carolina increased by 21.4 percent versus 13.1 percent nationwide (N) during the ’90s. In 2000, children under 5 constituted 6.7 percent of the state population versus 6.8 percent (N) and females were 51 percent compared to 50.9 percent (N).

That year, the ethnic/racial distribution and education (4) in North Carolina, expressed as a percentage, were as follows:

Whites 72 N. 75.1
Black (African American) 21.6 N. 12.3
American Indian 1.2 N. 0.9
Asian 1.4 N. 3.6
High school degree 78.1 N. 80.4
College degree (Bachelor’s) 22.5 N. 24.4

When the demographic results of the study are reviewed, it is unclear how the authors and the NCIPC felt comfortable projecting the North Carolina statistics to the remaining 97 percent of the U.S. population.

The JAMA study findings

All North Carolina children aged 2 years or under, who were admitted to a pediatric intensive care unit (PICU) or who died with a traumatic brain injury (TBI) in 2000 and 2001, were identified prospectively.

There were a total of 152 cases of serious or fatal TBI in the state during the study period among a population of approximately 230,000 children.

There were 119 infants under age one (78 percent) and 87 boys in all (57 percent)
80 cases (53 percent) were judged to have been inflicted

Inflicted injuries were determined on the basis of disinterested parties witnessing them or by “complete” medical and social services evaluations

There were a total of 71 non-Hispanic European-American children, 53 African-American children and 28 children from other minorities

The incidence of inflicted TBI for all children two years or younger was 17.0 per 100,000 person-years. Rates were markedly higher in infants (29.7 per 100,000 person-years) than children in the second 12 months of life (3.8 per 100,000 person-years)

“Boys were more likely to incur inflicted injuries than girls and non-European American children were more likely to incur inflicted injuries than European-American children.”

“There were 18 deaths from inflicted TBI (case fatality rate 22.5 percent)”

The incidence of non-inflicted TBI was 15.3 per 100,000 person-years in the first two years of life. Boys and girls had similar rates of injury; however, minority children had a higher incidence. There where 22 non-inflicted TBI deaths (30.5 percent case fatality rate)

Child characteristics: “A younger median age at injury was observed in the group with inflicted compared with non-inflicted injuries (4.0 months versus 7.5 months).”

Maternal characteristics associated with increased risk of inflicted TBI were young maternal age, unmarried status at the birth of the child and prenatal care started after the first trimester. Education level higher than high school appeared to be protective.

Family and community characteristics associated with an increased risk of inflicted, compared to non-inflicted, injuries included having a parent in the military and the presence of an extended family.

Being the first-born infant was also found to be a risk factor.

Multivariate analysis: “When comparing inflicted with not inflicted TBI, younger maternal age, younger child age and having a parent in the military remained important risk factors…. The presence of a father in the home and maternal education level higher than high school appeared to be protective.”

The inclusion criteria

The authors went through an exhaustive enumeration of how they defined inflicted and non-inflicted traumatic brain injuries. The inclusion criteria were based on the following: “Inflicted TBI required evidence of TBI as defined herein accompanied by a confession or a medical and child protective services determination that the injury was inflicted.”

The confession

In several SBS cases that I have reviewed, the “confession” consisted of a statement by the “presumed responsible” parent or caregiver to the police or social services that he (she) shook the baby who was blue and not breathing to stimulate him/her to start breathing again. It was not the angry, insane and violent shaking that is supposed to cause huge subdural and retinal hemorrhages.

Neither the number of the so-called confessions nor their circumstances were published in the North Carolina report. Having 60 out of 80 parents confess would be different than having two, of course.

Was the exhausted, scared, unmarried 17-year-old African-American mother, whose son was intubated and unconscious, questioned by an intimidating social worker, who, unlike detectives, was not required to inform her of her rights?

Was she offered legal counsel before her statement was taken?

Was she threatened?

Was she promised something?

How rattled was she?

These are only few of the questions that could be asked in reference to the “confessions.”

In a recent study published in the American Journal of Forensic Medicine and Pathology, “Case analysis of brain-injured admittedly shaken infants: 54 cases, 1969-2001,” (5) Jan E. Leestma, MD, stated: “The English-language medical case literature was searched for cases of apparent or alleged child abuse between the years 1969 and 2001. Three-hundred and twenty-four cases that contained detailed individual case information were analyzed yielding 54 cases in which someone was recorded as having admitted, in some fashion, to have shaken the injured baby. Indivédual case findings were tabulated and analyzed with respect to shaking as being the cause for the injuries reported. For all 54 admittedly shaken infant cases, the provided details regarding ühe shaking incidents and other events are reported. Data in the case reports varied widely with respect to important details. Only 11 cases of admittedly shaken babies showed no sign of cranial impac| (apparåntly fríe-shaken). This small number of cases dïes not permit valid statistical analysis or support for many of the commonly stated aspects of the so-called shaken baby syndrome.”

In other words: In 32 years, there were only 324 cases reported in the English medical literature that had enough details to be properly reviewed. In 54 of them, someone admitted to have actually shaken the infant and of these, only 11 cases appeared to have been just “shaken”. That’s 11 cases!

The medical and child protective agency determination

Such determination is only valid if careful and detailed history of past events is obtained. I have seen several medical records of SBS cases that had the statement “The past history was non-contributory.” In almost every one, my careful review yielded plenty of useful information and, indeed, very “contributory factors.” Every detail of the pregnancy, the delivery, the nursery stay and the period after discharge from the nursery is important. Vaccinations received within 21 days of an ALTE (apparent life-threatening event) should be listed and critically reviewed; “immunizations are up to date” is often the only mention found.

In addition, clinical and radiological findings obviously could have been misinterpreted and laboratory investigations could have been lacking, including a histamine blood level, serum Vitamin C and a PIVKA II test for vitamin K deficiency to name a few.

In 2004, a conviction for inflicted TBI was reversed because of problems with the autopsy and related testimony at the original trial. (6) The baby’s father, who was sentenced to a life sentence plus 10 years for child abuse and aggravated murder, had already served seven years.

When reading the Keenan study, one is unable to know how seriously the following three important aspects of the so-called shaken baby syndrome were reviewed or if they were at all.

Neck tissues injury

Every record of suspected SBS should describe traumatic findings in the neck structures. Famed researcher Werner Goldsmith, PhD, has stated, "I am absolutely convinced that in order to do serious or fatal damage to an infant by shaking you have to have soft tissue neck damage…. A fall backward from three feet onto a hard surface, like concrete, can produce nearly 180 Gs of acceleration — 180 times the force of Earth's gravity — enough to cause a subdural hematoma. Shaking a child once a second through a range of one foot produces only 11 Gs, at the most…. There is an order of magnitude difference between shaking and falling…. From the point of view of the brain, shaking is a much, much milder form of braking than a fall…. To complicate matters, between five and 10 percent of children are born with undiagnosed subdural hematomas, and 30 percent are born with retinal bleeding…. If you get a rebleed, you may get something that looks like shaken baby syndrome…. You should be able to show neck damage to prove shaken baby syndrome." Goldsmith is the former chair of the head injury model committee of the National Institutes of Health, and was a professor of mechanical engineering at the University of California, Berkeley and the recipient of the 2001 Distinguished Engineering Alumnus Award.

When the occupants of a stopped car (including infants in car seats) are hit from the rear by a truck going 30 to 40 miles an hour, the most likely injury is a whiplash of the neck. Subdural and retinal hemorrhages simply do not occur.

Associated injuries

In a large U.K. population-based study, only 15.1 percent of cases had no clear evidence of abuse. (7) Many U.S. infants presumed to be shaken baby syndrome victims have no bruises or other evidence of external trauma, no fractures or dislocations and no internal injuries. Often subdural and retinal hemorrhages are the only findings on which the medical and child protective consultants base their diagnosis of inflicted traumatic brain injuries.


There used to be a time when “experts” believed that unmarried under-educated young mothers — particularly those on welfare — were likely not to have their children vaccinated, while rich and educated parents always went religiously to their doctors and had their children vaccinated on schedule.

This is obviously not always true.

In the “good old days,” my little patients on “ADC” (Aid to Dependent Children) rarely, if ever, missed an appointment. The state of Rhode Island paid for the babies’ office visits and the Department of Heath (DOH) provided free vaccines. The mothers, often unmarried, incurred no cost. In addition, many well-baby clinics sprouted in neighborhoods and housing projects. Poor people on assistance did not and still do not have to go far to have their babies vaccinated; if they do not have a ride, their social workers will arrange for one.

Superior vaccination rates still persist in Rhode Island, where I practiced for years. (8)

The state is one of the few states that purchases all vaccines for children and distributes them to providers.

Immunization rates increased by 44 percent between 1995 and 2002.

Impoverished children had a higher vaccination rate statewide than children at or above the poverty level, while nationally children from families with incomes below the federal poverty level had a lower vaccination rate.

According to the 2001 National Immunization Survey, Rhode Island had the highest rate for full vaccination coverage in the United States among children aged 19 to 35 months. (9)

Many working parents in my practice, on the other hand, who were sometimes not allowed to leave work and had no one to bring the babies in, were forced to change their appointment and delay the visit and the vaccination. We tried to accommodate them by having evening and Saturday office hours. Things have evidently changed.

In the past decade, parents who have not or have selectively vaccinated their children were likely to be well off, educated and living in upscale suburban areas. These parents had medical coverage and often more than two cars in their garages. They had elected to wait, or forgo the vaccination altogether, because they were more concerned about the risks of multiple vaccinations than about their benefits.

This trend, that more educated and wealthier parents vaccinated their children less frequently, seems to also be evident in the U.K. “Parents in Yorkshire's most affluent communities have a substantially worse record for ensuring their children receive MMR immunization than those in poorer areas.… Department of Health figures for 2004-5 reveal Barnsley has one of the best records in the country for MMR immunization with 86.9 per cent of children protected by the age of five, yet in most respects has a poor record on health, which has largely been blamed on deprivation…. By contrast the wealthier areas appear at the bottom end of the table with the take-up rate in the Craven and Harrogate areas featuring among the country's 10 poorest performers at 52.8 per cent….” (10)

For many years, vaccination of babies has been equated by many social agencies with good mothering. When I practiced pediatrics, I often received telephone inquiries from social workers, usually with very young voices, checking on whether mothers on welfare were missing any appointments or failing to have their babies vaccinated on schedule. The same happened when accusations of abuse, sometimes anonymously lodged, were under investigation. Somehow, those young and eager social workers were under the impression that infants on medical assistance who missed an appointment because their mother could not get a ride to the office were likely to also be maltreated, neglected and abused, while other infants, if they had received all their “baby shots” on schedule, had acquired immunity against both diseases and abuse.

North Carolina Vaccination Policies

“North Carolina has had civil laws requiring immunization for school and day care entry for more than 20 years. Enforcement of these entrance requirements is a shared responsibility of school principals, day care and Head Start directors, and local and state health departments. School principals and day care providers make summary reports to the state regarding the immunization coverage of their enrollees. They are expected to work with local health departments to ensure completion of immunizations for those children who are not up-to-date. The state immunization program validates local enforcement efforts through a sample audit of their records. North Carolina law allows for the exchange of personal immunization record information between schools and public health departments. North Carolina also has a law requiring age-appropriate immunization as recommended by the public health service. This law allows criminal misdemeanor charges and injunctions to be brought against parents who fail to immunize their children on time, with exemptions allowed for religious and medical reasons.” (11)

“North Carolina has 170 federally qualified health care centers and rural health clinics, all of which provide free immunizations. It also operates a “Health Check” program designed to improve patient education and information, simplify administrative paperwork and increase payments to private health care providers. Other advantages include an automated data management system and outreach coordinators in each county.… PAIRS (Provider Access to Immunization Registry Securely), allows doctors and other health providers to view immunization records over a secure Internet connection. This project received a 2002 Excellence in Immunization Award from the National Partnership for Immunization. PAIRS contains immunization records for more than 1.5 million children throughout North Carolina.” (12)

As a result of former U.S. President Bill Clinton’s Childhood Immunization Initiative, childhood immunization rates reached “a historic high” in the late ’90s. According to the CDC, 90 percent or more of America’s toddlers received their routinely recommended vaccines in 1996, 1997 and 1998. In North Carolina in 1998, 96 percent of two-year-olds received the recommended doses of diphtheria, tetanus and pertussis vaccines; 94 percent received the recommended polio vaccine; 96 percent received an MMR vaccine and 95 percent received all the required doses of HIB (Haemophilus influenzae B) vaccine. (13)

Also in 1996, Health-Related Welfare Rules were promulgated. (14)

“... 20 of the waivers (and all 19 of the approved waivers) require parents to have their children immunized as a condition of receiving their full cash benefit. Most states are imposing these requirements on preschool children because of low immunization rates among children under two, and the absence of other mechanism to assure that these children receive proper immunizations.…”

North Carolina was one of the 19 states with approved waivers.

“Sanctions: To encourage parental compliance, these new waivers authorize a reduction in AFDC payments for noncompliance. In Michigan, for example, recipients lose $25 per month for each of their non-immunized children. In Colorado, if all children under two years of age are not immunized, the adult’s portion of the grant is eliminated; in Georgia, the child’s portion of the grant is eliminated.

Several states … increase the size or duration of the sanction when noncompliance continues.… Delaware reduces the benefit of its recipients by $50 for the first month they do not comply and increases the sanctioned by $50 for each subsequent month of noncompliance….”

“Judging from the few states that can provide data, it appears that most recipients of complying with the health rules. Some states report almost universal compliance.”

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) has been helping mothers, babies and children get the foods they need for over 25 years.

In many (if not all) states, the WIC rule, officially or unofficially, is “No shots — No vouchers.” In some, that rule is evident at registration: (15) “For your first visit to a WIC clinic, please bring the following with you:

Identification (examples: driver’s license, photo ID)
Proof of pregnancy (positive pregnancy test)
Proof of income (examples: your last two paycheque stubs, income tax form, Medicaid or Food Stamp ID or KidCare Card)
Proof of residency (examples: your utility bill or recent mail)
Proof of birth (birth certificate for your infant or child)
Proof of immunizations (shot records)
Person to be certified (you or your child)”
Interestingly, WIC does not require proof of citizenship or alien status.

A review of the North Carolina “History of Medicaid Eligibles” (16) reveals that there were 455,702 individuals eligible for Medicaid in fiscal year 1979-80 and 1,512,000 in 2003-04. In the fiscal year 2000-2001, when the SBS study information was collected, there were 1,354,593 individuals enrolled in the state’s Medicaid program, an increase of 10.92 percent from the previous fiscal year (1,221,266).

North Carolina’s Medicaid expenditures were even more revealing. They climbed from $5,789,133,085 in the fiscal year 2000 to 7,065,354,618 in 2001, an increase of 22 percent.

The Medicaid program covers needy individuals of all ages.

The issue of vaccinations and SBS

The words vaccine and vaccination were never mentioned in the six-page small script North Carolina “Population-Based Study of Inflicted Traumatic Brain Injury in Young Children.”

Because, as clearly outlined above, vaccines are available and free and vaccination of children is not only encouraged but mandated and carefully supervised in the State of North Carolina, it is unlikely that a young unmarried mother from a minority group, possibly receiving assistance, could not have or would not have fully vaccinated her infant(s).

Similarly, young military families taking their infants to the pediatric clinic at a military base would not be expected to tell the doctor, nurse or corpsman anything but “Yes, Ma’am” and “Yes, Sir.”

In fact, anywhere in the United States, it would be safe to say that young African-American unmarried mothers and young military families have to be the two groups least likely to question or refuse vaccinations.

Many of us who have reviewed cases of shaken baby syndrome have endorsed the Innis challenge because we have noticed that apnea, cardio-respiratory arrest, seizures, subdural and retinal hemorrhages have mostly occurred within three weeks from the two-month or the four-month series of pediatric vaccinations.

As mentioned earlier, Keenan et al stated, under “Child Demographics,” that age 4 months was the median age for infants with inflicted TBI in the North Carolina study. The authors of the first reference cited in the study, (17) who reviewed all infant homicides in the United States between 1983 and 1991, also reported that: “Half the homicides occurred by the fourth month of life.”

A limited search of VAERS, the vaccine adverse event reporting system, yielded the following relevant findings for the period from 1990 through December 2005. The fact that a report is filed with VAERS following one or more vaccinations does not necessarily mean that the vaccine(s) in question actually caused the reported side effect.

Table I
Children under age 1 (0.0-1.0)

Male Female M >F
Reports 18,668 16,587 12.5%
ER visits 7,722 7.070 9.2%
Hospitalized 2,743 2,356 16,4%
Deaths 1,019 637 59.9%

Table I shows all reports concerning children under the age of 12 months. In the greatest majority of cases, the child received more than one vaccine. It is clear that male infants have relatively more post-vaccinal events, emergency room visits and hospitalizations. The fact that there are 60 percent more deaths among boys is significant.

Table II
Children younger than 6 months (0.0-0.5)

Male Female M > F
Reports 12,562 10,826 16.0%
ER visits 4,871 4,354 11.8%
Hospitalized 2,114 1,822 16%
Deaths 927 569 62.9%
SIDS 566 352 60.7%
SIDS % Deaths 61% 61.8%

Table II shows reports of infants younger than six months of age and who have mostly only received their 2- and 4-months series of vaccinations. In most cases, they received several vaccines together. The table shows that 566 male infants out of 927 who died were believed to have died of Sudden Infant Death Syndrome (SIDS). Again, it is evident that more boys than girls have expired shortly after receiving vaccinations and that in some 60 percent of them, SIDS was believed to be the cause of death.

Table III
Infants younger than 1 month of age (0.0-0.1)

Male Female M > F
Reports 534 518 3.0%
Death 83 55 50.9%
SIDS 52 32 62.5%
SIDS % Deaths 62.6% 61.5%

Table III lists the number of VAERS reports following the administration of the first dose of Hepatitis B vaccine during or shortly after the nursery stay. Although the total number of reports does not much differ because of gender, it is evident that even at that age 50 percent more boys than girls die and, in 60 percent of each group, SIDS is listed as the cause of death.

Quite interestingly, maternal age younger than 20, unmarried status and late or no prenatal care, are risk factors also cited with SIDS. The CDC and the Institute of Medicine still deny that SIDS is any way associated with vaccination. Yet, of 253 infant death cases awarded more than $61 million by the U.S. Court of Federal Claims in the 1990s, 224, or 86 percent, were attributed to vaccination with DTP. The cause of death had originally been listed as Sudden Infant Death Syndrome (SIDS) in 90 of these cases or 40 percent. (18)


An excellent strategy to keep alive the belief that SBS is an entity caused by intentional shaking to the point of brain damage and possibly death is to:

Appear to report in excruciating detail all apparently conceivable data relating to head injuries in children.

Avoid mentioning vaccinations, when the two groups least allowed to choose anything other than compliance with vaccine recommendations, military dependents and non-Caucasians, are those "found" to be most likely to intentionally inflict TBI.

With the exuberant use and additions of new pediatric vaccines, such as RotaTeq® that joined the list a few days ago (due at the 2, 4 and 6 months visits), the role of vaccinations in causing apnea, seizures and symptoms mimicking SBS should at least be evaluated before being summarily dismissed.

In addition, because the African-American population represents 21.6 percent of the state’s population (versus 12.3 percent nationwide) it would be expected that proportionately more African-Americans infants and children in North Carolina will have health problems and seek medical care than in other states.

Equally important is the fact that the military presence in North Carolina is substantial.

The Office of the Governor web site (19) has the following message.

Support our military families

“As brave men and women depart overseas, risking their lives for American freedom, we here at home must do our part to support them and the families they are leaving behind. We remember that we live in freedom because of the contributions and sacrifices made by those who serve in the Armed Forces of the United States. Many of you have asked how you can help support for our troops and the families they have left behind. This web site will give you that opportunity. I am proud that North Carolina is the most military-friendly state in America.” — Governor Mike Easley

The following military communities are based in North Carolina:
Fort Bragg
Pope Air Force Base
Seymour Johnson Air Force Base
Marine Corps Base Camp Lejuene
Marine Corps Air Station Cherry Point
Marine Corps Air Station New River
U.S. Coast Guard Air Station Elizabeth City
The Reserves
North Carolina National Guard

Critically ill infants are usually treated at the nearest tertiary medical centre or pediatric intensive care unit. Putting everything into perspective, is it not logical that infants from military families in North Carolina will have relatively more health problems than in other states? Similarly, considering the fact that military dependents are unlikely to question vaccinations, is it any surprise that there may be more infants from those families having post-vaccinal reactions?

The blind conviction that subdural and retinal hemorrhages can only be due to SBS is simply outrageous; so is the concept that “shaking” alone can cause all the intracranial and ocular damage that is often found in these cases. It is a sad state of affairs when a family can be destroyed and a parent jailed because subdural hemorrhages were discovered on a CT-scan or an MRI, when it is evident that some of them have occurred a long time before the accused was alone with the child.

The same is true about retinal hemorrhages.

Quoting Ronald Uscinski, the renowned neurosurgeon: “… prior to 1972, the presence of retinal hemorrhages was a diagnostic aid in detecting the presence of chronic subdural hematoma in children, and has long been known among neurosurgeons to reflect an abrupt increase in retinal venous pressure.” (20)

In addition, there have been no controlled studies that have actually supported a purely mechanical etiology for retinal bleeding and there is no agreement on what specific pattern or appearance of the retinal hemorrhages absolutely suggests inflicted trauma by shaking.

The North Carolina study does not offer any reasonable or logical explanation as to why:

Boys are more frequently “shaken” than girls
Infants are more likely to be shaken when they are four months old
Young unmarried non-Caucasian mothers and military families are more likely to have infants who have been “diagnosed” as having “shaken baby syndrome.”
This study presents very plausible reasons for all.


A North Carolina population-based study of inflicted brain injury is reviewed.

It is a concern that the government-funded North Carolina study did not examine all the essential aspects of the serious problem it was charged to investigate and specifically injuries to the neck structures and recent multiple vaccinations

It is unfortunate that, nonetheless, the study has singled out two groups that need all our love and support.

A review of the recent vaccinations of the “80 cases of inflicted traumatic brain injuries” is not only possible but easy.

The results of such review may help solve the mystery that still surrounds the so-called “shaken baby syndrome.”


H.T. Keenan, D.K. Runyan, S.W. Marshall, M.A. Nocera, D.F. Merten, S.H. Sinal. “A population-based study of inflicted traumatic brain injury in young children.” JAMA. Aug. 6, 2003; 290(5): 621-6. PMID: 12902365
J.E. Leestma. “Case analysis of brain-injured admittedly shaken infants: 54 cases, 1969-2001.” Am J Forensic Med Pathol. September 2005; 26(3): 199-212. Review.
F.E. Yazbak. “Post-Mortem on a ‘Shaken Baby Syndrome’ Autopsy.” J Am Phys Surg. 2005; 10(2): 51-52
Also available on line at http://www.jpands.org/vol10no2/yazbak.pdf
S. Jayawant, A. Rawlinson, F. Gibbon, J. Price, J. Schulte, P. Sharples, J.R. Sibert, A.M. Kemp. “Subdural haemorrhages in infants: population based study.” BMJ. Dec. 5, 1998; 317(7172): 1558-61. PMID: 9836654
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Wilhelmine Miller, “Immunizations Policies and Funding in North Carolina.” Available on line here
“HHS 5 Improve Texas’ Child Immunization Rate.” Available at http://www.window.state.tx.us/etexas2003/hhs05.html
President Clinton and Vice President Gore’s Accomplishments: North Carolina. October 2000. Available at http://clinton4.nara.gov/WH/Accomplishments/states/North_Carolina.html
D.J. Besharov, K. Tanasichuk White, M.B. Cogestall. “Health-Related Welfare Rules.” Nov. 15, 1996. Available at
Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Illinois Department of Human Services (2000). Available at
History of North Carolina Medicaid Program. Available at http://www.dhhs.state.nc.us/dma/historyofmedicaid.pdf
M. Overpeck, R. Brenner, A. Trumble, L. Trufiletti. H. Berendes. “Risk factors for infant homicide in the United States.” N Engl J Med. 339 (1998) 1211-1216
F.E. Yazbak. “A Not-so-Perfect Vaccine. The Diphtheria, Tetanus and Acellular Pertussis Vaccine: An Investigation.” Available at
Support Our Military Families, Office of the Governor of North Carolina. Available at http://www.governor.state.nc.us/mil/
R. Uscinski. “Shaken Baby Syndrome: fundamental questions.”
Br J Neurosur. June 2002; 16(3): 217-9. Review.