This month in DISCOVER, Mark Anderson has a feature story on the medical controversy surrounding shaken baby syndrome (SBS). The crux of the debate is this:
On one side of the courtroom, representing mainstream medical opinion, are those who believe shaken baby syndrome (SBS) is a valid diagnosis. They say that decades of clinical experience and criminal confessions—in which a parent has admitted to shaking a child with symptoms of SBS—bolster their case to the point of near-certainty. On the other side, a growing number of skeptics are now claiming that the evidence for the syndrome rests on dubious medical ground with questionable biophysical models supporting it.
The confusion centers around the trio of symptoms that lead to an SBS diagnosis: bleeding between the brain and skull, bleeding behind the retinas, and brain swelling. Conventional medical wisdom holds that some or all of these mean a baby is suffering from SBS. But a growing number of skeptics say the symptom list could come from any number of other sources, from infections to diet to a fall.
While the final medical verdict is still up in the air, the issue highlights the tricky—and potentially devastating—fallout when medical uncertainty headbutts the legal system. SBS presents a clear dilemma: If a baby has it, the “fact” that the baby’s death or injuries were caused by SBS is in and of itself evidence that a parent, caretaker, or other handler intentionally committed a crime.
Of course, if SBS is, as one neurosurgery professor called it, “a sham,” then anyone convicted of abuse, negligence, or even murder in an SBS case has potentially been put in jail for a nonexistent crime.
The sticky law-versus-medicine issue came to a head with the 1997 trial of British nanny Louise Woodward, who was convicted of second-degree murder in Massachusetts after a baby in her charge died. While Woodward was accused of other acts of negligence such as dropping the baby, the cause of death was a subdural hematoma, and SBS was declared its source. The case received intense media scrutiny, and a judge later reduced the charge to involuntary manslaughter and sentenced Woodward to time already served.
If Woodward had in fact dropped the baby, chances are the fall caused far more damage than any shaking could. But dropping an infant would rarely if ever lead to criminal charges as serious as murder. What the SBS diagnosis brought to Woodward’s case was intention—no one accidentally shakes a baby hard enough to cause internal bleeding. The proof is in the pudding, so to speak. Except that if these deadly injuries are unrelated to shaking, the pudding is proof of nothing.