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.
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December 4th, 2008 at 5:35 pm
Thank you, Discover, for highlighting the debate on SBS. On October 1, 2008, the Goudge Inquiry (Google for details) determined after a long and in-depth investigation that every SBS conviction in Ontario should be reviewed. The diagnosis of Shaken Baby Syndrome is based on a couple of assumptions subsequent scientific discoveries have failed to support. First is that NOTHING other than shaking can cause a certain constellation of symptoms (retinal bleeding, subdural bleeding, brain swelling). Since SBS was proposed, it has been learned that a number of rare congenital diseases result in the same symptoms. I suspect there are congenital or environmental causes not yet known. A second assumption is that the last person alone with the child is an abuser. There are known and proven cases where children have been under medical supervision for 16-72 hours before displaying alarming symptoms (seizures, labored breathing). In Wisconsin, a baby was in hospital for 16 hours before a nurse noticed labored breathing. The child died of “classic” SBS symptoms and the nurse was not charged with abuse. Nevertheless, medical experts continue to testify that symptoms are immediate and devastating in fatal cases, and the last person must therefore be a perpetrator. Confessions by true perpetrators are considered proof that those who do not confess are lying, yet almost anyone can be led to “confess” using interrogation techniques developed for hardened criminals, not young parents or grandmothers who trust the police and are trying to “help” figure out what happened to the baby.
Doctors know even less about infant brains than adult brains, and further research needs to be conducted. The number of otherwise excellent parents and carers who have been accused of abuse after telling the identical “lame” story should raise alarm bells. Just because shaking can cause the symptoms does not prove NOTHING but shaking can cause them. A broken arm does not “prove” a person has fallen out of a tree! Much research needs to be done to find out what is really happening in some of these cases. I hope someone will begin to collect DNA samples from children with these symptoms. Perhaps as DNA decoding becomes better and better, things can be discovered. Thank you, in any case, for bringing the debate to the attention of the public. Jurors are too easily persuaded that the predominant medical opinion is correct absent the information you provided in the article. If a child death cannot otherwise be explained, juries who are heartbroken by the death of an innocent too easily accept the opinions of “experts” whether based on solid science or not.
December 31st, 2008 at 6:40 pm
Not only is Shaken Baby Syndrome not always the culprit, but there is also reason to fear that the poor and uneducated will be disproportionately penalized by a well meaning judiciary. Those who speak English as a second language, and are unfamiliar with the justice and police system in this country, will also be found guilty more often. It is highly indicative that the first major court case involved a young woman from a foreign country(Louise Woodward), away from parents and legal advisors. Fortunately she was attractive and English speaking and therefore did get some sympathy, imagine if she had been overweight and Spanish speaking!