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Abstract
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Caffey is often cited as the source of the diagnosis of shaken baby syndrome (SBS). Once the classic findings attributed to SBS are identified, it is rare for a differential diagnosis to be considered.
Caffey focused on radiologic findings, but while he was aware of the possible diagnosis of scurvy, the radiologic signs of infantile scurvy may not have had sufficient time to develop. Other findings in his cases were compatible with scurvy due to toxic histaminemia, which can cause capillary fragility, retinal petechiae, and subdural hematoma. Although dietary vitamin C deficiency is very rare today in our country, both vitamin C deficiency and toxic histaminemia can accompany systemic infection. Toxic histaminemia may also occur following immunizations.
In 1946, John Caffey, a radiologist, described multiple fractures in the long bones of infants suffering from chronic subdural hematoma. None of the parents reported any knowledge of falls or physical injury, but Caffey suspected child abuse to explain the injuries.
Following this retrospective, radiological study by Caffey, the diagnosis of shaken baby syndrome (SBS--including retinal petechiae, multiple fractures of the long bones, and subdural hematomas) evolved and has resulted in many men and women being convicted of child abuse, all without any meaningful consideration of a differential diagnosis. |