A popular video circulating the Internet this week has villagers in a town near Solapur, India, shrugging their shoulders and pediatricians in the United States shaking their heads.
The video, available here, shows a crowd tossing infants off a temple roof onto an outstretched cloth 50 feet below. Officials in the village of Musti say this 500-year-old ritual does not hurt the babies and is meant to bring good luck and protection.
But pediatricians reacted to the footage of infants plummeting and bouncing back from the cloth with varying degrees of concern.
"Of course there is risk of injury in this practice. Missing the stretched cloth might be fatal and even landing on it wrong might cause a limb fracture," said Dr. Joseph R. Zanga, past president of the American Academy of Pediatrics and a professor at the Brody School of Medicine, Greenville, N.C.
"I would not suggest that we try it in the U.S., but if they have been doing it for 500 years without any injury I'd be wary of stopping them," Zanga said.
Dr. Michael Wasserman, of the Ochsner Health System in New Orleans, felt the same pull toward cultural sensitivity. "It is hard for one to disagree with religious rituals, as they are private choices, at the same time, there is a real danger," Wasserman said.
However, some doctors thought the health risks trumped cultural sensitivity in this case.
"The idea that parents would participate in such a harmful practice and that no one would point out the dangers to them seems inconceivable," said Dr. Astrid Heppenstall Heger, professor of clinical pediatrics and executive director of the Violence Intervention Program at the University of Southern California, Los Angeles.
Injuries related to shaken baby syndrome topped the list of worries among pediatricians watching the video. Shaken baby syndrome results from a whiplash-type motion -- an acceleration pushing the brain against one side of the head and a quick deceleration bouncing it back, which can cause brain injuries, bleeding of the brain and potentially brain damage.
While the villagers claim there are no injuries, whether all the babies escaped harm may be difficult for anyone in Musti to tell. Shaken baby syndrome can be difficult to diagnose, even in U.S. doctor's offices, and parents in India may not recognize the subtle signs of brain injury.
The National Institutes of Health report there are usually no physical signs of injury like bruising, bleeding or swelling when a child has shaken baby syndrome. Instead, infants commonly show mild to severe irritably, sleepiness or poor feeding.
Infants, especially young infants, can be at risk for whiplash-like injuries because children's brains are softer, their neck muscles weaker and their heads are much larger compared to the size of the rest of their bodies.
But while much older kids could stand whiplash better, the babies in the video might also be better suited to take the good-luck fall onto the sheet.
"The infants pictured were not relatively fragile newborns," said Zanga, who noted the babies looked to be about 5 to 6 months old and would have greater head control than a newborn. "They also, at that age, have more body fat and cartilage to dissipate the 'energy' of the fall."
Zanga said infants may handle a fall better because they generally relax and stay more flexible, whereas adults might tense up, making injury more likely.