Guidance for a clinical and forensic diagnosis of pediatric abusive head trauma (AHT): a narrative review

Monica Concato¹Anita Galic Mihic²Tijana Petrovic³Djordje M Alempijevic³Davide Radaelli¹Stefano D'Errico^1*

• ¹Universita degli Studi di Trieste Dipartimento Universitario Clinico di Scienze Mediche e Chirurgiche e della Salute, Trieste, Italy
• ²Institute of Forensic Medicine and Criminalistics, School of Medicine, University of Zagreb, Zagreb, Croatia
• ³Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

The term Shaken Baby Syndrome, now largely replaced by the more general term abusive head trauma (AHT), poses significant challenges for forensic assessment and investigation. The clinical assessment of these cases remains a complex process that necessarily involves collecting a complete medical history, taking into account the caregivers and the child's socio-economic and family context, a thorough physical examination, and additional diagnostic investigations. In cases where the child has died, the autopsy—whether performed for investigative or purely diagnostic purposes—remains an essential step requiring a rigorous methodological approach, technical expertise, and in-depth knowledge of the subject. Guided by previously conducted instrumental examinations, the autopsy includes a fundamental macroscopic evaluation followed by the essential histological assessment of the injuries. Given the importance of the topic, and the implications of an erroneous conclusion for both the young patient and their family, this work aims to compile methodological updates from the last ten years, in order to promote greater uniformity in the medico-legal practice.