What is Shaken Baby Syndrome?

Shaken baby syndrome is a term defining a constellation of injuries (subural hematomas and retinal hemorrhages) seen on a child which are said to be indicators of non-accidental trauma. The standard scenario given by Randall Alexander and other pediatricians who testify for the prosecution on "shaken Baby" cases, is that a baby is crying and a caretaker gets angry or frustrated and shakes that baby in an effort quiet him or her.

Because the muscles in the neck of an infant are weak, and the brain is smaller than the skull cavity, when a baby is shaken it has been said that the brain literally "sloshes" back in forth in the skull. This causes the veins on the top of the head to bleed. The pool of blood that collects on the brain after such a bleed, is known as a subdural hemorrhage. It also thought that this shaking mechanism, which pruduces accelerational/decelerational and rotational injuries, also causes retinal hemorrhages.

There is some debate as to whether shaking alone, of an otherwise healthy infant can produce subdural hematomas and retinal hemorrhages. Some doctors believe that it can, while others rely on scientific literature that suggest that impact is needed. No one disputes whether shaking can cause serious trauma, the scientific controversy surrounds whether shaking alone can cause this degree of trauma without other indications of soft tissue damage to the neck or gripping injuries and, whether other explanations could exist.


What are the Symptoms of Shaken Baby Syndrome?

As with any illness the symptoms typically mirror the severity of the injury. In mild "SBS", symptoms may go unnoticed or may range from lethargy, vomiting, irritability, poor sleeping to poor feeding. Moderate symptoms might show glassy or unfocused eyes, poor muscle tone, grimacing, twitching, siezures, or an inability to suck. More servere symptoms include breathing problems, a budging soft spot (due to the increased intracranial pressure caused by the excess bleeding), seizures, projectile vomiting or unconsciousness.

What Kinds of Injuries do Doctors Associate with Shaken Baby Syndrome?

The two tell tale signs of SBS are retinal bleeding and subdural hematoma. Other injuries we would expect to see with with Shaken Baby Syndrome but most often don't, are ribs or arm bone fractures or, bruising around the chest/rib area (caused by griping too tightly as the baby is shaken), or previous signs of abuse.

How Do Doctors Discover These Injuries?

When a baby is brought into the hospital under respiratory arrest, they are often given a CAT Scan or MRI and a fundoscopic examination. If these tests produce the combination of subdural hematomas and/or retinal hemorrhages, regardless of the age of either, the case is generally given a diagnosis of non-accidental trauma and further screening is discontinued. Because most pediatricians and emergency room doctors trained in recent years have been told that a finding of retinal and subdural hemorrhages equates to a diagnosis of Shaken Baby to the exclusion of all others, they feel obligated under mandatory reporting laws, to report these cases as suspiscious of abuse.

Timing of the Injuries:

The theory behind the timing of "Shaken Baby Syndrome" is that the injury to the child is so severe (no matter how mildly the brain is affected) that the brain would immediately swell, causing almost instant distress symptoms such as choking, turning blue, altered consciousness, breathing problems or seizures. There is some scientific evidence to idicate that this is not always the case. Studies show, that subdural hematomas in children, can go asymptomatic for hours, days or weeks and some subdurals never become symptomatic.(CITE)

Dating subdural hematomas by CAT scan has not been found to be a very reliable method of timing injuries. MRI's are generally said to be better at dating subdurals, but still have many flaws. MRI's are able to date subdural effusins within windows but they are not perfect and the widows remain fairly broad. Furthermore, resarch and testimony in these cases have shown that timing estimations of subdural hematomas from Cat scans or MRIs often do not comport with histological findings at autopsy. At autopsy, forensic pathologists or forensic neuropathologists have the benifit of gross visual inspection of the dura for staining and histological tests that can pick up more subtle indicators of a healing or evolving subdural.

Regardless of the method used to date the injuries, there is currently NO test available that can pinpoint the exact time of an injury. The closest dates provide a 1-4 day window.

Fundoscopic examinations are generally required for a diiagnosis of SBS. If Retinal Hemorrhages are found it is assumed that the case involved non-accidental trauma. Until recently, there have been no cameras available to photograph retinal hemorrhages. Some more advanced hospitals are begining to employ cameras now, but as of yet, very foew if any of these pictures have been used in court. Ironicly, it is also rare to see opthalmologist testify in these cases or write reports. While it is widely recognized that retinal hemorrhages can't be accurately dated, it has been noted that certain types of retinal heorrhages don't always heal at the same rates.

Can Other Diseases, Illnesses or Conditions Cause Retinal Hemorrhages and Subdural Hematomas?

There seems to be several conditions or situations aside from abuse, that can produce subdural hematomas and retinal hemorrhages in infants or toddlers.