Dr. Lolita McDavid, a child advocate at Rainbow Babies and Children's Hospital in Cleveland, said intentional injuries are diagnosed based on both the medical evidence and a careful investigation of the family.
"It's not one thing; it's a constellation of things that make us concerned," she said. "Clearly, this is a compelling story. ... But we have to remember this child had a skull fracture, brain damage and eye injuries as well as two broken legs and a fractured rib that hadn't healed. This isn't someone who lightly tapped their head on a table."
McDavid said new imaging techniques make it easier to detect brain bleeds, fractures and other signs of possible abuse.
"We've come so far. And compelling personal stories from families are just that -- compelling stories," she said. "They don't negate the fact a child was hurt."
Shaking a baby for even five seconds can lead to life-threatening injuries, according to the National Institutes of Health. Most cases of shaken baby syndrome start with a frustrated parent or caretaker who has no intention of hurting the baby.
"The babies happen to be a sort of lightning rod for an angry and sometimes violent discharge," Cole of the St. Louis Children's Hospital said. "But there's always help and support available. It's important never to feel alone in trying to manage a difficult baby."