Overturned abusive head trauma and shaken baby syndrome convictions in the United States: Prevalence, legal basis, and medical evidence

Child Abuse Negl. 2021 Dec:122:105380. doi: 10.1016/j.chiabu.2021.105380. Epub 2021 Nov 4.


Background: Media reports and the Innocence Network assert that wrongful Abusive Head Trauma (AHT)/Shaken Baby Syndrome (SBS) convictions pervade the United States (U.S.) criminal justice system. Yet, no empirical evaluation of overturned AHT/SBS convictions has been conducted.

Objective: To evaluate the prevalence, legal basis, and characteristics of appellate rulings of AHT/SBS convictions.

Participants and setting: U.S. appellate cases in a legal database, Westlaw.

Methods: Retrospective review of AHT/SBS convictions that had appellate rulings from January 2008 through December 2018. Multiple search terms ensured all potential AHT/SBS cases were included. A mixed-methods analysis was conducted on overturned AHT/SBS convictions.

Results: We identified a total of 1431 unique AHT/SBS criminal convictions that had appellate rulings since 2008. Of those, 49 convictions (3%) were overturned, and 1382 (97%) were affirmed/upheld. Of those overturned, 20 cases (1% overall) were overturned on medical evidence-related grounds. The most common themes from the medical evidence-related reversals were controversy over the AHT/SBS diagnosis (n = 12) and accidental injury mechanism (n = 11). After being overturned on appeal, upon retrial, 42% of defendants either re-plead guilty to or were convicted again of the same offense.

Conclusion(s): AHT/SBS convictions are rarely overturned on medical evidence-related grounds. When overturned, medical evidence-related themes seldom reflect new scientific or clinical discoveries, but rather are alternative or differing medical opinions from those offered at the original trial. Our data tends to support the concerns of other authors regarding irresponsible communication of medical information in AHT/SBS cases.

Keywords: Abusive head trauma; Expert testimony; Medical evidence; Overturned convictions; Shaken baby syndrome; Wrongful convictions.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Child Abuse* / diagnosis
  • Craniocerebral Trauma* / diagnosis
  • Craniocerebral Trauma* / epidemiology
  • Craniocerebral Trauma* / etiology
  • Humans
  • Infant
  • Prevalence
  • Retrospective Studies
  • Shaken Baby Syndrome* / epidemiology
  • United States / epidemiology