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Shaken Baby Syndrome: Questions and Controversies
The number of cases of Shaken Baby Syndrome appears to be growing at an
alarming rate. Are there really more children who suffer abuse by violent
shaking or are there underlying illnesses or other possible explanations
for the infant's injuries and/or death?
Currently there are 5 major controversies in the field of Non-Accidental
Trauma to Children. These controversies surround 5 major assumptions offered
by the sworn testimony of state medical experts.
Assumption #1: It is shaking alone, of an otherwise healthy child
that causes retinal hemorrhages and subdural hematomas.
Biomechanical Research and human case material does not unequivocally support the theory that shaking alone can cause these symptoms but that short falls cannot.
Assumption #2: Short distance falls do not kill infants or children.
Medical Research and Case Studies indicate that some children can and do die from short falls.
Assumption #3: Chronic subdural hematomas do not rebleed spontaneously or with lesser trauma or no trauma at all.
It is undisputed in adult literature that subdurals can rebleed within the healing course and there are no reasons to think that children's brains would act differently. Plus medical literature and case studies Going back 60+ years have documented The same processes In pedeatric subdural hematoma with or without known abuse.
Assumption #4: A child suffering from an ultimately fatal head injury cannot experience a lucid interval between the inception of the subdural and his or her respiratory arrest.
It is undisputed that adults can experience "lucid" intervals after an intracranial hemorrhage and there is NO data to support a conclusion that children's brains are different. Medical literature and case studies have documented numerous instances of lucid intervals in fatal childhood head injury cases.
Assumption #5: Retinal hemorrhages only occur in cases of "Shaken Baby Syndrome" or non-accidental trauma.
Retinal hemorrhage can be found in a myriad of different scenarios (Child Birth. CPR, Coagulation Disorders etc) and cannot be pathologically interpreted or dated with any accuracy. At one time, retinal hemorrhages were a sign of possible chronic subdurals in children (Matson, Neurosurgery of Infancy and Childhood).
In order to answer the questions regarding how to properly diagnose accidental and non-accidental trauma in children and how to accurately prosecute the correct perpetrator in child abuse cases more research needs to be done on the following areas:
· The biomechanics of short falls and other accidental injuries?
· The pathology and diagnostic quality of retinal hemorrhages?
· The timing and dating of Retinal Hemorrhages?
· The amount of force required to cause a subdural hematoma?
· The etiology and clinical course of a Chronic Subdural Hematoma.
· The timing and dating of subdural hematomas?
· The amount of force required to cause a subdural hematoma to rebleed.
· The underlying conditions that might increase a child's vulnerability to a fatal head injury or a rebleed.
· Other conditions that can mimic Shaken Baby Syndrome
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