Abusive head trauma (AHT) is one of the most challenging and consequential diagnoses in pediatric and forensic medicine. The classic triad of subdural hemorrhage, retinal hemorrhage, and encephalopathy has long been considered a key indicator of inflicted injury in infants. However, growing evidence has questioned the specificity of this triad and the assumption that it can be attributed to a single mechanism, particularly violent shaking. Concerns have also been raised regarding circular reasoning, diagnostic bias, and inadequate consideration of alternative medical conditions. This article critically re-examines the triad within the broader framework of AHT. It reviews current controversies regarding biomechanics and causation. It also highlights the importance of careful differential diagnosis. Possible alternative explanations include birth-related hemorrhage, accidental trauma, bleeding disorders, infections, metabolic diseases, vascular anomalies, and cerebral venous sinus thrombosis. It also discusses the value of structured clinical prediction tools, such as PredAHT and PediBIRN, and considers the emerging role of artificial intelligence in risk assessment and hemorrhage detection. A multidisciplinary, evidence-based, and bias-aware approach remains essential in suspected AHT cases.