Methods of Inference and Shaken Baby Syndrome


  • Nicholas Binney Department of Medical Ethics, Philosophy and History of Medicine, Erasmus University Medical Center, Rotterdam



Induction, Abduction, Abusive head trauma, Non-accidental head injury, Diagnostic criteria


Exploring the early development of an area of medical literature can inform contemporary medical debates. Different methods of inference include deduction, induction, abduction, and inference to the best explanation. I argue that early shaken baby research is best understood as using abduction to tentatively suggest that infants with unexplained intracranial and ocular bleeding have been assaulted. However, this tentative conclusion was quickly interpreted, by some at least, as a general rule that infants with these pathological signs were certainly cases of abuse. Rather than focusing on inductive arguments, researchers today may be better off focusing on making a compelling inference to the best explanation.


American Academy of Pediatrics: Committee on Child Abuse and Neglect. 2001. “Shaken Baby Syndrome: Rotational Cranial Injuries—Technical Report.” Pediatrics 108, no. 1: 206–210.

Beebe, James R. 2009. “The Abductivist Reply to Skepticism.” Philosophy and Phenomenological Research 79, no. 3: 605–636.

Bennett, Harvey S. and Joseph H. French. 1980> “Elevated Intracranial Pressure in Whiplash-Shaken Infant Syndrome Detected with Normal Computerized Tomography.” Clinical Pediatrics 19, no. 9: 633–634.

Bird, Alexander. 2010. “Eliminative Abduction: Examples from Medicine.” Studies in History and Philosophy of Science Part A 41, no. 4: 345–352.

Bolton, Jonathan W. 2015. “Varieties of Clinical Reasoning.” Journal of Evaluation in Clinical Practice 21, no. 3: 486–489.

Cabrera, Frank. 2017. “Can There Be a Bayesian Explanationism? On the Prospects of a Productive Partnership.” Synthese 194, no. 4: 1245–1272.

———. 2022. “Inference to the Best Explanation: An Overview.” In Handbook of Abductive Cognition, edited by Lorenzo Magnani, 1–34. Cham: Springer International Publishing.

Caffey, John. 1972. “On the Theory and Practice of Shaking Infants: Its Potential Residual Effects of Permanent Brain Damage and Mental Retardation.” American Journal of Diseases of Children 124, no. 2: 161–169.

———. 1974. “The Whiplash Shaken Infant Syndrome: Manual Shaking by the Extremities with Whiplash-Induced Intracranial and Intraocular Bleedings, Linked with Residual Permanent Brain Damage and Mental Retardation.” Pediatrics 54, no. 4: 396–403.

Campos, Daniel G. 2011. “On the Distinction between Peirce’s Abduction and Lipton’s Inference to the Best Explanation.” Synthese 180, no. 3: 419–442.

Chiffi, Daniele. 2020. Clinical Reasoning: Knowledge, Uncertainty, and Values in Health Care. Cham: Springer.

Choudhary, Arabinda Kumar, Sandeep K. Narang, Joëlle Anne Moreno, Cindy W. Christian, Sabah Servaes, Vincent J. Palusci, Gary L. Hedlund, et al. 2019. “A Consensus Response on the Complete Picture: Reply to Lynøe and Eriksson.” Pediatric Radiology 49, no. 3: 424–428.

Choudhary, Arabinda Kumar, Sabah Servaes, Thomas L. Slovis, Vincent J. Palusci, Gary L. Hedlund, Sandeep K. Narang, Joëlle Anne Moreno, et al. 2018. “Consensus Statement on Abusive Head Trauma in Infants and Young Children.” Pediatric Radiology 48, no. 8: 1048–1065.

Christian, Cindy W. and Robert Block. 2009. “Abusive Head Trauma in Infants and Children.” Pediatrics 123, no. 5: 1409–1411.

Climenhaga, Nevin. Forthcoming. “Evidence and Inductive Inference.” In The Routledge Handbook of the Philosophy of Evidence, edited by Maria Lasonen-Aarnio and Clayton Littlejohn. New York: Routledge. A preview of this chapter is available here:

Cohen, Marta C. 2019. “The Swedish Shaken Baby Syndrome Report and Review: What Does the Latest Knowledge Tell Us?” Acta Paediatrica 108, no. 2: 198–199.

Cory, C.Z. and M.D. Jones. 2003. “Can Shaking Alone Cause Fatal Brain Injury? A Biomechanical Assessment of the Duhaime Shaken Baby Syndrome Model.” Medicine, Science and the Law 43, no. 4: 317–333.

Darwin, Charles. 1872. The Origin of Species. London: John Murray.

Debelle, Geoffrey David, Sabine Maguire, Patrick Watts, Rosa Nieto Hernandez, and Alison Mary Kemp. 2018. “Abusive Head Trauma and the Triad: A Critique on Behalf of RCPCH of ‘Traumatic Shaking: The Role of the Triad in Medical Investigations of Suspected Traumatic Shaking’.” Archives of Disease in Childhood 103, no. 6: 606–610.

Dellsén, Finnur. 2021. “Explanatory Consolidation: From ‘Best’ to ‘Good Enough’.” Philosophy and Phenomenological Research 103, no. 1: 157–177.

Donohoe, Mark. 2003. “Evidence-Based Medicine and Shaken Baby Syndrome: Part I: Literature Review, 1966–1998.” American Journal of Forensic Medicine and Pathology 24, no. 3: 239–242.

Douven, Igor. 2022. The Art of Abduction. Cambridge, MA: Massachusetts Institute of Technology Press.

Dragulinescu, Stefan. 2016. “Inference to the Best Explanation and Mechanisms in Medicine.” Theoretical Medicine and Bioethics 37, no. 3: 211–232.

Duhaime, Ann-Christine and Cindy W. Christian. 2019. “Abusive Head Trauma: Evidence, Obfuscation, and Informed Management: JNSPG 75th Anniversary Invited Review Article.” Journal of Neurosurgery: Pediatrics 24, no. 5: 481–488.

Duhaime, Ann-Christine, Thomas A. Gennarelli, Lawrence E. Thibault, Derek A. Bruce, Susan S. Margulies, and Randall Wiser. 1987. “The Shaken Baby Syndrome: A Clinical, Pathological, and Biomechanical Study.” Journal of Neurosurgery 66, no. 3: 409–415.

Fann, K.T. 1970. Peirce’s Theory of Abduction. The Hague: Martinus Nijhoff.

Findley, Keith A., Patrick D. Barnes, David A. Moran, and Wayne Squier. 2012. “Shaken Baby Syndrome, Abusive Head Trauma, and Actual Innocence: Getting it Right.” 12 Houston Journal of Health Law and Policy 209, Univ. of Wisconsin Legal Studies Research Paper No. 1195.

Findley, Keith A. Michael Risinger, Patrick Barnes, Julie Mack, David A. Moran, Barry Scheck, and Thomas Bohan. 2019. “Feigned Consensus: Usurping the Law in Shaken Baby Syndrome/Abusive Head Trauma Prosecutions.” Wisconsin Law Review 2019, no. 5: 1211–1268.

Flach, Peter A. and Antonis C. Kakas. 2000. “Abductive and Inductive Reasoning: Background and Issues.” In Abduction and Induction: Essays on their Relation and Integration, edited by Peter A. Flach and Antonis C. Kakas, 1–27. Dordrecht: Springer Netherlands (Applied Logic Series).

Gabaeff, Steven C. 2016. “Exploring the Controversy in Child Abuse Pediatrics and False Accusations of Abuse.” Legal Medicine 18: 90–97.

Gent, Thomas and Antoine Adamantidis. 2017. ‘Anaesthesia and Sleep: Where Are We Now?” Clinical and Translational Neuroscience 1, no. 1.

Guthkelch, A.N. 1971. “Infantile Subdural Haematoma and Its Relationship to Whiplash Injuries.” British Medical Journal 2, no. 5759: 430–431.

———. 2011. “Problems of Infant Retino-Dural Hemorrhage with Minimal External Injury.” Houston Journal of Health Law & Policy 12, no. 2: 201–208.

Hanson, Norwood Russell. 1958. Patterns of Discovery: An Inquiry Into the Conceptual Foundations of Science. Cambridge: Cambridge University Press.

Harman, Gilbert H. 1965. “The Inference to the Best Explanation.” Philosophical Review 74, no. 1: 88–95.

Hellgren, Kerstin, Ann Hellström, Anna-Lena Hård, Lena Jacobson, Ulrika Lidén, Stefan Löfgren, Kristina Teär Fahnehjelm, and Jan Ygge. 2017. “The New Swedish Report on Shaken Baby Syndrome Is Misleading.” Acta Paediatrica 106, no. 7: 1040.

Henderson, Leah. 2020. “The Problem of Induction.” In The Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta. Spring 2020. Metaphysics Research Lab, Stanford University.

———. 2022. “Putting Inference to the Best Explanation into Context.” Studies in History and Philosophy of Science 94: 167–176.

Herrup, Karl. 2022. “Fallacies in Neuroscience: The Alzheimer’s Edition.” eNeuro 9, no. 1.

Högberg, Ulf, Erik Lampa, Göran Högberg, Peter Aspelin, Fredrik Serenius, and Ingemar Thiblin. 2018. “Infant Abuse Diagnosis Associated with Abusive Head Trauma Criteria: Incidence Increase Due to Overdiagnosis?” European Journal of Public Health 28, no. 4: 641–646.

Ingraham, Franc D. and Donald D. Matson. 1954. Neurosurgery of Infancy and Childhood. Springfield: Charles C. Thomas.

Janson, Staffan. 2020. “Towards a Deeper Understanding of Abusive Head Trauma.” Acta Paediatrica 109, no. 7: 1290–1291.

Jellema, Hylke. 2021. ‘The Reasonable Doubt Standard as Inference to the Best Explanation.” Synthese 199, no. 1: 949–973.

Johannesson, Eric. 2022. “The Statistical Riddle of Induction.” Australasian Journal of Philosophy: 1–14.

Karlsen, Bjørg, Torgeir Martin Hillestad, and Elin Dysvik. 2021. “Abductive Reasoning in Nursing: Challenges and Possibilities.” Nursing Inquiry 28, no. 1.

Kempe, C. Henry, Frederic N. Silverman, Brandt F. Steele, William Droegemueller, and Henry K. Silver. 1962. “The Battered-Child Syndrome.” JAMA 181, no. 1: 17–24.

Laurent-Vannier, Anne, Catherine Adamsbaum, Jean-Sébastien Raul, Caroline Rey-Salmon, and Caroline Rambaud. 2018. “Flawed Swedish Study on Traumatic Shaking Is Already Being Used by Defence Lawyers and Its Findings Must Be Ignored.” Acta Paediatrica 107, no. 12: 2048–2050.

Lindberg, Daniel M., Howard Dubowitz, Randell C. Alexander, and Robert M. Reece. 2019. “The ‘New Science’ of Abusive Head Trauma.” International Journal on Child Maltreatment: Research, Policy and Practice 2, no. 1–2: 1–16.

Lipton, Peter. 2004. Inference to the Best Explanation. 2nd edition. London: Routledge.

Lucas, Steven, Anna Bärtås, Anna-Karin Edstedt Bonamy, Lisa Törnudd, Peter Wide, and Gabriel Otterman. 2017. “The Way Forward in Addressing Abusive Head Trauma in Infants: Current Perspectives from Sweden.” Acta Paediatrica 106, no. 7: 1033–1035.

Ludwig, Stephen and Matt Warman. 1984. “Shaken Baby Syndrome: A Review of 20 Cases.” Annals of Emergency Medicine 13, no. 2: 104–107.

Lynøe, Niels, Göran Elinder, Boubou Hallberg, Måns Rosén, Pia Sundgren, and Anders Eriksson. 2017a. ‘Authors’ Overarching Reply to All the Responses Received to the Systematic Literature Review on Shaken Baby Syndrome.” Acta Paediatrica 106, no. 7: 1031.

———. 2017b. “Insufficient Evidence for ‘Shaken Baby Syndrome’: A Systematic Review.” Acta Paediatrica 106, no. 7: 1021–1027.

Lynøe, Niels and Anders Eriksson. 2019. ‘The Swedish Systematic Review of Traumatic Shaking Is Not Flawed and Should Not Be Ignored.” Acta Paediatrica 108, no. 2: 381.

Lynøe, Niels, Måns Rosén, Göran Elinder, Boubou Hallberg, Pia Sundgren, and Anders Eriksson. 2018. “Pouring Out the Dirty Bathwater without Throwing Away Either the Baby or Its Parents: Commentary to Saunders et al.” Pediatric Radiology 48, no. 2: 284–286.

Mackonis, Adolfas. 2013. “Inference to the Best Explanation, Coherence and Other Explanatory Virtues.” Synthese 190, no. 6: 975–995.

Magnani, Lorenzo. 2004. “Model-Based and Manipulative Abduction in Science.” Foundations of Science 9, no. 3: 219–247.

———. 2009. Abductive Cognition: The Epistemological and Eco-Cognitive Dimensions of Hypothetical Reasoning. Cham: Springer Science & Business Media.

Maguire, Sabine Ann, Alison Mary Kemp, Rebecca Caroline Lumb, and Daniel Mark Farewell. 2011. “Estimating the Probability of Abusive Head Trauma: A Pooled Analysis.” Pediatrics 128, no. 3: e550–e564.

Mashour, George A., Stuart A. Forman, and Jason A. Campagna. 2005. “Mechanisms of General Anesthesia: From Molecules to Mind.” Best Practice & Research Clinical Anaesthesiology 19, no. 3: 349–364.

Matschke, Jakob, Bernd Herrmann, Jan Sperhake, Friederike Körber, Thomas Bajanowski, and Markus Glatzel. 2009. “Shaken Baby Syndrome.” Deutsches Ärzteblatt International 106, no. 13: 211–217.

Mcauliffe, William H.B. 2015, “How Did Abduction Get Confused with Inference to the Best Explanation?” Transactions of the Charles S. Peirce Society 51, no. 3: 300–319.

McCain, Kevin and Ted Poston. 2017. Best Explanations: New Essays on Inference to the Best Explanation. Oxford: Oxford University Press.

McClelland C.Q., H. Rekate, B. Kaufman, and L. Persse. 1980. “Cerebral Injury in Child Abuse: A Changing Profile.” Pediatric Neurosurgery 7, no. 5: 225–235.

Mohammadian, Mousa. 2021. “Abduction: The Context of Discovery + Underdetermination = Inference to the Best Explanation.” Synthese 198, no. 5: 4205–4228.

Musgrave, Alan. 1988. “The Ultimate Argument for Scientific Realism.” In Relativism and Realism in Science, edited by Robert Nola, 229–252. Dordrecht: Springer Netherlands.

Narang, Sandeep. 2011. “A Daubert Analysis of Abusive Head Trauma/Shaken Baby Syndrome.” Houston Journal of Health Law and Policy 11: 505–633.

Narang, Sandeep K., Cynthia Estrada, Sarah Greenberg, and Daniel Lindberg. 2016. “Acceptance of Shaken Baby Syndrome and Abusive Head Trauma as Medical Diagnoses.” Journal of Pediatrics 177: 273–278.

Niiniluoto, Ilkka. 2018. Truth-Seeking by Abduction. Cham: Springer.

Okasha, Samir. 2000. “Van Fraassen’s Critique of Inference to the Best Explanation.” Studies in History and Philosophy of Science Part A 31, no. 4: 691–710.

Ommaya, Ayub K., Fred Faas, and Philip Yarnell. 1968. “Whiplash Injury and Brain Damage: An Experimental Study.” JAMA 204, no. 4: 285–289.

Ommaya, Ayub K. and Philip Yarnell. 1969. “Subdural Haematoma after Whiplash Injury.” Lancet 2, no. 7614: 237–239.

O’Rorke, P., S. Morris, and D. Schulenburg. 1990. “Theory Formation by Abduction: A Case Study Based on the Chemical Revolution.” In Computational Models of Scientific Discovery and Theory Formation, edited by Jeff Shrager and Pat Langley, 197–224. San Mateo, CA: Morgan Kaufman.

Paavola, Sami. 2005. “Peircean Abduction: Instinct or Inference?” Semiotica 2005, no. 153: 131–154.

Papetti, Randy, Paige Kaneb, and Lindsay Herf. 2019. “Outside the Echo Chamber: A Response to the Consensus Statement on Abusive Head Trauma in Infants and Young Children.” Santa Clara Law Review 59, no. 2: 299–368.

Park, Woosuk. 2015. “On Classifying Abduction.” Journal of Applied Logic 13, no. 3: 215–238.

Peirce, Charles Sanders. 1932. Collected Papers of Charles Sanders Peirce, Volumes I and II: Principles of Philosophy and Elements of Logic. Edited by Charles Hartshorne and Paul Weiss. Cambridge, MA: Harvard University Press.

———. 1935. Collected Papers of Charles Sanders Peirce, Volumes V and VI: Pragmatism and Pragmaticism and Scientific Metaphysics. Edited by Charles Hartshorne and Paul Weiss. Cambridge, MA: Harvard University Press.

———. 1958. Collected Papers of Charles Sanders Peirce, Volumes VII and VIII: Science and Philosophy and Reviews, Correspondence and Bibliography. Edited by Arthur W. Burks. Cambridge, MA: Harvard University Press.

———. 1992. The Essential Peirce: Selected Philosophical Writings. Edited by the Peirce Edition Project. Indianapolis: Indiana University Press.

Pietarinen, Ahti-Veikko and Francesco Bellucci. 2014. “New Light on Peirce’s Conceptions of Retroduction, Deduction, and Scientific Reasoning.” International Studies in the Philosophy of Science 28, no. 4: 353–373.

Plutynski, Anya. 2011. “Four Problems of Abduction: A Brief History.” HOPOS: The Journal of the International Society for the History of Philosophy of Science 1, no. 2: 227–248.

Price, Kelly J. and Kenna J. Miskelly. 2015. “Why Ask Why? Logical Fallacies in the Diagnosis of Fetal Alcohol Spectrum Disorder.” Ethics & Behavior 25, no. 5: 418–426.

Ramoni, M., M. Stefanelli, L. Magnani, and G. Barosi. 1992. “An Epistemological Framework for Medical Knowledge-Based Systems.” IEEE Transactions on Systems, Man, and Cybernetics 22, no. 6: 1361–1375.

Reece, Robert M. 2001. “Chapter Eighteen: Controversies in Shaken Baby/Shaken Impact Syndrome.” Journal of Aggression, Maltreatment & Trauma 5, no. 1: 367–388.

Robinson, Thaddeus. 2021. “Chapter 14: Inductive Generalizations.” In Arguments in Context: An Introduction to Critical Thinking, by Thaddeus Robinson. Allentown, PA: Muhlenberg College.

Roche, William and Elliott Sober. 2013. “Explanatoriness Is Evidentially Irrelevant, or Inference to the Best Explanation Meets Bayesian Confirmation Theory.” Analysis 73, no. 4: 659–668.

Saunders, Dawn, Maria Raissaki, Sabah Servaes, Catherine Adamsbaum, Arabinda Kumar Choudhary, Joëlle Anne Moreno, Rick R. van Rijn, and Amaka C. Offiah. 2017. “Throwing the Baby out with the Bath Water: Response to the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) Report on Traumatic Shaking.” Pediatric Radiology 47, no. 11: 1386–1389.

Schupbach, Jonah N. 2017. “Inference to the Best Explanation, Cleaned Up and Made Respectable.” In Best Explanations: New Essays on Inference to the Best Explanation, edited by Kevin McCain and Ted Poston, 39–61. Oxford: Oxford University Press.

Schurz, Gerhard. 2016. “Common Cause Abduction: The Formation of Theoretical Concepts and Models in Science.” Logic Journal of the IGPL 24, no. 4: 494–509.

Sober, Elliott. 1988. Reconstructing the Past: Parsimony, Evolution, and Inference. Cambridge, MA: Massachusetts Institute of Technology Press.

Stanford, P. Kyle. 2006. Exceeding Our Grasp: Science, History, and the Problem of Unconceived Alternatives. New York: Oxford University Press.

Strouse, Peter J. 2016. “Child Abuse: We Have Problems.” Pediatric Radiology 46, no. 5: 587–590.

———. 2018. “Shaken Baby Syndrome Is Real.” Pediatric Radiology 48, no. 8: 1043–1047.

Tait, Gordon. 2009. “The Logic of ADHD: A Brief Review of Fallacious Reasoning.” Studies in Philosophy and Education 28, no. 3: 239–254.

Thagard, Paul R. 1978. “The Best Explanation: Criteria for Theory Choice.” Journal of Philosophy 75, no. 2: 76–92.

Upshur, Ross. 1997. “Certainty, Probability and Abduction: Why We Should Look to C.S. Peirce rather than Gödel for a Theory of Clinical Reasoning.” Journal of Evaluation in Clinical Practice 3, no. 3: 201–206.

Van Fraassen, Bas C. 1989. Laws and Symmetry. Oxford: Oxford University Press.

Williamson, Timothy. 2018. Doing Philosophy: From Common Curiosity to Logical Reasoning. Oxford: Oxford University Press.

Woods, John. 2013. Errors of Reasoning. Naturalizing the Logic of Inference. London: College Publications.

Yu, Shiyang and Frank Zenker. 2018. “Peirce Knew Why Abduction Isn’t IBE: A Scheme and Critical Questions for Abductive Argument.” Argumentation 32, no. 4: 569–587.

Zimmerman, Robert A., Larissa T. Bilaniuk, Derek Bruce, Luis Schut, Barbara Uzzell, and Herbert I. Goldberg. 1979. “Computed Tomography of Craniocerebral Injury in the Abused Child.” Radiology 130, no. 3: 687–690.




How to Cite

Binney, N. (2023). Methods of Inference and Shaken Baby Syndrome. Philosophy of Medicine, 4(1).



Original Research Articles (clinical research, evidence-based medicine)

Funding data