What is Shaken Baby Syndrome
Doctors who suspect that a baby has been violently shaken, will examine the baby for the “triad” of injuries associated with shaken baby syndrome (SBS) also known as abusive head trauma. The triad of injuries are:
- subdural haematoma (bleeds inside the brain)
- retinal haemorrhages (bleeds behind the eyes) and
- cerebral edema (swelling or inflammation inside the brain)
Expert opinion suggest that when a baby is violently shaken, the brain rotates within a more stationary skull and dura, creating rotational and angular forces of the head, causing the bridging veins to tear and bleed into the dura.
The forces produced during a shaking episode may cause the layers of the retina to slide across each other creating stretching and shearing of the retinal vessels, resulting in haemorrhages. It is argued that retinal haemorrhages are frequently seen in SBS victims and are uncommon in other types of head injury.
The diagnosis of SBS often indicates a presumption of child abuse by the carer leading to criminal prosecution and intervention by children social services. Many such accused parents and carers are given long prison sentences and their children are permanently removed from their families.
Controversy & Studies into SBS
SBS has been called into serious question by various professionals including those in the medical, legal and biomechanics fields as well as the media. The evidence of the prosecution experts who alleged death or serious injury from SBS has been shown to be significantly flawed in many instances.
The precise causation of the injuries arising from SBS, together with the degree of force required and whether impact in addition to whiplash forces is needed is what brings about the controversies with SBS. Many believe that parents are being accused on the basis of SBS, yet it is only a hypothesis with no scientific evidence to support it.
Evidence from biomechanical experts has revealed that that shaking without impact would only produce the triad of injuries in association with other injuries to the neck and spinal column that are typically not found in alleged SBS cases.
In 2001 neuropathologist Dr Jennian Geddes concluded that much of the brain damage in cases of SBS came not from direct trauma but from a lack of oxygen to the tissues, as bleeding and swelling interfere with normal systems.
Working from a foundation laid by Geddes (Geddes et al, 2003), neuropathologist Dr. Waney Squier and her colleagues proposed that the very thin subdural collections often seen in presumed shaking cases represent seepage of blood from the dura itself, rather than spillage from torn bridging veins.
Dr. Squier in her work has discussed alternative and common causes for the triad of symptoms, including accidental falls, cortical vein and sinus thrombosis, inflicted injury, vitamin D deficiency, second impact syndrome, aneurysm rupture, rare genetic conditions, and resuscitation related injuries.
In 2016 a research team at the Karolinska Institute of Stockholm which examined various cases of SBS found that you could not conclude when looking at the changes in the infant brain, that the infant had been shaken. While the team didn’t seek to determine alternative causes of the triad, some cases they looked at suggested small falls or bleeding in the head during natural births may also be associated with these symptoms.
Conclusion
In defending cases involving SBS it is important that courts are asked to consider the various differential diagnoses such as congenital malformation; metabolic disorders, haematological diseases, infectious diseases, autoimmune conditions, accidents and birth related issues. There have been several reported miscarriages of justice where parents have been accused of deliberate harm of this nature only to find that there was a medical explanation for the injuries and that the parents were in facts not perpetrators.
Whilst critics argue that shaking is still the most likely explanation for retinal haemorrhaging and subdural haematomas, it is clear from the controversy that still surrounds shaken baby syndrome, that judges need to look at all other possible explanations before making findings.
Parent Not Perpetrator, June 2017
