Policy critique: The conflation of shaken baby syndrome and abusive head trauma - a measure with several negative effects.

The amalgamizing of shaken baby syndrome (SBS) with the much broader and heterogeneous abusive head trauma (AHT) diagnosis is problematized. We suggest that the reason why American Academy of Pediatrics (AAP) took this step in 2009 was a response to another theory being presented and discussed from 2001 and onwards. This theory had completely different legal consequences as it suggested that the medical findings on which the SBS diagnosis were based, i.e. "the triad" (subdural hemorrhages/SDH, retinal hemorrhages/RH, and encephalopathy) were non-traumatic. If such an explanation was accepted, this would reveal not only that serious legal abuses had occurred in the past and that the pediatricians should be held responsible for this, but also that it would in the future be more difficult to protect the child by claiming abuse in cases of unclear diagnosis. We present also other steps, taken by other pediatric organizations, having similar effects upon the current SBS controversy. We suggest that these value-based considerations were the underlying reasons why SBS was integrated in the AHT concept, and why competing theories and evidence-based criticism is ignored, allowing to always interpret triad findings as the result of abuse. If the ethical principle to protect the child is more important to AAP than the scientific ambition to develop evidence-based diagnostic procedures, we encourage AAP to be honest and admit this prioritization. Or at least to admit that in this ethical dilemma, AAP finds that the least bad choice is despite the price is that many infants and its siblings may be separated on wrong grounds from their family, and that caregivers might be falsely accused and convicted of child abuse.