A critical review of the American Academy of Pediatrics technical report on abusive head trauma

In 2025, the American Academy of Pediatrics (AAP) released a Technical Report (TR) providing guidance for diagnosing abusive head trauma (AHT). We critically examined the primary research studies cited in the TR, focusing on how cases of AHT were classified. We identified studies that sought to identify findings specific to AHT or to evaluate diagnostic accuracy, and categorized each by its methods for classifying cases as AHT. Across these studies, 71 % included cases classified by multidisciplinary team opinion, 30 % by medical records, 22 % by predetermined criteria, 22 % by caregiver confessions (only two relied exclusively on this), 9 % by court decision, and 6 % by witnessed events; totals exceed 100 % because several studies applied more than one method. We evaluated methodological rigor with particular attention to circular reasoning and incorporation bias, and found that none of these studies adequately addressed these risks. The heavy reliance on expert opinion and the systematic incorporation of prior assumptions into case classification call into question the validity of the current diagnostic framework. These findings highlight the urgent need for more rigorous, evidence-based approaches to support the validity of the AHT diagnosis.