The American Academy of Pediatrics is publishing a position paper this month that replaces the term "shaken baby syndrome" with the more generic "abusive head trauma."
So I learned last October at the seventh annual North American Conference on Shaken Baby Syndrome in Vancouver, British Columbia.
Some won't approve. Many people - victims' families, prosecutors, investigators and medical specialists - are wedded to the concept that violent shaking causes devastating injury or death.
They further believe that a constellation of findings called the triad (bleeding in the eye, bleeding around the brain and brain swelling) is diagnostic of fatal shaking. Specifically with regard to eye bleeding (retinal hemorrhages), people thought this finding alone was virtual proof of child abuse. Some still do.
People were certain that victims of fatal shaking collapsed immediately, meaning the person with the child at the time of collapse must be the perpetrator. Some still are.
A majority of forensic pathologists once believed these things. A minority were skeptical. Only a few insisted shaking could not produce fatal injury without an impact, and these heretics were shunned and shouted down at conferences.
In years past, forensic pathologists routinely testified that the infliction of lethal head injuries in children required forces equivalent to a multistory fall or high-speed vehicular crash.
They testified that the type of forceful shaking sufficient to inflict disabling or fatal injury would be obviously abusive to any dispassionate observer.
Times and opinions change.
During the North American conference, when a prosecutor stated in a panel discussion that he would have to elicit such testimony to get a conviction, forensic pathologists shuffled their feet, looked away or studied their notebooks.
A pediatric ophthalmologist (eye doctor) who has published extensively on child abuse stated in his lectures that the term "retinal hemorrhage" is no more specific than "fracture."
Contrary to previously held views, he no longer can go further than to say that retinal hemorrhages that are extensive and widespread as opposed to localized and few are more likely to be the result of inflicted injury than accidental trauma.
Other presenters said no currently available biomechanical models are reliable (models proved long ago that bumblebees can't fly). Animal model results are not transferable to humans, biomarkers for injury cannot reliably determine time or mechanism of injury, caregiver accounts are not reliable and neither are confessions.
At another recent conference, a well-known pathologist, who was a staunch believer in shaking as a killing mechanism and convinced of the validity of the triad for the diagnosis of shaking, presented a paper recanting that certainty.
Everyone knows some people brutalize children, but it's becoming increasingly difficult to prove who did what and when.
I have been warning colleagues and fellow coroners for some time that some people's medical hubris in child-abuse testimony soon will make it very difficult to convict anybody of anything.
We've been too certain. The result is a sad situation largely of our own making. Of that, I have no doubt at all.
Dr. Carol J. Huser, a forensic pathologist, has served as La Plata County coroner since January 2003.