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We welcome scientific debate around the recognition of abusive head trauma. The Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) report concludes, ‘There is limited scientific evidence that the triad and therefore its components can be associated with traumatic shaking.’1 We have provided a methodological critique of the SBU report2 which we hope provides points for others to consider when interpreting it.

We would just like to correct a couple of inaccuracies presented in the letter from Binney et al 3 and reiterate the importance of correct terminology in this field. Binney et al state that we ‘claim the SBU are inconsistent by saying that shaking may cause the triad,’ then concluding ‘that there is insufficient evidence that the triad is diagnostic for shaking.’ And second that we ‘argue that studies the SBU dismiss due to circularity bias would if included, support the ‘correct’ conclusion that the triad is specific for abuse.’ We would like to make it absolutely clear that at no point do we advocate that the ‘triad is specific for abuse’ or ‘diagnostic of shaking’. We simply propose that in light of the SBU statement about the two studies that they included in their systematic review… ‘Although both studies (moderate quality) have methodological limitations, they support the hypothesis that isolated traumatic shaking can give rise to the triad’ that ‘the correct conclusion would be that there is sufficient evidence that components of the triad are associated with traumatic shaking.’

There is a world of difference in clinical practice between the application of a definitive diagnostic test that is used to confirm a diagnosis and clinical signs that are associated with a condition that will point a clinician in the direction of a differential diagnosis to be considered.

Whatever the debate that surrounds this topic and whatever points of view that different groups of clinicians hold it is NEVER acceptable to shake a baby.