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Abusive head trauma (AHT, formerly known as Shaken Baby Syndrome) is a serious form of maltreatment of young children. It appears to be virtually absent in South Africa, which is puzzling in a country where maltreatment rates are several times higher than the global average. Children under age 3 are most vulnerable to injury or death from shaking. We examined two sources of data to establish whether AHT occurs in South Africa and what the incidence rate is: records of injuries of children under age 3 from a tertiary hospital trauma unit (the ChildSafe database 1996–2015), and autopsy records of deaths of children under age 3 from three Magistrates’ Courts in greater Cape Town, South Africa (2006–2016). Of the 52,165 injuries in this age-group in the ChildSafe database, there were only three accounts of shaking, of which only one caused injury. However, the structure of the database made it impossible to identify clusters of injuries that may have resulted from AHT, nor were doctors constrained to indicate whether shaking had occurred. There were no reports of shaking in autopsy findings, although several cases had indications that shaking may have occurred. It therefore remains unclear as to whether AHT is occurring in South Africa. In order to detect shaking in future, we recommend that: (1) the form which doctors in trauma units are required to complete explicitly enquires about this; (2) doctors performing autopsies are provided with a standard protocol that requires them to investigate the possibility of AHT; (3) a prospective study of infants and caregivers be conducted, to establish the incidence of shaking and whether it causes injury.

Does ‘Shaken baby syndrome’ occur in South Africa? A review of emergency room and inquest records in Cape Town