Bias in shaken baby syndrome diagnoses when the outcome is death
Physicians’ judgments may vary in shaken baby syndrome cases
In recent years, the method to detect shaken baby syndrome – caused by violent shaking of a small child or infant – has been called into question. A recent study finds physicians’ judgments vary depending on whether the case was fatal or non-fatal. If a baby died, they are more likely to conclude brain damage was caused by violent shaking.
Niklas Juth is professor of clinical medical ethics
Because shaken baby syndrome diagnoses can result in children being removed from families and parents receiving long prison sentences, they must be evidence-based and unbiased.
“Our findings suggest their judgments are shaped not just by medical evidence but also by outcome severity and ethical framing. This of course raises concerns about courtroom testimony, reliability of diagnosis and the balance between child protection and scientific rigour,” says Niklas Juth, professor of clinical medical ethics at Uppsala University’s Centre for Research Ethics & Bioethics, and one of the authors of a paper recently published in Annals of the Child Neurology Society.
The study asked 391 physicians to review identical case reports that differed only in whether the outcome was fatal or non-fatal. If the child survived, physicians were more likely to diagnose it with hypoxia (respiratory arrest) than shaken baby syndrome and the other way around. This suggests the judgement is not purely medical or evidence based, but shaped by outcome severity and ethical framing.
Paediatricians and ophthalmologists, who are typically involved in shaken baby syndrome diagnosis, were more likely to attribute symptoms to intentional shaking if the baby died, while radiologists and forensic pathologists, who typically have less direct family contact, showed less bias.
There are strong consequences, both social and legal, depending on the interpretation of these medical findings. Because their findings challenge the notion that SBS diagnoses are purely medical, free of legal or moral judgment, the authors call for re-evaluating training, guidelines, and evidentiary standards.
By Anna Holm Bodin
Lynøe N, Castor A, Juth N & Eriksson A. Questionnaire-Based Experimental Study of the Diagnostic Process in Suspected Shaken Baby Syndrome. Annals of the Child Neurology Society. 2025; 1-7. DOI: 10.1002/cns3.70031