John Caffey and the birth of pediatric radiology: from accidental radiologist to architect of a discipline.

BACKGROUND

John Patrick Caffey (1895-1978) is widely regarded as among the foundational figures of pediatric radiology. The translational scope of his contributions, spanning textbook authorship, forensic radiology, and the evidentiary basis for child protection legislation, has rarely been examined as a coherent whole.

OBJECTIVE

To examine Caffey's contributions across historical, technical, clinical, and medicolegal dimensions, including the controversies surrounding shaken infant syndrome that complicate his later legacy, and to assess the continued relevance of his methodological principles to contemporary pediatric imaging practice.

METHODS

Narrative historiographic review drawing on three categories of sources: Caffey's primary publications (1945-1974), peer-reviewed biographical tributes and obituaries published in radiology and pediatric journals, and secondary historiographic analyses indexed in PubMed and Google Scholar through February 2026.

KEY FINDINGS: Caffey entered radiology in 1929 without formal training, assigned by accident to the radiology department at Babies Hospital, Columbia University. Working systematically from plain radiographs, he contributed substantially to the intellectual framework of pediatric radiology, producing one of the field's earliest comprehensive textbooks in 1945 and describing the skeletal syndrome of infantile cortical hyperostosis (Caffey disease) in that same year. His 1946 paper on unexplained long-bone fractures in infants with subdural hematomas initiated the evidentiary chain that culminated in the Child Abuse Prevention and Treatment Act of 1974. He co-founded the Society for Pediatric Radiology in 1958. His textbook, now in its thirteenth edition as Caffey's Pediatric Diagnostic Imaging, remains a standard reference in the field.

CONCLUSION

Caffey's methodological principles of clinical-radiological correlation and evidentiary restraint remain relevant to contemporary pediatric imaging practice, particularly in the medicolegal interpretation of skeletal findings in suspected non-accidental injury.