Mimics of child abuse: Can choking explain abusive head trauma?

• Abusive head trauma (AHT) is an important worldwide problem.
• Unscientific explanations like choking have been proposed to account for AHT.
• Omission and misrepresentation of facts have been used to justify unsupported explanations of AHT.
• Failure to adhere to facts violates the principles of science and erodes child protection.

Choking is one of the alternative explanations of abusive head trauma in children that have been offered in courtroom testimony and in the media. Most of these explanations — including choking — are not scientifically supported.This article highlights four points. (1) The origins of choking as an explanation for intracranial and retinal hemorrhages are speculative. (2) Choking has been used in high profile court testimony as an explanation for the death of a child thought to have been abused. (3) A case report that proposes choking as an alternative explanation for the death of a child diagnosed with abusive head trauma includes omissions and misrepresentations of facts. (4) There was a decision by the editor of the journal that published the case report that it was not necessary to include all the facts of the case; moreover, the editor indicated that facts are not required when presenting an alternative explanation.The use of scientifically unsupported alternative explanations for abusive head trauma based on inaccurate and biased information constitutes further victimization of the abused child and represents a travesty of justice.