The Significance of Macrocephaly or Enlarging Head Circumference in Infants with the Triad: Further Evidence of Mimics of Shaken Baby Syndrome

Infunts with the triad (neurologic dysfunction, subdural hema­ toma [SDH], and retinal hemonhage) are often diagnosed as victims of shaken baby syndrome. Medical conditions/predisposing factors to devel­ oping the triad are often dismissed: short falls, birth-related SDH that en­ Imges, macrocephaly, sinus/cortical vein thrombosis, and others. Six infimts with the triad are described in which child abuse was diagnosed, butparents denied wrongdoing. All 6hadeithermacmcephaly orenlaiging head circumfi:rence, which suggested medical explanations. Three infimts incurred short falls, 1 had a difficult delivery in which there was likely a rebleed ofa birth-related SDH, 1 had a spontaneous SDH associated with increased extra-axial fluid spaces, and 1had a !in.us thrombosis. Following legal proceedings, all 6 infants were retmned to their parents, and there has beenno child maltreatment infollow-up, suggesting child abuse neverhap­ peiied The results indicate that alternative rnedi.cal explanations for caus­ ing the triad should be considered and that macrocephaly or an enlaiging head circumference raises the posSJbility ofa medical explanation.