Data on the management of children with such injuries were collected from medical, social services, police, and court records in southwest England and South Wales. The data pertained to case management procedures and decisions from the time of presentation at a hospital through referral to police and social services. The study found that the children most at risk of shaking that caused a subdural hemorrhage were likely to be babies between 3 and 5 months old. They were most likely to live in families where parental stability was weak and social support for the caregivers was limited. Pediatricians who treated the child victims did not always refer the children to child protection agencies when coexisting signs provided strong evidence of physical abuse. The authors recommend that pediatricians and other clinicians who treat young children should engage in a multidisciplinary assessment protocol based on specialized training in the identification of nonaccidental head injuries in very young children and babies, so as to reduce their risk of further harm. There is also a need for improved collaboration among pediatricians, social workers, and the police. This would facilitate pediatricians' access to clinical information on previous hospital admissions of the child patient and his/her siblings; the obtaining of information on previous involvement of caretakers with social services regarding child protection issues; and police information on any criminal history of the child's caregivers. Training of pediatricians should be conducted in conjunction with social workers, health visitors, and the police. 16 references