Shaken Baby Syndrome Diagnosis

History 

Shaken Baby Syndrome (SBS) emerged as a med­ical diag­no­sis in the ear­ly 1970s, fol­low­ing research by pedi­atric neu­ro­sur­geon Norman Guthkelch, who sug­gest­ed that cer­tain brain injuries in infants could only be the result of being vio­lent­ly shak­en. The the­o­ry gained promi­nence through research by Dr. Guthkelch and Dr. John Caffey, who pub­lished influ­en­tial papers connecting a ​“tri­ad” of symp­toms — sub­dur­al hem­or­rhage, reti­nal hem­or­rhage, and brain swelling — to abu­sive shak­ing. By the 1980s, SBS had become an accept­ed diag­no­sis in the med­ical field and was increas­ing­ly used in crim­i­nal pros­e­cu­tions, with care­givers fac­ing seri­ous charges like mur­der, manslaugh­ter, and child abuse based pri­mar­i­ly on this tri­ad of symptoms. 

Prosecutors relied heav­i­ly on the pres­ence of the symp­toms as defin­i­tive proof of abuse, even in the absence of exter­nal injuries or wit­ness­es. Courts large­ly accept­ed med­ical expert tes­ti­mo­ny regard­ing SBS as con­clu­sive, lead­ing to con­vic­tions, sub­stan­tial prison sen­tences, and even some death sentences.

By the late 1990s and into the ear­ly 2000s, how­ev­er, sci­en­tif­ic chal­lenges to SBS began to emerge and gain momen­tum. Biomechanical stud­ies ques­tioned whether man­u­al shak­ing alone could gen­er­ate enough force to cause the tri­ad of injuries, while oth­er med­ical researchers iden­ti­fied alter­na­tive expla­na­tions for the same symp­toms, includ­ing acci­den­tal falls, birth trau­ma, cer­tain med­ical con­di­tions, and genet­ic dis­or­ders. These find­ings led the med­ical com­mu­ni­ty to change the diag­no­sis once con­sid­ered SBS to Abusive Head Trauma (AHT), which reflects a more inclu­sive under­stand­ing of the poten­tial caus­es of the symptoms. 

The legal com­mu­ni­ty was slow to respond to the change in the sci­en­tif­ic community’s under­stand­ing. Some courts now allow lim­it­ed post-con­vic­­tion chal­lenges in recog­ni­tion of the changes in sci­en­tif­ic under­stand­ing. Though AHT remains wide­ly accept­ed in pedi­atric med­i­cine, many courts now require more com­pre­hen­sive evi­dence beyond the pres­ence of the tri­ad of symp­toms alone, and many juris­dic­tions have seen acquit­tals, dis­missals, and suc­cess­ful appeals in cas­es that once end­ed in con­vic­tions dur­ing peak use of the SBS diagnosis.

Standard of Care

The foun­da­tion of an SBS diag­no­sis is the pres­ence of a tri­ad of symp­toms: sub­dur­al hem­or­rhage — bleed­ing between the brain’s sur­face and lin­ing — reti­nal hem­or­rhage — rup­ture of blood ves­sels in the eyes — and brain swelling caused by the alleged shak­ing. The med­ical com­mu­ni­ty attrib­uted each ele­ment to spe­cif­ic trau­ma mech­a­nisms: bridg­ing veins that car­ry blood from the brain to the dur­al sinus­es were thought to rup­ture trau­mat­i­cal­ly, caus­ing sub­dur­al hem­or­rhages; blood ves­sels in the reti­na were thought to burst from trau­ma, result­ing in reti­nal hem­or­rhages; and wide­spread dam­ages to neur­al con­nec­tions between brain cells was con­sid­ered evi­dence of traumatic disruption. 

Given the bilat­er­al and exten­sive nature of brain injuries asso­ci­at­ed with SBS, med­ical experts believed these pat­terns required forces com­pa­ra­ble to those expe­ri­enced in severe car crash­es or falls from sig­nif­i­cant heights. Because of this, when care­tak­ers pro­vid­ed his­to­ries lack­ing such cat­a­stroph­ic events, physi­cians deemed these accounts incon­sis­tent with the med­ical find­ings and con­clud­ed that abuse was the only plau­si­ble expla­na­tion for the injuries. For chil­dren exhibit­ing these char­ac­ter­is­tic find­ings with­out exter­nal trau­ma mark­ings, the med­ical hypoth­e­sis fur­ther spec­i­fied that vio­lent shak­ing must have been the abuse mech­a­nism, as it could sup­pos­ed­ly gen­er­ate the nec­es­sary forces to cause injury with­out leav­ing exter­nal bruis­ing or oth­er vis­i­ble signs of trauma. 

An exten­sion of the SBS hypoth­e­sis also held that med­ical find­ings alone could estab­lish both the tim­ing of the injuries and thus the iden­ti­ty of the per­pe­tra­tor. Medical experts the­o­rized that wide­spread trau­mat­ic dam­age to neur­al con­nec­tions through­out the brain would pro­duce imme­di­ate and cat­a­stroph­ic func­tion­al impair­ment, sim­i­lar to those found in con­cus­sion injuries. This imme­di­ate-effect the­o­ry reject­ed the idea of a ​“lucid inter­val,” a peri­od dur­ing which the child might appear rel­a­tive­ly nor­mal after sus­tain­ing the crit­i­cal injury. The pre­sumed instan­ta­neous onset of symp­toms cre­at­ed a tem­po­ral link between the injury and the appear­ance of neurological distress. 

Prosecutors large­ly accept­ed this med­ical propo­si­tion, as it cre­at­ed a straight­for­ward inves­tiga­tive frame­work: since symp­toms would man­i­fest imme­di­ate­ly after the trau­mat­ic event, the per­son car­ing for the child when­ev­er symp­toms first appeared must be the per­pe­tra­tor of the abuse. This med­ical tim­ing the­o­ry effec­tive­ly trans­formed the clin­i­cal SBS diag­no­sis into a foren­sic tool for establishing culpability.

Concerns with Shaken Baby Syndrome Diagnosis 

Despite SBS’s grow­ing accep­tance in the 1980s, some med­ical pro­fes­sion­als raised ear­ly con­cerns. In 1987, Dr. Ann-Christine Duhaime, a neu­ro­sur­geon, along with sev­er­al bio­me­chan­i­cal engi­neers, attempt­ed to val­i­date the SBS hypoth­e­sis by mea­sur­ing the force on a child’s skull while shak­ing and com­par­ing it to known injury thresh­olds. This ear­ly exper­i­ment showed that the force gen­er­at­ed when shak­ing a baby was far below the estab­lished head injury cri­te­ria, and a small frac­tion (1/​50) of the force was gen­er­at­ed from impact. The study found that ​“shak­en baby syn­drome, at least in its most severe acute form, is not usu­al­ly caused by shak­ing alone.” Dr. Duhaime would go on to sug­gest that the tri­ad of injuries asso­ci­at­ed with SBS were like­ly the result of shak­ing fol­lowed by impact.

2001 research by Dr. Jennian Geddes and her col­leagues stud­ied the brains of infants who report­ed­ly died from abuse. They found that the brain pathol­o­gy of these infants was hypox­ic or ischemic, indi­cat­ing a lack of oxy­gen, rather than a trau­mat­ic event. While some of the infants showed injury to neur­al con­nec­tions in the brain, most did not. This con­tra­dict­ed the found­ing prin­ci­ples of SBS. 

The same year, Professor Werner Goldsmith, a bio­me­chan­i­cal engi­neer, expressed con­cerns with SBS hypoth­e­sis to the National Institute of Health (NIH). Professor Goldsmith’s pre­sen­ta­tion empha­sized that pedi­atric head injuries pre­dom­i­nant­ly occur acci­den­tal­ly, though some stem from abuse or nat­ur­al caus­es with­out mechan­i­cal trau­ma. Research from Dr. John Plunkett, a foren­sic pathol­o­gist, cen­tered on fatal short falls and includ­ed a video­taped fall of a tod­dler who pre­sent­ed with the tri­ad symp­toms and died after a short lucid peri­od. The video demon­strat­ed that the tri­ad could occur as the result of a short fall and that lucid inter­vals could occur. 

In 2002, the NIH held a con­fer­ence to address con­cerns with the SBS hypoth­e­sis. While the atten­dees sup­port­ed the SBS the­o­ry, many acknowl­edged the lack of ground­ed sci­en­tif­ic evi­dence sup­port­ing the the­o­ry. Through the ear­ly 2000s, bio­me­chan­i­cal stud­ies con­tin­ued to show the force required to cause the tri­ad of symp­toms did not result by shak­ing an infant, and that doing so would also expect the pres­ence of neck injury. By 2006, pro­po­nents of the SBS hypoth­e­sis broad­ly acknowl­edged numer­ous con­di­tions oth­er than abuse that could mim­ic its pre­sen­ta­tion. These includ­ed var­i­ous acci­den­tal injuries, med­ical con­di­tions, and ill­ness­es span­ning from birth-relat­ed trau­ma to pediatric strokes. 

In an Arizona post-con­vic­­tion relief case in February 2012, Dr. Guthkelch, who was among the first to pro­pose the SBS hypoth­e­sis, sub­mit­ted a dec­la­ra­tion crit­i­ciz­ing the term ​“Shaken Baby Syndrome” as unsuit­able. He admit­ted there had been no con­clu­sive evi­dence at the time of his orig­i­nal pro­pos­al that shak­ing alone caused the diag­nos­tic tri­ad. Dr. Guthkelch fur­ther acknowl­edged that var­i­ous con­di­tions, includ­ing nat­ur­al caus­es, acci­dents, and abuse, could poten­tial­ly pro­duce the same tri­ad of symptoms. 

The con­ven­tion­al SBS hypoth­e­sis pro­posed that chil­dren would lose con­scious­ness imme­di­ate­ly after suf­fer­ing a head injury, pre­sumed to involve torn veins and axons. This led to the con­clu­sion that the per­son present dur­ing the child’s col­lapse was the per­pe­tra­tor. However, this rea­son­ing con­tra­dicts the well-estab­lished pat­tern of delayed dete­ri­o­ra­tion fol­low­ing minor head trau­ma, where extend­ed peri­ods of nor­mal or near-nor­­mal func­tion­ing often pre­cede even­tu­al col­lapse. Studies show that there can be a peri­od of more than 24 hours of delayed dete­ri­o­ra­tion between trau­ma and the appear­ance of symptoms. 

Many med­ical experts today cite the fact that the SBS hypoth­e­sis relies on an over­sim­pli­fied three-part mod­el that does not address the com­plex­i­ty of the infant brain. Infant sub­dur­al hem­or­rhages are typ­i­cal­ly too small to result from rup­tured bridg­ing veins as orig­i­nal­ly thought, like­ly orig­i­nat­ing instead from small blood ves­sels in the pro­tec­tive lay­ers sur­round­ing the brain that don’t match the mod­el’s hypoth­e­sis. Retinal hem­or­rhages, asso­ci­at­ed with trau­mat­ic vein rup­ture accord­ing to SBS hypoth­e­sis, occur in var­i­ous nat­ur­al con­di­tions and share caus­es with adult cas­es — includ­ing oxy­gen depri­va­tion and blood clots. Brain swelling, incor­rect­ly attrib­uted to wide­spread nerve tis­sue dam­age, has been rec­og­nized as result­ing from oxy­gen depri­va­tion regard­less of cause. This evi­dence was dis­re­gard­ed to pre­serve the orig­i­nal mod­el of SBS.

Case Studies 

Jeffrey Havard 

Jeffrey Havard was con­vict­ed and sen­tenced to death in 2002 in Mississippi for sex­u­al abuse and mur­der in the death of six-month-old Chloe Benn, the daugh­ter or his girl­friend. Mr. Havard was accused of shak­ing Chloe and sex­u­al­ly abus­ing her before her death, but the med­ical expert who tes­ti­fied at his tri­al lat­er recant­ed, rais­ing seri­ous doubts about the state’s the­o­ry of Chloe’s cause of death. 

During Mr. Havard’s tri­al, which last­ed just two days, the state pre­sent­ed tes­ti­mo­ny from state pathol­o­gist Steven Hayne, who told the jury that Mr. Havard had shak­en Chloe hard enough to cause injuries that would even­tu­al­ly lead to her death. Mr. Hayne tes­ti­fied that Chloe presented the ​“tell­tale symp­toms” of SBS. The defense pre­sent­ed only one wit­ness, who pro­vid­ed just three pages worth of tes­ti­mo­ny, and failed to chal­lenge the foren­sic tes­ti­mo­ny in the case. Defense coun­sel also failed to ques­tion the prosecution’s the­o­ry. Mr. Havard alleges that on the night in ques­tion, Rebecca Britt, his girl­friend and Chloe’s moth­er, went out to get food, leav­ing Chloe with him. After Chloe spit up food on her cloth­ing, Mr. Havard gave her a bath, and as he lift­ed her from the tub, she slipped from his hands. She hit her head on the toi­let as she fell. Mr. Havard admit­ted to the author­i­ties that he lied to Ms. Britt about drop­ping Chloe ini­tial­ly, claim­ing he did not know what caused her injuries. 

Since the 2002 tri­al, Mr. Hayne has recant­ed his diag­no­sis that Chloe died from Shaken Baby Syndrome. He had tes­ti­fied under oath that he reg­u­lar­ly per­formed 1,500 or more autop­sies each year, near­ly five times the max­i­mum num­ber rec­om­mend­ed by the National Association of Medical Examiners. Mr. Hayne had nev­er been cer­ti­fied in foren­sic pathol­o­gy by the American Board of Pathology and failed the cer­ti­fi­ca­tion exam in 1980. Three oth­er rep­utable experts who reviewed Mr. Hayne’s autop­sy report found no evi­dence of abuse of the infant. In 2008, Mr. Hayne was barred from doing autop­sies for Mississippi pros­e­cu­tors and the U.S. Court of Appeals for the Sixth Circuit called his work ​“dis­cred­it­ed.” 

During an evi­den­tiary hear­ing in August 2017, Mr. Hayne told the court that SBS is no longer a wide­ly accept­ed diag­no­sis in the sci­en­tif­ic com­mu­ni­ty and that his assess­ment of Chloe Britt came to incor­rect con­clu­sions. On September 14^th, 2018, Adam County Circuit Judge Forest Johnson ruled that Mr. Hayne’s recantation was ​“not suf­fi­cient to under­mine this court’s con­fi­dence in the con­vic­tion,” but that ​“there is a cau­tious dis­tur­bance in con­fi­dence of the sen­tence of death, even if slight.” Ultimately, Judge Johnson did not dis­pute the sci­en­tif­ic community’s declin­ing accep­tance of the diag­no­sis but found that even if Mr. Havard’s jury heard this tes­ti­mo­ny, they like­ly would have con­vict­ed him any­way. Judge Johnson point­ed to an inter­view in which Mr. Havard admit­ted to light­ly shak­ing Chloe after she first fell and was unre­spon­sive, but the experts that tes­ti­fied at the evi­den­tiary hear­ing all agreed that this shak­ing would not have been sub­stan­tial enough to cause injury. 

In December 2018, Judge Johnson for­mal­ly resen­tenced Mr. Havard to life in prison with­out the pos­si­bil­i­ty of parole, tak­ing him off Mississippi’s death row. 

Robert Roberson

Robert Roberson was con­vict­ed and sen­tenced to death in Texas for the 2002 death of his two-year-old daugh­ter, Nikki Curtis. At the time of her death, she was sick with a high fever and undi­ag­nosed pneu­mo­nia and had been pre­scribed med­ica­tions inap­pro­pri­ate for her age (Phenergan and Codeine) before suf­fer­ing a short fall from bed. Mr. Roberson imme­di­ate­ly brought Nikki to the emer­gency room when he found her unre­spon­sive and was unable to explain his chron­i­cal­ly ill daughter’s symp­toms. At the hos­pi­tal, staff were unaware that Mr. Roberson has autism and mis­con­strued his flat man­ner­isms as lack of con­cern for his daugh­ter. Using one physi­cian’s hypoth­e­sis that Nikki’s death was the result of Shaken Baby Syndrome (SBS), police arrest­ed Mr. Roberson, even pri­or to an autop­sy being performed. 

At tri­al, Mr. Roberson’s attor­ney ignored his claims of inno­cence, instead con­ced­ing the pros­e­cu­tion’s argu­ment that it was a ​“clas­sic” SBS case but not­ed that Mr. Roberson lacked the intent to kill his daugh­ter. Doctors tes­ti­fied that Nikki had died of SBS. 

The jury nev­er learned that Nikki had pneu­mo­nia at the time of her death and that she had been on med­ica­tion no longer rec­om­mend­ed for chil­dren because it can sup­press breath­ing. CAT scans also showed a sin­gle impact injury to Nikki’s head, con­sis­tent with impact from a fall. She had no injuries to her neck, which would be expect­ed had she been sub­ject­ed to vio­lent shak­ing. Mr. Roberson was con­vict­ed and sen­tenced to death in 2003. 

In 2016, the Texas Court of Criminal Appeals stayed a sched­uled exe­cu­tion date for Mr. Roberson, and the tri­al court con­duct­ed an eight-day evi­den­tiary hear­ing. In February 2022, Judge Deborah Evans rec­om­mend­ed the TCCA deny Mr. Roberson’s claims, stat­ing that the court ​“had found insuf­fi­cient facts to sup­port grant­i­ng relief.” Judge Evans said that the defense failed to present any new­ly dis­cov­ered evi­dence that was not already avail­able at the time of tri­al that estab­lish­es Mr. Roberson’s inno­cence, nor any new evi­dence that would lead a rea­son­able juror to a different decision. 

In June 2024, Anderson County District Attorney Allyson Mitchell filed a motion to set an exe­cu­tion date for Mr. Roberson, while a motion request­ing a new hear­ing remained pend­ing. The motion for a new hear­ing explained that since June 2016, Mr. Roberson’s attor­neys devel­oped new evi­dence of his actu­al inno­cence. At the same time, Mr. Roberson asked the TCCA to recon­sid­er its pre­vi­ous rul­ing. The sug­ges­tion argued that anoth­er case, Ex parte Roark, pend­ing before the TCCA, showed that the state con­ced­ed the false nature of near­ly iden­ti­cal evi­dence from expert tes­ti­mo­ny on SBS. Both Mr. Roberson and Mr. Roark were con­vict­ed and sen­tenced more than two decades ago using the SBS the­o­ry and tes­ti­mo­ny from the same child abuse expert. The court ulti­mate­ly set an October 17, 2024, exe­cu­tion date for Mr. Roberson. 

In July 2024, coun­sel for Mr. Roberson filed an addi­tion­al writ of habeas cor­pus with three new expert opin­ions pre­cise­ly explain­ing the cir­cum­stances of Nikki’s death. After exam­in­ing new evi­dence, unavail­able dur­ing the pre­vi­ous appli­ca­tion for habeas relief in 2016, these three experts unan­i­mous­ly con­clud­ed Nikki’s death was caused by severe viral and bac­te­r­i­al pneu­mo­nia that pro­gressed to sep­sis and then sep­tic shock and was not the result of SBS. 

In September 2024, the TCCA dis­missed Mr. Roberson’s request for habeas relief with­out review­ing the mer­its of any of his claims, cit­ing a fail­ure to meet pro­ce­dur­al require­ments, despite the inclu­sion of new, pre­vi­ous­ly unavail­able med­ical and sci­en­tif­ic evi­dence. The TCCA denied an emer­gency motion for a stay of exe­cu­tion and the U.S. Supreme Court denied a writ of cer­tio­rari to deter­mine whether TCCA’s unex­plained use of a pro­ce­dur­al rule vio­lates fed­er­al due process when a death row pris­on­er has an actu­al inno­cence claim pre­vi­ous­ly unavail­able. Mr. Roberson was sched­uled to be exe­cut­ed October 17, 2024, but his exe­cu­tion was stayed because of a sub­poe­na issued by the leg­is­la­ture for Mr. Roberson to tes­ti­fy after his scheduled execution. 

On February 19, 2025, Mr. Roberson again asked the TCCA for relief, pre­sent­ing sub­stan­tial new evi­dence that sup­port­ed his actu­al inno­cence claim. Counsel again point­ed to TCCA’s deci­sion in Ex parte Roark, where the Court over­turned a mur­der con­vic­tion based on the SBS tes­ti­mo­ny from the same expert who tes­ti­fied against Mr. Roberson. Evidence-based sci­ence has dis­man­tled each of the SBS premis­es that were pre­sent­ed as med­ical facts at Mr. Roberson’s tri­al, a devel­op­ment offi­cial­ly rec­og­nized by the TCCA in the Roark case. This fil­ing also includ­ed a new affi­davit for Dr. Michael Laposata, a pathol­o­gist with more than four decades of exper­tise in coag­u­la­tion and bleed­ing dis­or­ders. Dr. Laposata, who reviewed Nikki’s med­ical records, autop­sy, and oth­er avail­able infor­ma­tion deter­mined that based on those records, Nikki suf­fered from Disseminated Intravascular Coagulation (DIC), a blood clot­ting dis­or­der that is com­mon­ly caused by seri­ous ill­ness­es, such as pneu­mo­nia. He also explained that the bleed­ing in Nikki’s brain that the med­ical exam­in­er attributed to ​“mul­ti­ple impact” sites was, in actu­al­i­ty, because of DIC. Dr. Laposata also reviewed the reports of the three oth­er med­ical experts and found their con­clu­sions to be con­sis­tent with his own. The fil­ings also include a joint state­ment of 10 pathol­o­gists who con­clude that the autop­sy per­formed on Nikki was not reliable. 

In July 2025, an Anderson County judge set anoth­er exe­cu­tion date for Mr. Roberson, October 16, 2025. Just a week before his sched­uled exe­cu­tion, the TCCA stepped in a grant­ed a stay of exe­cu­tion based on the February 2025 motion. With the TCCA’s grant of relief, Mr. Roberson may get an evi­den­tiary hear­ing to deter­mine whether sci­en­tif­ic changes since his ini­tial con­vic­tion war­rant a new trial. 

Sources

Hayley Bedard, Robert Roberson Once Again Asks Texas Court of Criminal Appeals to Consider New Evidence Supporting His Actual Innocence and Grant Him Relief, Death Penalty Information Center, February 26, 2025; Innocence: The Death Penalty in 2024, Death Penalty Information Center, December 19, 2024; Texas Court of Criminal Appeals Dismisses New Evidence of Innocence and Denies Robert Roberson Habeas Relief, Death Penalty Information Center, September 12, 2024; Anderson County, Texas District Attorney Requests Execution for Robert Roberson, Despite a Conviction Obtained with Debunked Forensic Science, Death Penalty Information Center, June 20, 2024; Scientists, Physicians, Retired Federal Judges, and Innocence Groups File Amicus Briefs in Support of Robert Roberson, Texas Man Convicted and Sentenced to Death in ​“Shaken Baby Syndrome” Case, Death Penalty Information Center, June 15, 2023; Forensics Experts and Shaken-Baby Exonerees File Briefs Supporting Texas Death-Row Prisoner Robert Roberson’s Innocence Claim, Death Penalty Information Center, April 18, 2022; Questionable Ruling Grants Jeffrey Havard New Sentencing but Not New Trial in Controversial ​“Shaken Baby” Case, Death Penalty Information Center, September 24, 2018; Radley Balko, The mur­der evi­dence evap­o­rat­ed, but Jeffrey Havard still sits in a Mississippi prison, The Washington Post, September 19, 2018; Keith A. Findley, Patrick D. Barnes, David A. Moran, and Waney Squier, Shaken Baby Syndrome, Abusive Head Trauma, and Actual Innocence: Getting it Right, Houston Journal of Health and Law Policy, April 30, 2012; Ivan Blumenthal, Shaken baby syn­drome, Postgraduate Medical Journal, 2002.