The battered-child syndrome

At the University of Colorado Hospital, the pediatrician C. Henry Kempe found that explanations for children's injuries that were plainly absurd were routinely accepted. Children who had clearly been beaten by their parents were diagnosed with rare brittle bone diseases, spontaneous bleeding under the skull, unexplained bleeding disorders or the catch-all label of failure to thrive.

Radiologists had seen the pattern first. In 1946 John Caffey, a pediatric radiologist at the Babies Hospital in New York, described six infants with subdural haematoma whose X-rays showed multiple fractures of the long bones, though none had any bone disease; he insisted the fractures looked traumatic. Fred Silverman, whom Caffey trained between 1945 and 1947, became director of roentgenology at Cincinnati Children's Hospital and in 1953 reported three more infants with skeletal injuries.

Kempe's article, 'The Battered-Child Syndrome', appeared in the Journal of the American Medical Association on 7 July 1962, written with Silverman, B. F. Steele, W. Droegemueller and H. K. Silver, experts in pediatrics, psychiatry, obstetrics and gynecology, and radiology. It defined the syndrome as a clinical condition in young children who had received serious physical abuse, generally at the hands of a parent or substitute parent. The authors also acknowledged that physicians were reluctant to believe parents could inflict such violence on their own children.

The idea crossed the Atlantic within a year. In 1963 two orthopedic surgeons, D. Li Griffiths of Manchester University and F. J. Moynihan of Guy's Hospital in London, published a British Medical Journal article on multiple epiphyseal injuries in babies, the battered baby syndrome, to publicize a condition they thought commoner than usually believed. Over the next 20 years, pediatricians and radiologists became the recognized experts on child battering in both Britain and the United States.