Doubt over shaken baby diagnosis

Other experts said that bleeding from the eyes could suggest a baby had been shaken violently - but the evidence was only compelling if there were also signs of brain damage and bleeding in the brain.

The researchers focused on the case of a healthy 14-month-old child who was brought to hospital with a severe head injury after a television fell on him at home.

Despite the father's repeated, detailed, and consistent account of the incident, Child Protective Services removed the child's three-year-old brother from the home because the baby had injuries to the retina of the eye.

Only after a careful investigation by a paediatrician and a forensic pathologist was the child's injury deemed to have been an accident.

The Wake Forest team searched the medical literature on the eye injury observed in this case.

Members found no valid scientific studies to indicate that this particular eye injury could only result from shaken baby syndrome - echoing the findings of another recent study into the same topic.

No proof

Lead researcher Dr Patrick Lantz told BBC News Online: "It is important to remember that this theory has been based on observations but has never been proven.

"Also, no studies have been done comparing the presence of this eye injury in shaken baby syndrome and serious accidental head injuries in young children.

"If some doctors believe that this eye injury can only result from shaking and haven't critically reviewed the medical literature, false allegations of child abuse could exist."

In an editorial in the same edition of the BMJ, forensic pathologist Dr John Plunkett and brain damage expert Dr Jennian Geddes argue the research suggests that the criteria used to diagnose shaken baby syndrome require re-assessment.

They say it is not unusual for shaken baby syndrome to be diagnosed on the basis of signs of bleeding from the eyes alone.

"If the issues are much less certain than we have been taught to believe, then to admit uncertainty sometimes would be appropriate for experts.

"Doing so may make prosecution more difficult, but a natural desire to protect children should not lead anyone to proffer opinions unsupported by good quality science."

In a second editorial, Dr Brian Harding and Dr Anthony Risdon, two experts at Great Ormond Street Hospital for Children in London, UK, argue that a conclusion about a baby being violently shaken should only be based on a careful examination of all the features of an injury.

However, they say that if all three elements - brain damage and bleeding, and bleeding from the eyes - are present, this is powerful evidence that undue force has been applied.

"Damage to the neck or spinal cord is further useful confirmation, and the presence of gripping injuries, while often absent, can provide further weight."

Disturbing findings

The Five Percenters, who support parents who say they have been wrongly accused of shaken baby syndrome, said the findings raised "disturbing questions" about the opinion of medical experts given in court.

Director Rioch Edwards-Brown, who was wrongly accused of shaking her own baby son, said their study of parents' accounts of child injuries supported other reasons for bleeding behind the eyes.

She said: "In approximately a third of cases their child's injuries followed a minor fall, but both birth trauma and difficulty in breathing can also cause bleeding under the skin and at the back of the eyes.

"Doctors have been so convinced that these injuries could only be caused by shaking, they have simply ruled out the possibility that the parents might be innocent after all."