Shaken Baby Syndrome: Debunking the Myth

The problem isn’t with what we don’t know. The problem is with what we do know that isn’t so. -Will Rogers 


In 1997 the world held its breath as the media followed closely Louise Woodward’s “nanny” trial. She had allegedly committed the crime of shaking a baby, which resulted in the death of infant Matthew Eappen. Miss Woodward was a 19-year-old British au pair with no criminal record, yet she was “disliked” by the camera and as is often the case in crimes involving children, was presumed guilty. 

Prosecutors maintained Woodward was frustrated and angry with the baby's parents who objected to her late nights out past curfew. In retaliation, it is speculated Woodward violently shook and then slammed the baby's head against a hard surface, causing the massive brain damage that led to his death five days later at Children's Hospital in Boston.

Accompanied by a host of experts, attorneys and UK supporters via satellite, Woodward was convicted to life with the possibility of parole after 15 years when a jury decided no “reasonable” person would have done what she was accused of doing to baby Matty (Bowker). 

Both the prosecution and defense had presented respected expert witnesses who disagreed on the evidence. Judge Hiller Zobel found that the jury had found her guilty of a second-degree murder without being allowed to consider a manslaughter verdict and that there was much reasonable doubt in this case. He then vacated the verdict, convicted Woodward with manslaughter and gave her a time served sentence (Zobel). 

Even a seasoned judge felt there is not much validity in the prosecution’s argument. So, if Shaken Baby Syndrome, (SBS), is a diagnosis full of disagreement and doubt, then SBS should be considered “junk science” because SBS is based on theory and cannot be proven, a time of injury cannot be isolated and there may be alternate causes for the injuries. 

SBS originated over 30 years ago. 

John Caffey, an American pediatric neurologist and radiologist, coined the diagnosis theory of SBS in 1972. Shaken Baby Syndrome (SBS) is a popular diagnosis given over the last 30 years when a child has internal injuries that cannot be explained from obvious accidental injury.

The "whiplash shaken infant syndrome" is a result of manual shaking by the extremities with whiplash-induced intracranial and retinal bleedings, linked with permanent brain damage or death. He came to this conclusion when a nurse who worked in a neonatal unit admitted that she had shaken infants to stop them from crying and many of those infants were found to have had head injuries, (Caffey 161).

There is reason for an inference here, but certainly not a scientific basis on which to convict caretakers for murder when the stories are inconsistent with the history provided. No one can prove the theory because it is obviously unethical to shake a baby. 

Although there have been many confessions, it is not abnormal for a caregiver to find a child unconscious, panic and shake them to illicit a response and then feel that surely the doctors and police know what they are doing; thus assuming that responsibility lies within themselves. 

Brian J. Clark, a consultant pathologist from the UK contends,

 “No reasonable professional of any discipline wants to see malicious child homicide go undetected and unpunished. However, it is equally abhorrent over-zealous investigation, refusal to study alternative explanations, or narrow-minded pursuit of blame for an infant’s death (that) can destroy the lives of the accused and their family, creating supplementary victims. This is particularly salient when the accused and the families of the accused are recently bereaved relatives of the deceased child. We have an inescapable duty to get this right!” (415).

There is much debate within the medical community, particularly forensic pathologists, as to the time of injury. This presents a huge problem to the enthusiastic law enforcement so eager to make an arrest in what is presumably SBS. 

The majority of professionals contend that an injury severe enough to produce death must have occurred immediately before symptoms’ onset and that the responsible party must have been the last caregiver who is often alone with the child. 

However, as there has been little research to validate this assumption, many are coming forward to debate this evidence, (or lack of), by disputing that there may be a lucid stage in which the child, lacking obvious external injury, appears to an unknowing public as being fine. 

Upon accusation, the parties may realize that a baby was fussy, lethargic or “not himself” when it is too late to validate with physicians.  The ‘lucid interval” has been accounted to actually last from 5 minutes to 3 days and has been proven in studies when many parties or even video has evidence of an accidental head injury, such as a fall from playground equipment. 

John Plunkett, a pediatric forensic pathologist has done studies specifically involving children who fall observed from short distances and suffer injuries as serious as a subdural hematoma and retinal hemorrhages, the hallmark signs of SBS. 

Other than a non-accidental, inflicted injury, these damages had formerly been attributed only to falls from a two-story building or a high-speed vehicle accident. However, there has never been any study to determine a minimum force to cause lethal injury. 

“Many physicians believe that a lucid interval in an untimely fatal pediatric head injury is extremely unlikely or does not occur unless there is an epidural hematoma. Twelve children in this study had a (observed) lucid interval. A non-caretaker witnessed 9 of these 12 falls. One child had an epidural hematoma” (9). 

So, a lucid interval is always possible and a tragic accident, such as a fall may also be to blame. Plunkett concludes: “A fall from less than 3 meters in an infant or child may cause fatal head injury and may not cause immediate symptoms. The injury may be associated with bilateral retinal hemorrhage, and an associated subdural hematoma may extend into the interhemispheric fissure. A history by the caretaker that the child may have fallen cannot be dismissed” (10). 

Also, there is debate as to whether a previous injury from birth or an overlooked fall, etc. may have first injured the child and a rebleed when something minor happens may cause the tender tissue to rupture. This would be a prime understanding for a chronic subdural in which a child is supposedly abused over a long period of time. 

However, no one really knows what may cause a rebleed because there hasn’t been much research on it. 

Harold Buttram, a physician who studies SBS, has written, 

“It has been demonstrated that the neomembrane surrounding an organizing subdural hematoma may itself bleed, and that expansion of a subacute/chronic subdural hemorrhage may cause new bridging veins to rupture, and that an acute clot may predispose to new bleeding. New bleeding in an established subdural hematoma may occur spontaneously and without new trauma. In the cited example, the child was in a hospital under the care of a physician.” (84).

Despite popular belief that vaccines are required for a child to attend school, all 50 states allow for a religious and/or philosophical exemption. When a child is vaccinated, a pediatrician must have the parental signature before he may proceed because it is known that adverse reactions, even death may result. 

If parents were aware of the toxic ingredients and devastating consequences of vaccines, perhaps they would choose not to immunize. 

Vera Scheibner, an Australian physician and researcher has written extensively on vaccine damage. 

“One only has to peruse a product insert of hepatitis B vaccine to see that besides local reactions, a number of neurological signs may occur, such as paraesthesia and paralysis (including Guillain-Barre syndrome, optic neuritis and multiple sclerosis)” (82). 

Also, a group of Japanese physicians did research on pertussis vaccine and determined it to cause brain swelling.

“Indeed, vaccines like the pertussis (whooping cough) vaccine are actually used to induce encephalo-myelitis (experimental allergic encephalomyelitis) in laboratory animals. This is characterized by brain swelling and haemorrhaging of an extent similar to that caused by mechanical injuries” (Iwasa et al. 56). 

In Japan, children are no longer immunized for pertussis due to the local medical community’s outrage. 

In many cases of SBS, the symptoms occur following routine vaccinations. The child may cry intensely and inconsolably, may stop feeding properly, vomit, have difficulty swallowing, become irritable, stop sleeping, and may develop convulsions with accelerating progressive deterioration of its condition and mainly its brain function (Scheibner 82). 

Adverse reactions to vaccines do not have to occur immediately as many pediatricians will tell a parent. They have been noted to take up to 14 days. If a parent shows concern that his child is behaving oddly, a pediatrician or emergency room tells him that it is a normal reaction, give the child infant Tylenol and within time the symptoms will cease. 

If he persists in considering the baby’s reaction abnormal, he is called worrisome. Sadly, by the time the parent second guesses the physician(s), the damage is often irreversible and the child may be found comatose or deceased. 

It has already been mentioned that infant Tylenol is encouraged when a child has a fever or is “fussy” following vaccinations. Although there have not been thorough studies done to assess the damages, a parent should use extreme caution when dispensing such medicine as an overdose may cause severe damage as acetaminophen alters blood viscosity and could trigger or further intercranial pressure. 

In addition to vaccines, there are other plausible definitions for what may mimic SBS. 

Glutaric aciduria, also called glutaric acidemia, is a rare inherited metabolic disorder. There are two types, 1 and 2. The symptoms of type 1 are remarkably similar to those seen in shaken baby syndrome and often include subdural hematoma and retinal hemorrhage

Scurvy (in infants known as Barlow’s disease), may also explain subdural hemorrhage, bruising and broken bones that can further be a red flag to abuse. Archie Kalokerinos, a physician in Australia, submits that scurvy is more prevalent at an earlier age than 75-100 years ago due to administration of antibiotics, administration of vaccines, failure to exclusively breastfeed and the role played by endotoxins. 

Scurvy is a disease caused by vitamin C deficiency that affects collagen formation. Poor collagen formation can damage tissue, blood vessels and bone which can lead to bruising and hemorrhages anywhere on the body. This includes subdural hemorrhages, retinal hemorrhages and fractures. 

Further, if an infant receives vitamin C supplements that outweigh the recommended daily dose, he may also develop scurvy! (Kalokerinos). 

Oxygen deprivation (hypoxia) can be caused by choking, asphyxia, or infection and causes a lack of oxygen identifiable in the blood and swells the brain, causing a respiratory arrest, which then illictis bleeding. 

A reporter for The Times newspaper in London recently wrote an article entitled “Junk Science: Shaken Baby Syndrome” in which he has discovered that-

“among one sample of babies who were classified as victims of SBS, more than half showed evidence of a lack of oxygen in the blood. This could have caused the brain to swell and cause bleeding as a secondary symptom” (Ahuja,). Other conditions that may induce symptoms which mimic SBS include but are not limited to hemophilia, coagulopathies, hydrocephalus, Thrombocytopenia (TCP), Thrombocythemia, Von Willebrands Disease (VWD), Waldenstrom's Macroglobulinemia, Multiple Mylomas, Cryoglobulinemia, sepsis and certain antibiotics may increase endotoxins.  

If a case is misdiagnosed as child abuse, the child is denied proper attention and it is not known how many caretakers may have been falsely accused and prosecuted.

One has simply to reflect on the historical reference of the Salem witch trials of 1692 to comprehend that a theory can become overblown. 

In the 1980’s, there was an epidemic where innumerable childcare workers were arrested on allegations of ritualistic sexual abuse. Respectable men and women who so loved children lost their livelihood and reputations spending tens of thousands of dollars on a criminal defense before it was recognized that many of the children had been prompted to accuse their caregivers. Although many were vindicated, others spent lengthy time incarcerated and cannot replace lost years.

It is possible that infanticide and child abuse are involved in some of the alleged SBS cases. However, law enforcement has given no justification as to why, within the past 30 years, thousands of caregivers and parents have suddenly decided to shake their beloved infants for whatever reason is presented as motive to a jury. 

It is incredibly callous to accuse a grief-stricken parent or loved one of harming a child when all avenues for explanation have not been explored by an ignorant or uninformed coroner. 

British neurologist, JF Geddes, wrote a controversial article in the British Medical Journal in March of 2004. Titled, “The Evidence Base for Shaken Baby Syndrome”, she questions the diagnosis. 

“If the issues are much less certain than we have been taught to believe, then to admit uncertainty sometimes would be appropriate for experts. Doing so may make prosecution more difficult, but a natural desire to protect children should not lead anyone to proffer opinions unsupported by good quality science. We need to reconsider the diagnostic criteria, if not the existence, of shaken baby syndrome” (720). 

There are so many alternate causes, timing of injury cannot be isolated and research on theory is lacking. 

SBS should be considered “junk science” until further technology can prove that it is a viable diagnosis.

Sabrina Nedrow

Sabrina Nedrow is a mother falsely accused of SBS and is fighting for her children for four years with SCDSS while being denied a criminal trial.


References
Ahuja, A. (2004, April 10). Junk medicine: shaken baby syndrome. The Times. Retrieved April 26, 2004 from www.timesonline.co.uk/article/0,,8124-1067819,00.html

Bowker, H. & Jenkins, B. (1997, October 31). British au pair convicted of murder. CNN. Retrieved April 20, 2004 from http://www.cnn.com/US/9710/31/aupair.onite.wrap/index.html

Buttram, H. (2001). Shaken baby syndrome or vaccine-induced encephalitis? Medical Sentinel. 6(3):83-89.

Caffey J. (1972). On the theory and practice of shaking infants. American Journal of Diseases of Childhood.124:161-169. 

Clark, B. (2001). Retinal hemorrhages: Evidence of abuse or abuse of evidence? American Journal of Forensic Medicine and Pathology. 22(4): 415-419.

Geddes, J. (2004). The evidence base for shaken baby syndrome: British Medical Journal. 328:719-720.

Iwasa, A., Ishida, S., Akam a, K. (1985). Swelling of the brain caused by pertussis vaccine: its quantitative determination and the responsible factors in the vaccine. Journal Medicine, Science and Biology. (Japan) 35:53-65.

Kalokerinos, A. (April, 2003). Shaken babies. Retrieved April 25, 2004 from http://www.freeyurko.bizland.com/kaloksb1.html

Plunkett, J. (2001). Fatal pediatric head injuries caused by short-distanced falls. American Journal of Forensic Medicine and Pathology. 22(1):1-12.

Scheibner, V. (August-September,1998).Shaken baby syndrome—the vaccination link. Nexus. 82-85.


Zobel, H. (1997, November 10) Memorandum and order, commonwealth v. louise woodward, superior court criminal No. 97-0433. Court TV. Retrieved April 20, 20004 from http://www.courttv.com/trials/woodward/zobel.html