It has been suggested that violent shaking of a child, in the absence of head impact, can result in closed head injury. Specifically, the symptoms associated with shaken baby syndrome (SBS) are relegated to the head, and include retinal hemorrhaging, cerebral hemorrhaging, and encephalopathy. Careful characterization of the injuries resulting from shaking is critical when determining a potentially abusive situation. Unfortunately, a paucity of real- world or empirical validation exists to confirm the SBS injury pattern.

Both real-world and empirically derived data from automobile collisions provides valuable information related to pediatric injury patterns during pure inertial loading of the head, which is similar to violent shaking. These data indicate the presence of cervical spine trauma in the absence of closed head injury.

Therefore, the objective of the current study was to evaluate pediatric neck and head injury potential during purely inertial loading of the head. Given the anatomical and biomechanical properties of the pediatric cervical spine, we hypothesized that inertial loading of the pediatric head provides a greater risk of injury to the cervical spine when compared with closed-head injury. In order to test this hypothesis, frontal crash test data from over 100 pediatric anthropomorphic test dummies was analyzed. The results generally indicated a greater risk of neck injury when compared with the head.

These data suggest that the injury pattern associated with violent shaking should be altered to include the presence of cervical spine injury. Moreover, during instances in which abusive shaking is suspected, special consideration should be paid to the cervical spine. 

Davison MA, Weaver BT, Rundell SA. Investigation of Neck and Head Injury Potential during Inertial Loading of the Pediatric Head: Implications to Shaken Baby Syndrome Characterization, American Society of Biomechanics Annual Meeting, Poster Presentation, 2015