Shaken Baby Syndrome: Men Inflict More Harm

March 4, 2011 -- Children with shaken baby syndrome, a form of child abuse, tend to suffer worse injuries from male perpetrators than from females, a new study suggests.

Men are also far more likely than women to be convicted of shaking or slamming a baby, finds Debra Esernio-Jenssen, MD, medical director of the child protection team at the University of Florida, Gainesville.

"Even when controlling for defendant and offense characteristics, women were statistically more likely than men to be released and have their charges dropped," Esernio-Jenssen and colleagues find. "In addition, when convicted, female defendants received lighter sentences."

Brain damage caused by abusive shaking or slamming is now officially called abusive head trauma, according to 2009 guidelines from the American Academy of Pediatrics. Technically, shaken baby syndrome is a subset of abusive head trauma.

The new name reflects that the diagnosis is based on injury to the child's brain, and not on a specific action that caused the injury, says Jordan Greenbaum, MD, medical director of the child protection center at Children's Hospital of Atlanta.

"Abusive head trauma refers to any inflicted, non-accidental head injury. It is not restricted to shaking," Greenbaum tells WebMD. "We can't tell in a lot of cases whether the child has been shaken."

Neither abusive head trauma nor shaken baby syndrome can be caused by normal baby handling.

"It requires a great deal of force, because milder forces are common among children," Greenbaum says. "If it were in the realm of normal or near-normal forces, the emergency rooms would be seeing a lot more cases. This is well outside the range of forces usually seen in normal child care."

Shaken baby syndrome is a controversial diagnosis. Last month, an article in The New York Times Magazine gave voice to medical experts who say shaking cannot cause brain damage, as well as to medical experts who say it most certainly does.

"Mainstream physicians and surgeons recognize this as a real diagnosis," Greenbaum says. "We also recognize it is complex. You have to take into consideration a lot of very real information. This diagnosis does not rest on one or two findings but on a careful analysis of the whole picture."

Esernio-Jenssen and colleagues analyzed data from 48 cases of abusive head trauma diagnosed at Cohen's Children's Hospital of New York between 1998 and 2008. In 37 of these cases, a perpetrator was identified: 17 men and 17 women.

A comparison of these men and women showed that the men tended to be younger than the women, with a median age of 27 for the men and 34 for the women.

Among the accused perpetrators:

• 10 were mothers of the victim
• 9 were fathers of the victim
• 7 were the mother's boyfriend
• 4 were grandmothers of the victim
• 3 were female babysitters
• 1 was a babysitter's husband

Eighteen of the accused perpetrators admitted to shaking the victim in some way. Four described head impact.

Fourteen of the 17 accused male perpetrators were convicted and two await trial. Five of the 17 accused female perpetrators were convicted; none still awaits trial.

Among the 34 victims of identified perpetrators, six died. All of their accused abusers were men. Of the 28 survivors, 13 required rehabilitation services and 15 had apparently normal hospital discharge. However, it is not uncommon to see delayed symptoms of serious brain damage in such children.

Esernio-Jenssen and colleagues report their findings in the March 7 issue of Pediatrics.