{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T06:11:25Z","timestamp":1789711885042,"version":"4.0.1"},"reference-count":134,"publisher":"Archives of Pathology and Laboratory Medicine","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Context.<\/jats:italic>\n                    \u2014Shaken baby syndrome is a controversial topic in forensic pathology. Some forensic pathologists state that shaking alone is insufficient to explain death and that an impact must have occurred even if there is no impact site on the head.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Objective.<\/jats:italic>\n                    \u2014To examine a large cohort of fatal, pediatric head injuries for patterns of specific autopsy findings and circumstances that would support or dispute pure shaking as the cause of death.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Design.<\/jats:italic>\n                    \u2014We retrospectively reviewed 59 deaths due to head injuries in children younger than 2 years certified in our office during a 9 year period (1998\u20132006). The review included autopsy, toxicology, microscopy, neuropathology, and police and investigators' reports.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Results.<\/jats:italic>\n                    \u2014There were 46 homicides, 8 accidents, and 1 undetermined death from blunt-impact injury of the head. In 10 (22%) of the homicides, there was no impact injury to the head, and the cause of death was certified as whiplash shaking. In 4 (40%) of these 10 deaths, there was a history of shaking. In 5 (83%) of the other 6, there was no history of any purported accidental or homicidal injury. All 8 accidental deaths had impact sites. Of the 59 deaths, 4 (6.7%) had only remote injuries (chronic subdural hematomas, remote long bone fractures) that were certified as undetermined cause and manner. These 4 deaths were excluded from the study.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusions.<\/jats:italic>\n                    \u2014We describe a subset of fatal, nonaccidental head-injury deaths in infants without an impact to the head. The autopsy findings and circumstances are diagnostic of a nonimpact, shaking mechanism as the cause of death. Fatal, accidental head injuries in children younger than 2 years are rare.\n                  <\/jats:p>","DOI":"10.5858\/133.4.619","type":"journal-article","created":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T09:47:07Z","timestamp":1613123227000},"page":"619-627","source":"Crossref","is-referenced-by-count":44,"title":["Fatal Head Injury in Children Younger Than 2 Years in New York City and an Overview of the Shaken Baby Syndrome"],"prefix":"10.5858","volume":"133","author":[{"given":"James R.","family":"Gill","sequence":"first","affiliation":[{"name":"From the New York City Office of Chief Medical Examiner and the Department of Forensic Medicine, New York University School of Medicine, New York (Drs Gill, Goldfeder, Coleman, Mena, and Hirsch); and the Department of Neuropathology, Armed Forces Institute of Pathology, Washington, DC (Dr Armbrustmacher)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara B.","family":"Goldfeder","sequence":"additional","affiliation":[{"name":"From the New York City Office of Chief Medical Examiner and the Department of Forensic Medicine, New York University School of Medicine, New York (Drs Gill, Goldfeder, Coleman, Mena, and Hirsch); and the Department of Neuropathology, Armed Forces Institute of Pathology, Washington, DC (Dr Armbrustmacher)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vernon","family":"Armbrustmacher","sequence":"additional","affiliation":[{"name":"From the New York City Office of Chief Medical Examiner and the Department of Forensic Medicine, New York University School of Medicine, New York (Drs Gill, Goldfeder, Coleman, Mena, and Hirsch); and the Department of Neuropathology, Armed Forces Institute of Pathology, Washington, DC (Dr Armbrustmacher)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Coleman","sequence":"additional","affiliation":[{"name":"From the New York City Office of Chief Medical Examiner and the Department of Forensic Medicine, New York University School of Medicine, New York (Drs Gill, Goldfeder, Coleman, Mena, and Hirsch); and the Department of Neuropathology, Armed Forces Institute of Pathology, Washington, DC (Dr Armbrustmacher)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hernando","family":"Mena","sequence":"additional","affiliation":[{"name":"From the New York City Office of Chief Medical Examiner and the Department of Forensic Medicine, New York University School of Medicine, New York (Drs Gill, Goldfeder, Coleman, Mena, and Hirsch); and the Department of Neuropathology, Armed Forces Institute of Pathology, Washington, DC (Dr Armbrustmacher)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles S.","family":"Hirsch","sequence":"additional","affiliation":[{"name":"From the New York City Office of Chief Medical Examiner and the Department of Forensic Medicine, New York University School of Medicine, New York (Drs Gill, Goldfeder, Coleman, Mena, and Hirsch); and the Department of Neuropathology, Armed Forces Institute of Pathology, Washington, DC (Dr Armbrustmacher)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3906","reference":[{"key":"i1543-2165-133-4-619-b1","series-title":"Am J Dis Child","first-page":"161","article-title":"On the theory and practice of shaking infants: its potential residual effects of permanent brain damage and mental retardation.","volume":"124","author":"Caffey, J.","year":"1972","unstructured":"Caffey, J.\n          \n          On the theory and practice of shaking infants: its potential residual effects of permanent brain damage and mental retardation.\n          Am J Dis Child\n          1972. 124:161\u2013169."},{"key":"i1543-2165-133-4-619-b2","series-title":"Pediatrics","first-page":"396","article-title":"The whiplash shaken infant syndrome: manual shaking by the extremities with whiplash-induced intracranial and intraocular bleedings, linked with residual permanent brain damage and mental retardation.","volume":"54","author":"Caffey, J.","year":"1974","unstructured":"Caffey, J.\n          \n          The whiplash shaken infant syndrome: manual shaking by the extremities with whiplash-induced intracranial and intraocular bleedings, linked with residual permanent brain damage and mental retardation.\n          Pediatrics\n          1974. 54:396\u2013403."},{"key":"i1543-2165-133-4-619-b3","series-title":"Forensic Sci Med Pathol","first-page":"9","article-title":"Controversies in pediatric forensic pathology.","volume":"1","author":"Krous, H. 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Traumatic axonal injury is exacerbated following repetitive closed head injury in the neonatal pig.J Neurotrauma2004. 21:307\u2013316."},{"key":"i1543-2165-133-4-619-b53","series-title":"J Neurosurg","first-page":"143","article-title":"Anthropomorphic simulations of falls, shakes, and inflicted impacts in infants.","volume":"99","author":"Prange, M. T.","year":"2003","unstructured":"Prange, M. T., B.Coats, A. C.Duhaime, and S. S.Margulies. Anthropomorphic simulations of falls, shakes, and inflicted impacts in infants.J Neurosurg2003. 99:143\u2013150."},{"key":"i1543-2165-133-4-619-b54","series-title":"Am J Forensic Med Pathol","first-page":"321","article-title":"Shaken adult syndrome.","volume":"18","author":"Pounder, D. J.","year":"1997","unstructured":"Pounder, D. J.\n          \n          Shaken adult syndrome.\n          Am J Forensic Med Pathol\n          1997. 18:321\u2013324."},{"key":"i1543-2165-133-4-619-b55","series-title":"Acta Neurochir (Wien)","first-page":"20","article-title":"\u201cHead-shaking syndrome\u201d neurological deterioration during continuous head-shaking as an adjunct to cisternal irrigation for clot removal in patients with acute subarachnoid haemorrhage.","volume":"132","author":"Aoki, N.","year":"1995","unstructured":"Aoki, N.\n          \n          \u201cHead-shaking syndrome\u201d neurological deterioration during continuous head-shaking as an adjunct to cisternal irrigation for clot removal in patients with acute subarachnoid haemorrhage.\n          Acta Neurochir (Wien)\n          1995. 132:20\u201325."},{"key":"i1543-2165-133-4-619-b56","series-title":"J Neurosurg","first-page":"236","article-title":"Effectiveness of the head-shaking method combined with cisternal irrigation with urokinase in preventing cerebral vasospasm after subarachnoid hemorrhage.","volume":"100","author":"Kawamoto, S.","year":"2004","unstructured":"Kawamoto, S., K.Tsutsumi, and G.Yoshikawa. et al. Effectiveness of the head-shaking method combined with cisternal irrigation with urokinase in preventing cerebral vasospasm after subarachnoid hemorrhage.J Neurosurg2004. 100:236\u2013243."},{"key":"i1543-2165-133-4-619-b57","series-title":"J Forensic Sci","first-page":"1097","article-title":"Neck injuries, III: ligamentous injuries of the craniocervical articulation without occipito-atlantal or atlanto-axial facet dislocation\u2014a pathologic study of 21 traffic fatalities.","volume":"38","author":"Adams, V. I.","year":"1993","unstructured":"Adams, V. I.\n          \n          Neck injuries, III: ligamentous injuries of the craniocervical articulation without occipito-atlantal or atlanto-axial facet dislocation\u2014a pathologic study of 21 traffic fatalities.\n          J Forensic Sci\n          1993. 38:1097\u20131104."},{"key":"i1543-2165-133-4-619-b58","series-title":"J Forensic Sci","first-page":"565","article-title":"Neck injuries: II. 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Structural properties of spinal nerve roots: biomechanics.Exp Neurol1986. 91:30\u201340."},{"key":"i1543-2165-133-4-619-b61","series-title":"Am J Forensic Med Pathol","first-page":"1","article-title":"Fatal pediatric head injuries caused by short-distance falls.","volume":"22","author":"Plunkett, J.","year":"2001","unstructured":"Plunkett, J.\n          \n          Fatal pediatric head injuries caused by short-distance falls.\n          Am J Forensic Med Pathol\n          2001. 22:1\u201312."},{"key":"i1543-2165-133-4-619-b62","series-title":"Pediatrics","first-page":"179","article-title":"Head injury in very young children: mechanisms, injury types, and ophthalmologic findings in 100 hospitalized patients younger than 2 years of age.","volume":"90","author":"Duhaime, A. C.","year":"1992","unstructured":"Duhaime, A. C., A. J.Alario, and W. J.Lewander. et al. Head injury in very young children: mechanisms, injury types, and ophthalmologic findings in 100 hospitalized patients younger than 2 years of age.Pediatrics1992. 90:179\u2013185."},{"key":"i1543-2165-133-4-619-b63","series-title":"Pediatrics","first-page":"869","article-title":"Accidental falls from elevated surfaces in infants from birth to one year of age.","volume":"44","author":"Kravitz, H.","year":"1969","unstructured":"Kravitz, H., G.Driessen, R.Gomberg, and A.Korach. Accidental falls from elevated surfaces in infants from birth to one year of age.Pediatrics1969. 44:(suppl):. 869\u2013876."},{"key":"i1543-2165-133-4-619-b64","series-title":"Pediatrics","first-page":"533","article-title":"Injuries resulting when small children fall out of bed.","volume":"60","author":"Helfer, R. E.","year":"1977","unstructured":"Helfer, R. E., T. L.Slovis, and M.Black. 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Analysis of perpetrator admissions to inflicted traumatic brain injury in children.Arch Pediatr Adolesc Med2004. 158:454\u2013458."},{"key":"i1543-2165-133-4-619-b1","series-title":"Am J Dis Child","first-page":"161","article-title":"On the theory and practice of shaking infants: its potential residual effects of permanent brain damage and mental retardation.","volume":"124","author":"Caffey, J.","year":"1972","unstructured":"Caffey, J.\n          \n          On the theory and practice of shaking infants: its potential residual effects of permanent brain damage and mental retardation.\n          Am J Dis Child\n          1972. 124:161\u2013169."},{"key":"i1543-2165-133-4-619-b2","series-title":"Pediatrics","first-page":"396","article-title":"The whiplash shaken infant syndrome: manual shaking by the extremities with whiplash-induced intracranial and intraocular bleedings, linked with residual permanent brain damage and mental retardation.","volume":"54","author":"Caffey, J.","year":"1974","unstructured":"Caffey, J.\n          \n          The whiplash shaken infant syndrome: manual shaking by the extremities with whiplash-induced intracranial and intraocular bleedings, linked with residual permanent brain damage and mental retardation.\n          Pediatrics\n          1974. 54:396\u2013403."},{"key":"i1543-2165-133-4-619-b3","series-title":"Forensic Sci Med Pathol","first-page":"9","article-title":"Controversies in pediatric forensic pathology.","volume":"1","author":"Krous, H. 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R.","year":"2003","unstructured":"Reichard, R. R., C. L. I. I. I.White, C. L.Hladik, and D.Dolinak. Beta-amyloid precursor protein staining in nonhomicidal pediatric medicolegal autopsies.J Neuropathol Exp Neurol2003. 62:237\u2013247."},{"key":"i1543-2165-133-4-619-b23","series-title":"Brain","first-page":"1290","article-title":"Neuropathology of inflicted head injury in children, I: patterns of brain damage.","volume":"124","author":"Geddes, J. F.","year":"2001","unstructured":"Geddes, J. F., A. K.Hackshaw, G. H.Vowles, C. D.Nickols, and H. L.Whitwell. Neuropathology of inflicted head injury in children, I: patterns of brain damage.Brain2001. 124:1290\u20131298."},{"issue":"1","key":"i1543-2165-133-4-619-b24","series-title":"J Forensic Sci","first-page":"114","article-title":"Shaken babies\u2014some have no impact injuries.","volume":"41","author":"Gilliland, M.","year":"1996","unstructured":"Gilliland, M. and R.Folberg. 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The cause of infant and toddler subdural hemorrhage: a prospective study.Pediatrics2001. 108:636\u2013646."},{"key":"i1543-2165-133-4-619-b67","series-title":"Arch Pediatr Adolesc Med","first-page":"454","article-title":"Analysis of perpetrator admissions to inflicted traumatic brain injury in children.","volume":"158","author":"Starling, S. P.","year":"2004","unstructured":"Starling, S. P., S.Patel, B. L.Burke, A. P.Sirotnak, S.Stronks, and P.Rosquist. Analysis of perpetrator admissions to inflicted traumatic brain injury in children.Arch Pediatr Adolesc Med2004. 158:454\u2013458."}],"container-title":["Archives of Pathology &amp; Laboratory Medicine"],"original-title":[],"link":[{"URL":"https:\/\/aplm.kglmeridian.com\/view\/journals\/arpa\/133\/4\/article-p619.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/meridian.allenpress.com\/aplm\/article-pdf\/133\/4\/619\/2767365\/1543-2165-133_4_619.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/aplm.kglmeridian.com\/downloadpdf\/journals\/arpa\/133\/4\/article-p619.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/aplm.kglmeridian.com\/downloadpdf\/journals\/arpa\/133\/4\/article-p619.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T01:05:45Z","timestamp":1770771945000},"score":1,"resource":{"primary":{"URL":"https:\/\/aplm.kglmeridian.com\/view\/journals\/arpa\/133\/4\/article-p619.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,4]]},"references-count":134,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.5858\/133.4.619","relation":{},"ISSN":["1543-2165","0003-9985"],"issn-type":[{"value":"1543-2165","type":"electronic"},{"value":"0003-9985","type":"print"}],"subject":[],"published":{"date-parts":[[2009,4]]}}}