Sunday, February 6, 2011

Shaken Baby Syndrome - The Latest

When a baby or toddler is injured or dies, was it abuse by parents or caregivers?  The questions start right away, and prosecutions often follow.  But what is shaken baby syndrome anyway, how did it come to be a syndrome everybody knows about, and most importantly to those accused of child abuse by shaking a baby, do those experts who testify at trials know what they are talking about?

Emily Bazelon, senior editor at Slate and the Truman Capote law-and-media fellow at Yale Law School, and author of a recent 8-page article in The New York Times Magazine, looks at shaken baby syndrome from every angle.

Bazelon takes the reader through details of several court cases, introducing us to parents, caregivers on trial, prosecutors, defense attorneys, and expert witnesses to make the medical controversy she uncovers as personal as possible.  Turns out that the simplistic diagnosis of shaken baby syndrome is itself based on shaky foundations.
A dozen years ago, the medical profession held that if the triad of subdural and retinal bleeding and brain swelling was present without a fracture or bruise that would indicate, for example, that a baby had accidently fallen, abuse must have occurred through shaking. In the past decade, that consensus has begun to come undone.
In 2008, the Wisconsin Court of Appeals, after reviewing a shaken-baby case, wrote that there is “fierce disagreement” among doctors about the shaken-baby diagnosis, signaling “a shift in mainstream medical opinion.” In the same year, at the urging of the province’s chief pathologist, the Ontario government began a review of 142 shaken-baby cases, because of “the scientific uncertainty that has come to characterize that diagnosis.”
In Britain, after one mother’s shaken-baby conviction was overturned, Peter Goldsmith, then attorney general, reviewed 88 more cases. In 2006, he announced doubts about three of the convictions because they were based solely on the triad; in the other cases, Goldsmith said, there was additional evidence pointing to the defendant’s guilt.
So the syndrome itself is becoming much more complicated with experts backing down and changing sides. All this uncertainty means doctors and law enforcement NEED TO KNOW why small children die rather than leaping to "must be shaken baby syndrome". The result (hooray for basic science!) is that everybody involved is taking a much-needed look with the latest scanners at infant and toddler anatomy, the possibility of unnoticed birth injuries, the reality of infection-caused strokes, and more. 

Bazelon spends several shocking pages describing how shaken baby syndrome was initially "discovered", perhaps more accurately, invented, by a neurosurgeon in the 1960s.  Here's the story:
Much of the science of shaken-baby syndrome dates from the late 1960s, when a neurosurgeon named Ayub Ommaya conducted a brutal animal experiment to figure out how much acceleration it took to cause a head injury.
Ommaya took more than 50 rhesus monkeys and strapped each one into a chair mounted on wheels, leaving their heads unsupported. He placed the chair on a 20-foot-long track, and an air-powered piston sent the monkeys zooming into a wall. Fifteen emerged with some kind of cerebral hemorrhage. Eight of those also had injuries to the brain stem or cervical cord.
Ommaya’s experiment involved neither shaking nor infants. Still, two pediatric specialists, John Caffey and A. Norma Guthkelch, each wrote a paper that pointed to the work as evidence that unexplained subdural bleeding in babies could occur without direct impact to the head and with or without a visible neck injury. In the 1980s, the term “shaken-baby syndrome” came into broad use, and a national prevention and awareness campaign was set in motion.
Shaken baby syndrome was a de facto reality. Sloppy science turned into common knowledge, which then became evidence presented to juries all around the western world.

COMMENT:  Thanks to Emily Bazelon for this article helping the rest of us understand that there is some new light in the murky darkness of the subject of child abuse.  Children need protecting, but it turns out the shaken baby syndrome accusations and prosecutions were closer to witch hunts than they were to justice.  Audrey Edmonds, who spent years in prison before being released three years ago after her conviction was challenged, understands society's need to do something, even the wrong thing.  “A baby has died,” she said simply. “They want to blame somebody.”


  1. Hi Lyn,

    I've heard some people say that shaken baby syndrome is caused by vaccinations. The bruises aren't from falling or being hit -- they're internal, from the tissues breaking down spontaneously.

    I can't imagine having my child die and then being accused of their murder. Complete tragedy.

  2. I hadn't heard the vaccination connection, but if infections can cause spontaneous head bleeds (strokes), then a lot of things are possible.

    You said it - complete tragedy!

  3. Vaccinations as a cause of Shaken Baby Syndrome are a myth that have been discredited.

    I believe that each case of an infant or child with a Shaken Baby Syndrome diagnosis needs to be looked at carefully. For example, a few small retinal hemorrhages in the eyes of a child does not a diagnosis of abuse make. These can occur in accidents. But...the typical signs of SBS (brain hemorrhage, retinal hemorrhage, brain swelling) should not be explained away by minimal force factors (i.e. bed fall, etc.).

    Babies, though fragile to some degree, are very resilient to potential injuries in falls. It is exceedingly rare that infants are hurt in any way in falls less than 6 feet. In fact, with infants who have fallen several stories, most live and some are even unharmed.

    Unfortunately, defense attorneys like to find "expert" witnesses to build a smokescreen and confuse jurors in SBS cases. The condition really isn't difficult to diagnose though. It is real and happens every day.

    For more information, see our website and even attend the Shaken Baby Syndrome webinar scheduled for 2/15/11 @ 3:00 (EST) - anyone is welcome.

    Thanks for looking at this important issue.

    James Peinkofer, LCSW
    Peinkofer Associates

  4. Thanks, James, for your comments, and the webinar invite ($20 enrollment fee per the website).

    Understanding and preventing child abuse should be a top priority for society, but like domestic violence, it is not.

    We all need to be intelligently aware and informed about what goes on behind closed doors. Working together, we can make family life safer and society much better for the effort.