Monday, September 17, 2012

Shaken Baby Syndrome: The fake diagnosis we can't seem to shake

The myth of shaken baby syndrome continues. And defense attorneys everywhere go a little bit crazy. Or crazier, I guess. (At least, I hope they do because they're up to date on the medical and legal literature on the  topic.)

According to this story, a 19 year-old man in New Jersey has been charged with manslaughter and is accused of shaking his girlfriend's baby to death. There's just one problem: shaken baby syndrome is bunk. For decades now, we've been convicting people of some form of manslaughter or murder for shaking a baby too hard, so hard that the baby suffers massive brain trauma. But the fundamental underlying premise of the syndrome is flawed. Deeply flawed. So flawed that the syndrome has been renamed to Abusive Head Trauma (still a flawed name, though, as it doesn't just identify symptoms but presumes a cause).

I'm not going to get into all the details here. I haven't ever dealt with an SBS case, so I'm not as well-versed in the medical issues as I could be. Instead, I would refer you to this law review article (shameless plug: one of the authors was one of my advisers in law school: go Keith!).

Shaken Baby Syndrome, Abusive Head Trauma, and Actual Innocence: Getting It Right

The bottom line is that shaking as a mechanism for causing these head traumas has been debunked. The amount of force that would be necessary would also show massive injuries to the infant's neck. But SBS cases never involve those injuries. The premise is that a triad of symptoms exist (subdural hemorrhage, retinal hemorrhage, and encephalopathy) that trigger a diagnose of this shaking trauma and that the onset of symptoms can be used to pinpoint the time of injury, thus identifying the perpetrator. But none of this is true. This triad of symptoms can occur from all sorts of natural and accidental causes and the onset of symptoms can vary widely.

Understandably, this is a hard topic for medical researchers to investigate because one cannot test the hypotheses on actual infants. So it has taken some time to realize the flaws in the premises behind SBS. But we have enough information now that we ought to have moved past still perpetuating the myth that people shake babies to death. Sadly, though, it is still a widely accepted concept. Then what happens is that a parent or family member or caretaker reeling from the death of an infant is confronted with this medical theory and urged to admit getting frustrated and possibly shaking the baby a little too hard. An awful lot of people have been convicted this way, which ought to trouble all of us.

In this New Jersey case, I have no idea what the circumstances are. Maybe there really are severe neck injuries to the child, but there probably aren't. And if there aren't, it's not a shaking case. (Sort of like the vast majority of purported shaking cases...) Perhaps it is clear that this young man is responsible for the child's death through some form of abuse and the use of the word "shaking" is just loose terminology. He may well be responsible, but we're not going to get any sort of reliable result if the police and prosecutors continue to pursue cases as shaking cases. Because the truth is there really isn't any such thing.


BellsforStacy said...

I don't understand what you mean by fake diagnosis. There is a real thing called shaken baby syndrome, right? Do you just mean that it's overused? Or used inappropriately?

S said...

No. Shaken baby is fake. Doesn't happen. The syndrome has been totally renamed.

Anonymous said...

Regardless of how you name it, shaken baby syndrome is in no way debunked. Trained pediatric providers have seen and continue to see the consequences from violent shaking of an infant. Shaking can cause shearing of bridging veins along the brain, leading to subdural hematomas, and/or impact injury to the brain from striking the inner areas of the skull. Is violent shaking of a baby the only cause? No, other types of trauma/injury can certainly cause similar findings. But if there is no plausible severe underlying medical condition and no known injury to account for such an injury, it certainly makes sense to investigate. Think of concussions - adults can get them without external signs of injury, and multiple concussions can lead to brain swelling and neurological deficits. Fortunately, adults don't tend to get repeated violent jarring injuries to the brain in a short period of time like a shaken baby does, lessening the likelihood of immediate swelling and death.

You can argue the legality of prosecuting, convicting, or punishing a parent who shakes their child. Many cases likely result from a sleep-deprived, stressed individual who is desperate to make their child stop crying. They shake until the crying stops. They can be otherwise loving parents who hit a moment of desperation and didn't recognize the damage they were inflicting until it was too late. Nevertheless, the doesn't change the consequences.

If you want to improve the system, help educate parents and caregivers to recognize their own stress, put their child in a safe place, and walk away before they do something they may regret for the rest of their lives. Your undermining of the problem does no one any favors.

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