Tuesday, 31 August 2010

SBS: Shaken Baby Syndrome or Scurvy?

Shaken Baby Syndrome or Scurvy?
C. Alan B. Clemetson, M.D.
Journal of Orthomolecular Medicine Vol. 17, No. 4, 2002
There has undoubtedly been a grave miscarriage of justice in the conviction of Alan Yurko of Orlando, Florida, who was accused of "shaken baby syndrome" and was sentenced to life imprisonment for murder. The error seems to have arisen because of fashionable adherence to a diagnosis now in vogue, and to a desire to blame one single preventable occurrence for an infant death. Everything is supposed to be preventable nowadays.
Surely Alan held his 10-week-old son by the heels and slapped him on the bottom after he began wheezing, spat up and stopped breathing, but he did not cause his son’s death; he was trying to resuscitate him.
Actually the infant died from a concatenation of circumstances, having been born prematurely, weighing 5 lbs. 8 oz., of a malnourished mother with several medical problems. After becoming pregnant, she became sick and remained so during her pregnancy, often to the point of dehydration, going from her original weight of 130 lbs. down to 120 lbs. at one point and finally coming back to her original weight of 130 lbs. at the time of delivery. She said she was too sick to take her prenatal vitamins.
When one considers that the currently recommended weight gain for pregnancy is 25 to 30 lbs., it is clear that she was malnourished and so was her unborn child. The infant had several medical problems including respiratory distress syndrome, pneumonitis and also jaundice which was still evident four weeks after leaving hospital; his health was further impaired when he received six inoculations (for diphtheria, whooping cough, tetanus, influenza B, oral polio vaccine and hepatitis B) at eight weeks of age.
Actually, the autopsy findings of subdural hemorrhage, four broken ribs, severe anemia and a few bruises, are characteristic of Barlow’s disease or infantile scurvy, but that diagnosis went out of fashion many years ago, so no blood analysis for vitamin C or for histamine was conducted. The prosecutors suspected both parents, but Francine Yurko refused to implicate her husband and Alan Yurko refused to plead guilty to a lesser charge, because he knew he was innocent.
Undoubtedly many others have also been wrongly convicted on equally flimsy evidence, sometimes just because there were petechial hemorrhages in the retina at the back of the eye, or because the fatal event occurred more the usual 3 to 7 days after the inoculations.
Undoubtedly child abuse does occur and we are all alarmed when we hear about an infant with bruises and broken bones, but we must appreciate that there are genetic disorders such as osteogenesis imperfecta, fragilitas osseum (brittle bone disease) other metabolic disorders and also nutritional states like Barlow’s disease, which can be mistaken for child abuse.
It is said that ignorance is bliss; this may be true for those who give evidence in our law courts with such conviction, following the standard teaching of the day. We should all keep an open mind and consider the possibility that the standard teaching may be wrong.
Barlow’s Disease
In the first half of the twentieth century many infants with bruises, broken bones and sores that would not heal, were correctly diagnosed as having infantile scurvy or Barlow’s disease, and recovered quickly when treated with orange juice, but now people don’t want to believe that malnutrition still occurs in the Western World, so one or other of the parents or a care giver has to be accused and possibly convicted of child abuse, without any blood analysis for vitamin C. Sores that will not heal are seen as cigarette burns and reported in newspapers. Barlow’s disease used to occur even in the homes of the wealthy, sometimes due to the custom of boiling cow’s milk to kill the germs of tuberculosis, sometimes due to feeding of a commercial "malt soup", whose alkalinity destroyed vitamin C and sometimes due to ignorance of the need to provide an orange juice supplement for bottle-fed infants.
There are even records of such an infant suffering a complete fracture across both femoral bones of the thigh in hospital, when a nurse lifted the heels in the gentle act of diapering a scorbutic infant. Luckily it did not occur at home, for even then someone would have been suspected of child abuse. Part of the problem now arises from the child abuse laws which require immediate reporting of any suspicion of child abuse, so that even the natural pigmentation of the "Mongol Spot," just above the natal cleft, was suspected as child abuse when a young mother brought her baby to our hospital for advice because it was not thriving. One of the nurses rushed to the phone to call the child abuse authorities. Before long the nurses were presenting the infant to each other, to social workers and to the doctors, as "this is the child abuse case". The physician who first sees the infant can have his or her opinion prejudiced by such hysteria, before making an examination.
What has happened to the practice of medicine? Our duty as physicians is to make a well-considered diagnosis and to provide advice with compassion, not accusation and vilification. Soon parents will be afraid to take their children to the emergency room of a hospital after a fall for fear that some "expert" will find petechial hemorrhages in the eyes and label the parents as child abusers. The social workers are in an unenviable position, for they can be dammed if they do and dammed if they don’t remove a child from parental custody. Even more perilous is the job of infant care providers and pre-school teachers, who have so often been embroiled in totally unreasonable litigation, like the McMartin pre-school family, who endured a new version of the Salem Witchcraft Trials.
Popeye, A Case of Classical Adult Scurvy
Ignorance is bliss. Not many people are aware that "Popeye the Sailor Man" was a well recognized character to be seen around any English seaport in the days of sail. The protrusion of one eye was due to a hemorrhage behind the eye ball (a retrobulbar hemorrhage) due to scurvy; this was only one of many hemorrhages beneath his skin and elsewhere; he should be recognized as a symbol of suffering who deserves our compassion and not a comic cartoon character for people to laugh at. He is a young man, who looks old beyond his years due to scurvy. He would have had foul breath due to his infected bleeding gums. His pipe juts up in front of his face because he has lost all his teeth to scurvy and he is holding his pipe between his upper and lower gums.
Clearly he has returned from a long sea voyage where he lived on food held in storage and maybe as many as half of his shipmates died of scurvy. We are told that his arch enemy "Bluto" has gone off with his woman "Olive Oil" and his child "Sweet Pea," but he does not have the strength to fight Bluto until he has been fortified with spinach. Of course it is vitamin C-rich fresh greens or fruit that he needs, not canned spinach that has lost its vitality, but his misery has been exploited and transformed into an advertising cartoon. In fact, we may conjecture that these poor men received little respect at the time, for the phrase "scurvy knave" persists in our literature.
It will be about a week before his bleeding gums are healed when he gets oranges, lemons, limes, tomatoes or lettuce, but it will be several weeks before his strength is restored. The bleeding gums, which are so characteristic of adult scurvy, are not seen in toothless infants, so the diagnosis is easily missed. Infection causes local vitamin C deficiency and vitamin C deficiency predisposes to infection, so a vicious cycle develops. Clearly it is the bacteria in the crevice between the tooth and the gum that cause a local infection leading to the foul mouth and the swollen bleeding gums of adult scurvy. This does not occur in edentulous infants.
Borderline Vitamin C Deficiency
There is a wide separation between frank scurvy and perfect health, and this is becoming more and more apparent as we learn about the underlying defects in vitamin C deficiency.
Bleeding from the smallest blood vessels, the capillaries and small venules is the principal manifestation of the disease; this is due to a weakness of the blood vessel wall and not the result of any defect in the blood coagulation system. Several tests have been used to measure capillary fragility, the strength or weakness of the small blood vessels, by counting the number of small pinpoint hemorrhages or petechiae produced by suction on the skin of the arm or by venous occlusion, but these tests for vitamin C depletion are rendered unreliable by the fact that so many other conditions such as thrombocytopenic purpura, measles and scarlet fever also cause capillary fragility and petechial hemorrhages. Only by chemical analysis can we tell for sure whether petechial hemorrhages are due to vitamin C deficiency or to something else. The word scurvy is used only for the almost complete absence of vitamin C from the blood and tissues, when fibroblasts and the related osteoblasts, chondroblasts and odontoblast cells can no longer manufacture collagen, the foundation matrix for connective tissue, bone, cartilage and tooth dentin respectively. But we now know that lesser degrees of vitamin C depletion cause the accumulation of histamine in the blood, and this causes weakness of the capillary blood vessels by separating the cells of the vascular intima from one another.
Histamine accumulation dissolves the intercellular cement; this increase in the blood histamine level begins as soon as the blood plasma vitamin C level begins to fall below the normal level of 1.0 mg/100 mL; frank scurvy does not occur until the vitamin C level falls to one tenth of that value.
The plasma vitamin C status of the general population is much poorer than is generally appreciated, being below 0.7 mg/100 mL in 34 per cent of ambulant people in Brooklyn, New York;1 below 0.5 mg/100 mL in 30 per cent and below 0.2 mg/100 mL in 6 percent of people attending a Health Maintenance Organization (HMO) clinic in Tempe, Arizona.

SBS: Excellent review to 2009, by Deborah Tuerkheimer

The Next Innocence Project: Shaken Baby Syndrome and the Criminal Courts
Deborah Tuerkheimer DePaul University - College of LawWashington University Law Review, Vol. 87, 2009
Abstract: Every year in this country, hundreds of people are convicted of having shaken a baby, most often to death. In a prosecution paradigm without precedent, expert medical testimony is used to establish that a crime occurred, that the defendant caused the infant's death by shaking, and that the shaking was sufficiently forceful to constitute depraved indifference to human life. Shaken Baby Syndrome (SBS) is, in essence, a medical diagnosis of murder, one based solely on the presence of a diagnostic triad: retinal bleeding, bleeding in the protective layer of the brain, and brain swelling. New scientific research has cast doubt on the forensic significance of this triad, thereby undermining the foundations of thousands of SBS convictions. Outside the United States, this scientific evolution has prompted systemic reevaluations of the prosecutorial paradigm. Most recently, after a seventeen-month investigation costing $8.3 million, a Canadian commission recommended that all SBS cases be reviewed. In contrast, our criminal justice system has failed to absorb the latest scientific knowledge. This is beginning to change: for the first time, an SBS conviction was overturned last year because "newly discovered" scientific evidence would likely create a reasonable doubt about the defendant's guilt; also for the first time, a state Supreme Court is considering whether a trial judge erred in excluding as unreliable the prosecution's expert testimony regarding SBS; and the U.S. Supreme Court is now reviewing a petition seeking review of a habeas grant in an SBS case. Yet the response has been halting and inconsistent. To this day, triad-based convictions continue to be affirmed, and new prosecutions commenced, as a matter of course. These developments have not attracted the attention of legal scholars. In the face of this void, this article identifies a criminal justice crisis and begins a conversation about its proper resolution. The conceptual implications of the inquiry - for scientific engagement in law's shadow, for future systemic reform, and for our understanding of innocence in a post-DNA world - should assist in the task of righting past wrongs and averting further injustice.

SBS: statement by J. Plunkett, Forensic Pathologist J F Geddes, retired (formerly reader in clinical neuropathology, Queen Mary, University of London)

J F Geddes, retired (formerly reader in clinical neuropathology, Queen Mary, University of London)
London ; Email:
J Plunkett, forensic pathologist
Regina Medical Center, 1175 Nininger Road, Hastings, MN 55033, USA
It is difficult to understand how Reece et al could interpret our editorial as displaying "a worrisome and persistent bias against the diagnosis of child abuse in general." Child abuse exists, and we know and attest that it exists. In fact, one of us (JP) has testified before the Minnesota State House and Senate on the need for "mandated reporting" laws. The editorial does not discuss "child abuse in general."
Child abuse exists in many forms: our editorial addresses the diagnostic criteria for a specific type of abuse, the so-called shaken baby syndrome. We emphasise, as have Donohoe and Lantz et al, that the literature to support a diagnosis of shaken baby syndrome/inflicted head injury is based on imprecise and ill-defined criteria, biased selection, circular reasoning, inappropriate controls, and conclusions that overstep the data. If it is the questioning of the criteria that is worrisome, we will continue to do so and to cause worry.
We omit "the most important element in this condition: brain injury itself" because there is little scientifically acceptable evidence that "shaking" causes primary traumatic brain injury except under laboratory conditions. Detailed neuropathological studies have shown that apart from the craniocervical junction, the brain is seldom damaged even in those deaths thought to be due to "shaking." Furthermore, the "research" referenced by the authors is misstated, misused, and remarkably selective. The diagnosis of non-accidental trauma in the authors’ cited studies is based on "assessment of the child protection committee," "multidisciplinary child protective team…or the forensic pathologist of the state medical examiner," or "multidisciplinary team consensus." We would no longer even use "the inclusion criteria of Geddes et al" for the reasons stated below. None of the above studies provides objective, reproducible criteria for case selection needed to evaluate methods of case selection, arrive at meaningful conclusions, or allow cross-study comparisons. These are exactly the concerns of Donohoe and Lantz et al., and the focus of our comments. Furthermore, two of the studies stated by the authors to show that "30% to 40% of newly diagnosed shaken baby cases had medical evidence of previously diagnosed head injury" do not even discuss this issue: Alexander et al describe impact trauma in association with shaken baby syndrome, while Kemp et al relate outcome to initial presentation.
We have ourselves previously used confession and criminal conviction as criteria to support a diagnosis of abuse, including "shaking." However, we would no longer do so. A person may confess for a variety of reasons, and even when properly assessed, a confession must be interpreted cautiously if it is used as "evidence" to prove a medical hypothesis. In the field of child abuse, the carer being told that the only way in which injury was possible was by shaking, or that the charge will be reduced if the carer confesses, may influence a confession. In the family courts a confession may prevent children being sent into care. Unless we have full details of the type of legal proceedings involved, the stage at which confession was made, whether a lighter sentence was passed, or whether it was a plea to get parole¾ all of which are highly relevant¾ the use of a confession to support a scientific argument is unsound. How does one reconcile "confession to shaking" with the fact that more than 50% of the infants in the study by Kemp et al had overt evidence for impact head injury?
If, as the authors state, in "crushing head injuries, as in Lantz et al’s report… child abuse is not a consideration" why was this injury initially considered "highly suspicious" for child abuse on the bais of the ocular findings, and why was the older sibling removed from the home because the eye findings were considered pathognomonic of shaken baby syndrome? The current American Academy of Ophthalmology website on ocular involvement in shaken baby syndrome, as in Lantz et al’s report contains the following statement: "When extensive retinal hemorrhage accompanied by perimacular folds and schisis cavities is found in association with intracranial hemorrhage or other evidence of trauma to the brain in an infant, shaking injury can be diagnosed with confidence regardless of other circumstances" (our italics). If shaken baby syndrome is "old news" why does a child abuse specialist believe that a diagnosis of an accidental injury is valid only if the incident is witnessed by a non-family member, and then create a scenario to fit a formulated belief system of infant head injury, shaken baby syndrome?
The primary objective of our editorial was to bring readers’ attention to one new and one recent study relating to infant head trauma, a specific subcategory of child abuse and to voice concerns about the quality of the scientific information available in the literature. We encouraged the readers to evaluate critically the evidentiary basis for a diagnosis of shaken baby syndrome in the light of the questions raised by the two papers. Of course Donohoe’s study was limited and would only retrieve papers that included the words "shaken baby syndrome" in the title, key words, or abstract. Nevertheless, his search did produce a number of articles that are commonly cited as authoritative in the pre-1999 literature. The important thing is that the lack of scientific rigour that he identified is not restricted to infant head injury papers that specifically mention shaken baby syndrome. If Reece et al perform a critical review of the "number of qualified studies" that they assert would have been included by a wider search they will encounter the same "data gaps, flaws of logic, and inconsistency of case definition" that were present in the literature studied Donohoe. We would urge them to look again, for example, at the paper they cite by Alexander et al, where they will find all the above shortcomings.
Evidence-based medicine (EBM) is a tool, not a panacea, to be sure. However, it is a method that encourages rigorous evaluation of what has been published, and what we believe to be true. Does this mean that anecdote cannot be valued? That small non-controlled studies cannot be one basis for evaluating or treating a patient? That "consensus statements" by "experts" cannot guide us? No. It does, however, mean that we must recognise when a diagnosis and treatment recommendation are a belief system, not a scientific truth. It does mean that we must be ever vigilant to recognise and to attest when "the Emperor is wearing no clothes." The authors implied difficulty in performing valid studies on diagnostic specificity or casual mechanisms does not excuse poorly designed observational studies or conclusions that overstep the data. Association does not equal causation.
Finally, we are at a loss to explain or accept the authors’ statement in their penultimate sentence: "Unfortunately, there remains considerable difficulty for some doctors to accept that children are abused." If the authors are suggesting that we are among those doctors, or are encouraging others to do so, their argument is a willful misinterpretation of what we have written. When there is new evidence that challenges an established conviction, medicine has the responsibility to critically evaluate the data, and if verifiable, reflect that change. We must have no vested interest in yesterday’s belief. We are encouraging doctors to think clearly and critically, even in an area as emotive as child abuse. No more. And no less.
Donohoe M. Evidence-based medicine and shaken baby syndrome. Part I: literature review, 1966-1998. Am J Forensic Med Pathol 2003;24:239-42.
Lantz PE, Sinal SH, Stanton CA, Weaver RG, Jr. Perimacular retinal folds from childhood head trauma. BMJ 2004;328:754-6. (27 March.)
Geddes JF, Vowles GH, Hackshaw AK, Nickols CD, Scott IS, Whitwell HL. Neuropathology of inflicted head injury in children. II. Microscopic brain injury in infants. Brain 2001;124:1299-306
Ewing-Cobbs L, Kramer L, Prasad M, et al. Neuroimaging, physical and developmental findings after inflicted and non-inflicted traumatic brain injury in young children. Pediatrics 1998;102:300-7.
Alexander R, Sato Y, Smith W, Bennett T. Incidence of impact trauma with cranial injuries ascribed to shaking. Am J Dis Child 1990;144:724-6.
Jenny C, Hymel KP, Ritzen A, Reinert SE, Hay TC. Analysis of missed cases of abusive head trauma. JAMA 1999;282:621-6.
Kemp AM, Stoodley N, Cobley C, Coles L, Kemp KW. Apnoea and brain swelling in non-accidental head injury. Arch Dis Child 2003;88:472-6.
Esernio-Jenssen DD. Killer televisions. Electronic response to: Perimacular retinal folds from childhood head trauma. http://bmj.bmjjournals.com/cgi/eletters/328/7442/754#55167 (accessed 20 May).
Lantz PE. Re: Killer televisions. Electronic response to: Perimacular retinal folds from childhood head trauma. http://bmj.bmjjournals.com/cgi/eletters/328/7442/754#55418 (accessed 20 May 2004).

Monday, 30 August 2010

SIDS?: Dead baby had strong sleeping tablets in his system

26 August 2010
A three-month-old baby found dead in his parents' bed had powerful sleeping tablets in his system.
Leighton McGloen was discovered by his distraught mum, Jackie Tunicliffe, 21, after they fell asleep together following an early-morning feed.Tests later revealed there was evidence of temazepam and diazepam in Leighton's blood and police identified Jackie and his dad John, 30, as former drug users.An inquest in Sunderland heard how John rang 999 and desperately tried to revive his son before an ambulance crew arrived at their former home in Bailey Rise, Peterlee.But Leighton was pronounced dead at Sunderland Royal Hospital soon after on February 15.Investigating officer DI Paul Colling, from Durham Constabulary, told the inquest at Sunderland Civic Centre that police were alerted to Leighton's death by paramedics at 8.14am on the morning he died.Officers later interviewed the couple at hospital.Urine samples were taken from Jackie and John, which showed Jackie had taken diazepam and temazepam and John had codeine, morphine and diazepam in his system.John told police he was taking the prescription medicine Subutex for drug withdrawal.Jackie admitted she had been given tablets for pain relief by her sister and thought they were codeine.She also said in interview she had breastfed Leighton since his birth in November last year.DI Colling told the inquest yesterday that Leighton woke Jackie at 2am on the day he died."He went to sleep in her arms and she laid him down on her side of the bed"John told police he was woken up about 7.50am by Jackie screaming that Leighton was not breathing, and called 999.No charges were brought against the couple and police have now closed the case.Paedatric pathologist Dr Christopher Wright said: "On the basis of what the toxicologist was able to tell me, I was not able to say for certain whether that (temazepam) would have played a direct role in his death.""The evidence does not allow me to go as far as saying Leighton died from the result of an overlaying situation, but that does mean that is the possibility that I cannot exclude."Another possibility I cannot exclude is that Leighton died from Sudden Infant Death Syndrome," he added.

Verdict: Open.

SIDS: sleeping arrangements

By Prue Salasky,
Damion Taft sleeps peacefully on the cushioned sofa, the occasional smile rippling across his features. His mother scoops up the 2-month-old when she answers the door to greet Tricey Primm, a family support worker from the
Newport News Healthy Families Initiative.On this visit, Primm brings with her a Pack 'n Play, a crib substitute donated by the Cribs for Kids program of the Virginia SIDS Alliance to provide a safe place for Damion to sleep.
Inappropriate sleeping arrangements are a contributing factor in the unexplained deaths of 2,500 infants each year to Sudden Infant Death Syndrome, or SIDS. The rate for African-American infants is double those of other ethnicities. Additionally, accidental suffocation, which can result from unsafe sleeping arrangements — such as sleeping with siblings or adults, with stuffed animals, or with ill-fitting bedding — is the leading cause of accidental deaths among infants.Primm has been visiting Uganda Smith twice a month since she was three months pregnant with her first son, Abraham Taft, who turns 3 in October. "She didn't know anything about babies. She realized she needed some help," says Primm, who has books and toys for Abraham to play with during her visit and a handout on nutrition that she leaves with Smith.Abraham outgrew his Pack 'n Play, which got too worn to re-use, and now sleeps either on the sofa, or on a full-size mattress on the floor. Primm advocates for the mattress until they can find him a safe crib or bed. "He could roll off the sofa," she points out.The new Pack 'n Play can safely accommodate his infant brother for up to a year. (There are height and weight restrictions on its safe use.) "You can put it on different levels as a child gets older but it's really only safe for a year. Then we have to look for something else," says Glynda Lowery, team leader for Healthy Families. The city's program enrolls about 140 families at a time, but Lowery also distributes crib substitutes to other low-income Newport News residents through Chesapeake's Sleeptight program. In the latter program recipients must attend a training session on safe sleeping before receiving the portable crib/playpen.When Primm delivers a crib, she has a checklist with pointers on safe sleeping practices — place a baby on its back, no smoking near the baby, no sleeping with siblings or in an adult bed, no pillows — that she goes over with the recipient and has them sign.The SIDS Alliance gives away Pack 'n Play portable cribs rather than full-size cribs for several reasons: Often there's insufficient space in the recipients' homes; full cribs require tools and can be difficult to assemble; and they are subject to recall and can create liability issues. The Pack 'n Play doesn't require any assembly, is safe for sleeping for infants younger than a year — those at the greatest risk for SIDS — and can be used as a playpen.Smith, 37, says she has forgotten a lot since having Abraham. "I'd forgotten all the things you go through in the months you're carrying," she says. She's also concerned about watching Abraham, who is naturally energetic and inquisitive, while looking after Damion at the same time. "He's on his own schedule," she says. Primm has helped her learn about time management, the different stages of development, and how the children grow and interact.She's learned how to cope when Abraham "goes through an emotional state," putting him in time out until they can discuss the problem. Primm also works with the toddler, encouraging him to express his frustrations in a manageable way while teaching him colors and working on his fine motor skills. He'll be screened for preschool at age 3, when he'll be expected to know numbers up to 20, his colors, and more, she explains.All the while Primm offers words of encouragement and advice to Smith. "You like cooking," she urges. "Try making this stew, it has vegetables in it. When he goes to school there'll be different tastes. Introduce him to some different things." Smith nods, saying that she's been trying to get him to eat more vegetables, but he balks at peas and beans. Abraham duly recites the names of the foods he likes.Primm points out the baby acne on Damion's face, but reassures Smith that it will clear up. It's nothing to worry about. Smith says the doctor gave her some cream to use on it.Damion starts to stir. He's hungry. Smith is breastfeeding Damion but supplements with bottles.Primm reminds her gently that she should avoid microwaving the bottle, that it can be too hot, and it's not good with the plastic. Warm it up in water instead, she urges, checking how much Smith's feeding him at one time — just two ounces is fine — and reminding her that milk is all the baby needs at this stage. He weighed less than 6 pounds at birth and now weighs a robust 10 pounds 12 ounces.After burping him, Smith lays Damion gently on his back on a thin mattress cover in the Pack 'n Play, ready for a nap.Virginia SIDS AllianceCribs for Kids program: It works with home visitors to supply portable Graco cribs to needy families when there are no other sleeping arrangements evident and the mother is within six weeks of delivering, or the baby is less than 1 year old. The donated cribs, which cost the alliance $55 plus $8 shipping, are set up at the home at no cost and a parent/guardian must sign a waiver after being instructed in safe sleeping practices. This year, the alliance will donate 250 cribs. There is currently a waiting list for cribs.

SIDS: Sydney, Australia, investigation

Tim Barlass August 22, 2010

" I just want her back" ... Liz Weippeart and her son Chris, pictured at their Tregear home, say they have been left out of the loop by police in the investigation surrounding Chris's missing six- year-old daughter Kiesha. Photo: Anthony Johnson
THE baby boy born to the parents of missing six-year-old Kiesha had been living at their home for only three days when he was found dead, his family has revealed.
His grandmother, Liz Weippeart, said Aiden died from sudden infant death syndrome, more commonly referred to as a cot death.
Ms Weippeart feared that police attention after Kiesha's disappearance could focus on the child's death in 2002.
Police said yesterday they had no plans to exhume the body of the six-week-old child.
But Detective Inspector Russell Oxford said: "We will check the investigation was conducted thoroughly at the time to see if there is anything that would connect to this case."
Chris Weippeart, the biological father of Kiesha, and Liz, her grandmother, gave their first interview since Kiesha disappeared.
It was three weeks yesterday since she was first reported missing from her home near Mount Druitt by her mother Kristi Abrahams and stepfather Robert Smith.
Ms Weippeart, fighting back tears, said: "The day Aiden came out of hospital he lived here with me for the first six weeks. She [Kristi] didn't feel like a mother and didn't feel like it was her child because she had a caesarean section and she didn't want to walk up the two flights of stairs [at their unit]. All three of them stayed here for the first six weeks.
"Three days after they moved out, Chris came running in and said, ‘Mum, Aiden's blue.'
"I went running up the street with Chris. Aiden was deceased three days after leaving my house."
That happened before the couple's relationship broke down and Kristi moved in with Mr Smith, taking Kiesha with her.
Ms Weippeart and her son also told how Kiesha had been in hospital after she was bitten on the upper arm.
Ms Weippeart said: "My son brought her down here and we took her to Mount Druitt Hospital and she was in there for three days.
"I have got a 10-year-old boy who is asking me questions: ‘Mummy will the police find her [Kiesha]?' I say: ‘The police are doing the best they can to bring her home safely."'
Detectives are awaiting results of DNA tests understood to have been taken from bedding and furniture from Kiesha's bedroom.
The family also confirmed that Kiesha had previously been in care and the family was known to the Department of Community Services. The revelations raise more questions about the role of DOCS, now under investigation by NSW Ombudsman Bruce Barbour in relation to its and other key agencies' "relevant activities" before Kiesha's disappearance.
Ms Weippeart complained she and her son had not been kept up to date on police progress. "It would be a common courtesy to come and see the family, especially the father."
She also questioned why everyone was calling her Kiesha Abrahams when the name on her birth certificate is Weippeart. She said: "I know where Aiden is. I can go and see Aiden every day. I know where my grandson is, but where's my granddaughter?
"She was such a happy-go-lucky kid. She was the most beautiful thing. The only problem I had with her was trying to get her to eat her vegies."
Inspector Oxford said: "We have got a death in the family and now this second child has disappeared. You would hope for the best but she may no longer be alive, and that would be the second one ... And, yes, the child was bitten and some action taken against the person who bit the child."
He said Kiesha's location during the seven days before she was reported missing on August 1 remained a focus of the investigation.
"It is now three weeks and the hope of finding her alive are very, very slim, even remote," he said.
Mr Weippeart said: "She used to run amok all the time. She used to love just playing. She was content with her toys – Pooh Bear and a bouncing Tigger.
"I just want her found. I just want my daughter back. I just want my daughter back – that's it."


SIDS: Black infants face triple death rate of others

August 19, 2010
Denise Dador
According to the Los Angeles County Department of Public Health, African-American infants in California are more than twice as likely to die during their first year of life compared to infants of other races.
A local organization is trying to change that and they're hoping to get dads more involved in the health of their babies.
A majority of African-American children are born out of wedlock and most are raised by single mothers. The Black Infant Health Program understands how absent fathers can affect the health of their children. So they've developed a strategy to help new dads.
All parents have stress, but in some communities the stress can be even greater. Many African-American families don't survive the added economic, social and emotional burdens. One local program recognizes this need and is reaching out to new moms.
At the Black Infant Health Program in Mission Hills, moms are connected with resources, but most of all they feel relief knowing they're not alone.
0 African-American babies in California are 2 to 3 times more likely to die of
sudden infant death syndrome than babies of other races.
"Since 1850, the data of infant mortality in the black community has not reduced. It's alarming," said Yodit Abraha, Black Infant Health Program manager for the Mission City Community Network.
Experts believe the cause for the high rates of
infant mortality in the black community may be many fold, from economic to social to possibly biological.
"The stressors that African-Americans walk with throughout a whole generation does impact physiological makeup. So it's a lot of stress hormones that are already high in the black community especially in the reproductive age of African-American woman," said Abraha.
The Black Infant Health Program helps families based on their needs. They offer infant care and other parent education seminars, as well as provide emotional and economic support.
"Love your children and love yourself because if you don't love yourself how are you going to love your child and take care of it, and get help. And it's OK to get help," she said.
Due to all the budget cuts, the state recently cut funding to the Black Infant Health Program. But they're staying afloat thanks to last minute help from the First Five Foundation. When that funding runs out, the organization will have to turn to private donors.


SIDE: Why You Should Not Co-Sleep With Your Infant

by Sue Hubbard, M.D.
There has been another newsworthy article that may support changes in the parental perception of risks associated with co-sleeping with their babies. The British Medical Journal reported this month that more than half of the SIDS (sudden infant deaths) in 80 infants in southwestern England between 2003 and 2006 occurred while the baby had been co-sleeping with a parent.
There have been many studies and developments in previous years relating to the prevention of SIDS, with ongoing research to hopefully one day solve the puzzle surrounding sudden infant death.
The public awareness of risk factors for SIDS, which include tummy sleeping, have reduced the incidence of SIDS from one in 800 live births 20 years ago, to one in 2,000 today. Other risk factors for SIDS include maternal smoking, having soft objects in the infant’s crib (such as pillows and blankets), and pre-term birth. Protective factors such as the use of a pacifier and ceiling fans has also recently been encouraged. The “back to sleep” campaign has probably had the greatest effect in reducing SIDS.
With this study of the SIDS infants, 54 percent died while co-sleeping, compared with 20 percent among the control groups. The infants who were co-sleeping had been sharing a bed or sofa with a parent or child at the time of their death. There was also an association with alcohol or drug use among the parents who had been co-sleeping with their infants.
Once again parents need to be reminded that co-sleeping with infants is dangerous. This study re-iterates previous studies which have also shown infant deaths after co-sleeping with parents. Having a baby in a bassinet with a firm mattress, next to the parental bed, is the preferred recommendation for the first four to eight weeks after birth. BACK TO SLEEP is always to be remembered.


SIDS: Eastbourne, England

Eastbourne mum: 'I couldn't believe my baby was gone'

20 August 2010
AN EASTBOURNE mum is doing a sponsored walk with her two small children to raise money for a cot death charity after her nine-week-old baby died.
Grieving Celine Mander battled to save tiny Leona after she stopped breathing during her morning nap.Nursery nurse Celine, 23, frantically dialled 999 and carried out CPR on the 'happy, perfect' baby but knew she was dead before paramedics arrived.
"Her lips were blue and she was cold," she told the Herald. "I couldn't believe my gorgeous little baby was gone. I just wanted her to open her eyes."Celine had to tell her three-year-old daughter Eloise her baby sister had gone to heaven and was now a star in the sky after she saw the tragic life-saving attempt. Now the toddler will walk beside her mum for six miles along the Cuckoo Trail from Polegate to Hailsham and back again - joined on 29 August by Celine's husband Daniel and 17-month-old little boy Duncan for the heartbreaking walk for Leona.Yesterday she said, "We will wear T-shirts with Leona's picture on them. She was only nine weeks and three days old when she died and we all miss her every day. It's so hard."Leona died of sudden infant death syndrome after she was put down for a nap.When dad Daniel went to check on her minutes later, he realised she wasn't breathing and called for Celine, who has paediatric first-aid training because of her job caring for babies and toddlers.Breaking down, Celine wept, "I tried everything but I knew she was dead. I was hysterical, we all were. The awful thing was Eloise saw it all. We had to have a post mortem and the coroner said Leona had just stopped breathing. "It wasn't that she couldn't breathe – her head was to the side. She just suddenly stopped breathing for no reason and we all kept asking why. But no one knows."It wasn't because she was on her tummy. Her head was turned to the side, but she would only ever settle on her tummy. All my children are like that. "They won't sleep on their backs, even though I know babies are supposed to. Even when we put her on her back, Leona would roll over."To cope with her grief, Celine rang the Foundation into the study of Infant Death Syndrome helpline. "They just let me talk and sob and really helped," she said. "That's why I want to raise as much money as I can for them, so they can help other people going through the same terrible thing."Leona's godmother Lara Carpenter – Celine's best friend – organised the sponsored walk while the family struggled to come to terms with their baby's death which happened in May."We had to get through the funeral, which was awful but Eloise's third birthday in July was the worst," Celine said. "She just kept asking where her baby sister was. She keeps getting confused. I've told her she's a star in the sky, but Eloise just keeps saying, "I want 'Ona." It's heartbreaking. We've all been affected. Daniel feels terribly guilty but it wasn't his fault. It could have happened anytime, anywhere."Devastated Celine has already been sponsored for more than £500 but is trying to raise as much as she can. "I want to help find out more about cot death to stop it happening to another family. "I spend every day down at Leona's grave, talking to her and telling her about her brother and sister. I can't ever imagine this terrible pain going away. "I've been asked if I'll have another child but I can't risk this happening again. I couldn't survive it and no one could ever replace Leona. She really was perfect."

SIDS: Jerusalem

Liel Kyzer
A 6-month-old baby died in Jerusalem on Monday, and police suspect her mentally disabled parents may have caused her death through neglect.
Another possibility is this is a case of sudden infant death syndrome (SIDS ) or crib death, which happens regardless of parents' conduct.
Police intend to seek a court-ordered autopsy to ascertain the cause of the baby's death. The parents were released on bail on Monday and forbidden to see their other six children for five days.
The baby's mother called the Magen David Adom emergency services at about 11 A.M. Monday and reportedly said the baby "doesn't look good to me." The medic on the phone understood from her that the child was unconscious and guided the mother on the phone on how to resuscitate the baby.
When the paramedics arrived at the apartment in Jerusalem's Katamon neighborhood, the infant was dead. Preliminary examination indicated she had been dead for hours.
Police suspect the child fell ill several days ago, and the parents, who have six other children, failed to give her adequate medical care.
Police investigators said the parents' apartment was dirty and run down, and that the children looked unkempt and uncared for. They asked how the city's social services could allow the family to deteriorate to such a state.
"We called social services only last week and nobody cared," a neighbor said. "The house was stinking, the children were neglected," she said.
The city's social services said social workers visited the parents three times a week to guide them on child care and parenting. "There was no indication justifying taking the children away from them," said the director of the city's social services, Bonnie Goldberg

SBS: Trudy Munoz appeal to Obama

March 19, 2010
Mr. Barack ObamaPresident of United States of AmericaThe White House1600 Pennsylvania Avenue NWWashington, D. C. 20500
Dear Mr. President:First of all, I would like to express to you my deepest respect and admiration for what you represent to millions of Americans and people all over the world, for your brilliant political ascension and for your incredible determination to reach your goals. Your presidency has broken through prejudicial dogmas and is forging a new era in American democracy.My name is Hernani Ames and I am an immigrant of Peruvian descent who came to the U.S. in 2001 with my wife Trudy Muñoz and daughter Renata, who was then only five years old. Then, in 2003, our second daughter Jimena was born, and we settled in the city of Alexandria, in Fairfax County, Virginia, where we have been living continuously to this day, paying our taxes and working honestly in order to achieve our “American Dream”.And so it was that in 2004 my wife Trudy set up a daycare center to take care of children, complying with all the permits, inspections and courses required by Fairfax County, ensuring that the nursery was equipped with everything necessary so that the infants´ stay would be safe, calm and enjoyable. With a lot of effort, dedication and professionalism, she gave her love to every child who came to the house, always offering much more than just “a place to pass the time”, taking care of their nutrition, teaching them a new language and motivating them in their development.On April 20, 2009, there was a tragic incident with Noah Whitmer, one of the children under her care, who went limp and stopped breathing while she was feeding him a bottle. Trudy realized this and immediately began performing first aid according to the procedures she had learned in the courses dealing with this type of emergency situation. Trudy responded with professionalism and diligence when faced with such a delicate situation and immediately called 911.Trudy managed to revive the infant and saved his life, after which the paramedics arrived, stabilized the boy and transported him to the hospital.A few minutes later, the police arrived to investigate the situation. They remained in our home for about 5 hours, while they took notes and photographs of the entire house.For an hour and a half they questioned Trudy about what had occurred, and she – far from refusing to cooperate – agreed to be interviewed and answered each of their questions time and time again trying to explain in detail what had occurred, thinking that all this information would be vitally important for the child´s immediate medical treatment.As the police were leaving, they told us that the next day there would be investigators from Fairfax County Child Protective Services coming to the house to investigate the events; when they came, Trudy welcomed them in and agreed to a second interview. They identified themselves as a detective from the Fairfax police department and a social worker from the office of Child Protective Services of Fairfax County.During the interview, the social worker also served as the interpreter. Trudy once again went over the events that occurred, but during the four hours that this interview lasted, both interviewers insisted over and over again that Trudy should “tell the truth” because “the child´s condition is getting worse with every minute that goes by”. The interview became very tense and finally the interviewers concluded that Trudy “had confessed”, and accused her of physically abusing a child through the so-called Shaken Baby Syndrome – SBS. Trudy was placed under arrest and denied bail since, according to the Judge, “the crime that she is being accused of is very serious (a Felony) and there is a risk that the accused may not appear for future court dates”. She remained incarcerated for seven months until finally, thanks to the work done by her lawyers and with the help and support of the Peruvian Consulate which assured the court that she would not be provided with any identification documents, she was set free on bail.During the trial that was held from the 11th until the 21st of January of this year, the jury found her guilty and recommended a sentence of 10.5 years in prison; immediately thereafter, she was taking into custody and is currently held in Fairfax County Adult Detention Center. The sentencing hearing is scheduled for the 9th of April, of this year, with Judge Dr. Jane Brodie.We used to have faith in the impartiality of U.S. justice system, and that Trudy´s innocence would be acknowledged, but apparently we were wrong. During the entire process, the prosecutor was not able to present one single piece of evidence that clearly incriminates Trudy. Quite the contrary, the defense presented medical evidence which shows that the child had been afflicted with medical problems since birth, and that it would have been impossible for the injuries found on him to have been caused by physical abuse.During the course of this trial, the medical experts testifying for the prosecution were not able to present any conclusive evidence that the child had been shaken.Quite the contrary, the evidence showed that:1. The child had been diligently attended to, since as soon as the child stopped breathing and Trudy performed the appropriate first aid maneuvers, in order to save him from asphyxiation. Court testimony given by Trudy Muñoz.2. That the child did not exhibit one single sign of physical abuse, such as bruises, fractures, head trauma, or muscle tears. Court testimony by the paramedic on the scene, a prosecution witness.3. That in order to generate injuries associated with “the shaken baby syndrome”, one would need to generate a minimum force of 50 g and a maximum force of 500 g – according to the testimony in court of the President of the National Shaken Baby Syndrome, Dr. Craig A. Futterman, a witness for the prosecution. (That is 50 gravitational forces)4. A healthy adult woman is capable of generating a maximum force of 8 gs, while a healthy adult man can generate a maximum force of 20 gs – according to the court testimony of the Biomechanical Engineer, Mr. Kirk Thibauld, a witness for the defense.5. That, the physical examination performed on the child immediately after the events took place revealed a prior bleed at the base of the skull, which is not the result of blunt trauma or abuse, but rather occurred during the birth process as the baby´s head emerges through the mother´s vaginal canal and it is compressed – according to the testimony in court of Dr. Ronald Uscinski, a Pediatric Neurosurgeon, witness for the defense.6. That, as a result of the continuous accumulation of blood at the base of the skull, there is an increased pressure generated from the inside out, and thus the baby´s skull exhibits an abnormal growth (that is, the baby´s head had undergone accelerated growth) – according to the court testimony of the Ophthalmologist, Dr. Horace Gardner, a defense witness.7. That Trudy never admitted guilt during the course of the interrogation. What she did instead was to explain the way in which she had interacted with the baby both before and after the incident. Furthermore, she had never refused to be questioned; she answered all their questions in the hope that any information which she provided could be useful for the medical care of the infant.To convict Trudy, the Prosecution presented false evidence alleging a confession of guilt. In other words, the prosecution called as its witness Mrs. Joselyn Waldron, the woman who had acted as the interpreter during the second interview, and she testified that Trudy had admitted to shaken the baby. This was a complete fabrication because Trudy never said that she had shaken the baby in the course of her interview with any of the investigators. Mrs. Waldron, nonetheless, had jotted down in her notes that Trudy had admitted to shaken the baby. In contrast to the first interview that Trudy had with the other police investigators, where the entire conversation was recorded, Mrs. Waldron did not record any portion of this second interview with Trudy, and did not even ask Trudy to sign her supposed “confession”.There is also an audio recording which reveals a conspiracy on the part of the Fairfax County Police Department to incriminate Trudy, which was submitted to the court and admitted into evidence, but which obviously was not heard by the Jury during their deliberations.Mr. President, it is clear that intolerance is what prevailed in this trial. The Jury completely discarded all the evidence that actually showed Trudy´s INNOCENCE. Instead, they found her guilty despite the fact that the prosecution was not able to establish her guilt beyond a reasonable doubt. The defense was able to prove Trudy’s innocence at every step of the process.I sincerely believe that the most fundamental legal principle in a criminal trial has been violated in this case: any doubts must be resolved in favor of the defendant.I would like to be able to describe how I feel upon seeing my family torn apart in this way, but I cannot find the right words to describe this pain. I can only say that as a father, I am very sorry for what happened to the baby, and that I wish with all my heart that he recovers fully and is able to have a full and complete life. At the same time, I also wish for this injustice to come to an end because I believe absolutely in the innocence of my wife, as the facts prove her to be, and I yearn with all my soul to be able to provide my daughters with the family they once had.It is for this reason that I turn to you, Mr. President, because it is critical for the Federal Government to intervene through the Department of Justice and review this case. I firmly believe that my wife Trudy was unfairly convicted, and that the only reason her testimony was so thoroughly dismissed is due to the simple fact that she is Latina. Each of the evidence presented by the prosecution was refuted at trial by the medical experts of the defense. Moreover, there is clear evidence of police misconduct from the very beginning of the investigation. Yet my wife was still found guilty. Could it be that being a minority makes us criminals before the eyes of the law? I believe in the Law, and in the equality of justice, and yet I also believe that when our rights have been violated, we must demand that they be restituted.Thanking you in advance for any interest you can give to this matter,
I remain,
Sincerely yours.HERNANI AMES

SBS: Nevada

A man who prosecutors say shook his infant daughter so hard that she suffered massive brain injuries because her cries interrupted his video game has been sentenced to 20 years in prison. During a sentencing hearing Wednesday, Chief Deputy DistrictAttorney Dan Greco said Gerardo Espinosa condemned the girl to a life of misery, unable to see or hear and with limited mobility.District Judge Patrick Flanagan said he would have sentenced the 19-year-old illegal immigrant to life in prison if the law allowed.A jury last month convicted Espinosa of child abuse causing substantial bodily harm. His daughter was 11 weeks old when she was injured. He told investigators the injuries were from an accidental fall.

SBS: Santa Clara County medical examiner is expert on shaken baby cases

By Lisa Fernandez
One morning, there was a knock on Michelle Jorden's door. She ushered in a special delivery: a baby's brain floating in a plastic bucket.
"No," she said. "It wasn't surprising."
Deliveries like that aren't that unusual for Dr. Jorden. As one of Santa Clara County's three medical examiners, she's the only one on the team who is board certified as a neuropathologist, an elite type of doctor who specialize in autopsies of brains.
Colleagues say that in the nearly two years she's been at the office, she's become the go-to woman on almost all the shaken-baby cases, and any death that needs special analysis of the brain. The 38-year-old's opinion on how a person died is crucial in the courtroom.
"She really likes the homicides," said Santa Clara County sheriff's Capt. Pete Rode, who helps manage the coroner's office, which gets about 60 homicides a year. "Law enforcement loves her because she's so thorough. When we can't figure out something that doesn't make sense, she'll come in and say, 'yes' or 'no.' "
In the case of the baby's brain delivered to her doorstep by a Vacaville detective last summer, she quickly determined that the story given -- that 4-month-old Nicholas Kelly was found unresponsive -- didn't add up. After her examination, she saw there had been a traumatic injury to the brain. Today, Angel Sanchez, who was the boyfriend of Nicholas' mother, faces murder charges in Solano County.
"With every case, there's always a story," said Jorden, a slight woman with long blond hair, a Chicago accent and a confident air. "My job is to see whether the story explains the autopsy results. When they don't match up, there's obviously a problem."
Jorden said she found such a problem in May.
She was conducting an autopsy on Anahi Hernandez, an 8-week-old San Jose baby whose 19-year-old father said she rolled off a 17-inch mattress.
Jorden examined Anahi's tiny body. She found head injuries and several broken bones.
Her conclusion, that baby Anahi had suffered weeks of abuse, led San Jose police to arrest father Pablo Rosas Hernandez on charges of murder.
"She doesn't show too much emotion," Rode said. "And this is difficult work to look at, looking at the body to figure out how they died, but she deals with it very well."
Jorden said she stays focused because when she's performing an autopsy, she is that person's doctor; it doesn't matter if that person can't move, speak or breathe.
"You can't go into an autopsy and be emotional," she said. "Then you wouldn't be doing that person justice."
It's not as though Jorden doesn't carry the work home with her, though, or shut off the stories of victims from swimming around in her head at night. Though she has cut into the organs of hundreds, if not thousands, of patients over the course of her career, two deaths stand out for her, and made her eyes well up with tears recently.
In 2007, when she worked in Chicago, where the Cook County coroner's office sees about 500 homicides a year, Jorden conducted the autopsy on two brothers, 12 and 13. They were bound, stabbed and fatally beaten as they tried to protect their sister from being raped.
"It was a horrific crime," Jorden said. "And they died trying to do a heroic act."
But although Jorden is the doctor of the deceased, she also has a keen awareness that her opinion likely will be a prosecutor's tool in putting someone behind bars, sometimes for life.
"I have to be sure," she said.
Has her testimony in court ever been proved false by a defense attorney?
"No," she answered.
Dr. John Ralston, who worked with Jorden in Cook County, said she is among the most "thorough, precise and analytical" medical examiners he's ever known. "She really goes the extra mile to get a complete diagnosis."
Jorden has been sure since she was 15, growing up in the Chicago area, that she's wanted to be a medical examiner after she tried out a high school internship doing rounds with a pathologist.
"I just thought it was the coolest thing," she said.
And she has been unwavering in her path, completing neuro, forensic and surgical pathology fellowships at Stanford University Medical Center and the Cook County Medical Examiner's Office in Chicago. At Stanford, she was also the chief resident of the anatomic and clinical departments in 2004 and 2005. Of nearly 750 members of the National Association of Medical Examiners, only 24 listed that they are certified in neuropathology, according to the organization.
Even though at cocktail parties, she often gets the "Ewwwwww!" factor, Jorden says that nothing about the human body grosses her out, even though the "smell is something you have to get used to."
"I'm fascinated," Jorden said. "Even when I've had to deal with maggots and beetles, I just push them away."
If anything, Jorden said her job delving into death has made her appreciate being able to go home to her daughter.
Outside of work, Jorden said spending time with her family is really the most important thing to her.
"Having this job really makes you appreciate life," she said, "and, really, the fragility of life."
Former Mercury News intern Olga Kuchment contributed to this report.

SBS: Maryland: Father charged with abuse

Aug. 20, 2010
A Mechanicsville man has been charged with child abuse in court papers alleging he told police he grabbed his crying 7-month-old daughter last week and forcibly shook her five times, and her body went limp.
Marcus Corwell Hall, 25, was released from custody Tuesday on personal recognizance by a court commissioner who issued the warrant earlier that day charging Hall with first-degree child abuse resulting in severe physical injury. Hall was ordered to not have any violent contact with the child as a condition of his pretrial release.
St. Mary's detectives reported Wednesday that they were notified last Friday, Aug. 13, that the child had been "critically injured," and that she had been transferred from a local hospital to the Children's National Medical Center in Washington, D.C., "with an unknown life-threatening condition."
The law officers commenced an investigation assisted by social workers.
An emergency-room doctor at St. Mary's Hospital told police that Shauntice Aniya Hall had either been dropped on her head or was a victim of shaken baby syndrome, court papers state, and the law officers asked the father what happened.
"Hall stated the baby fell off of his bed," about four or five feet to the floor, according to a charges application filed by detective Sgt. Jeffery Jones, and the emergency room doctor "agreed that could have been the cause."
On Tuesday, Hall contacted an employee with child protective services, the court papers state, "and stated he wanted to turn himself in."
He was questioned that evening by detectives.
"Hall stated the baby was sitting on the bed [and] would not stop crying," the sergeant wrote in the charges application. "He picked her up and rocked her. She still would not stop crying. Hall then grabbed the baby under her arm pits and forcibly shook her more than five times. She went limp, and Hall started CPR on her."
The baby suffered two small brain bleeds and has been having seizures while still in the care of the Washington, D.C., hospital, according to the court papers filed Tuesday by the detective.


SBS: GEORGIA: Shaken baby trial delayed again

by Lydia Senn
The trial of two Floyd County residents charged with murdering an infant will not proceed as planned this week, a judge decided after a hearing Monday.Attorneys for both Shamekia Shantell Byars, 26, and Mike Reggie Haynes, 30, filed motions to dismiss the case earlier, citing prejudice and violation of due process rights and the right to a speedy trial.At issue was the length of time it took to indict the two defendants. Byars and Haynes were indicted in 2009, charged with the November 2005 death of Byars’ daughter, Sha’niya L. Moses. Haynes was Byars’ live-in boyfriend at the time.The baby died as a result of severe head and brain injures believed to have been caused by physical abuse, according to the indictment. The couple is accused of not only injuring the baby but also delaying medical treatment after the child was injured. Their trial was set to begin Monday, but will be delayed while Floyd County Superior Court Judge Tami Colston considers the defense’s motion.The defense argues that the case was unreasonably delayed, stating the pair’s rights to due process were violated because the case is now more than five years old and it took more than four years for Byars and Haynes to be indicted.However, Assistant District Attorney John Tully said one reason the indictment was delayed was because the DA’s office had to launch its own investigation when they picked up the case nearly a year after the police investigation was completed.Tully also said law enforcement “dropped the ball” during the investigation, and until the autopsy report was issued there was no firm evidence that the baby had been murdered.“This is one of the most complex medical exams,” Tully said.Colston asked prosecutors if they feared another child in the couple’s custody would have been harmed if an indictment had not been pursued, and they said they did.“We are talking about due process. There is no statute of limitation for murder. Every defendant does have a due process right,” Colston said.The judge said she would reach a decision on whether or not to continue with a trial by the end of the week.“Any delay is going to prejudice the defendant. Memories fade,” Colston said.http://romenews-tribune.com/view/full_story/9246723/article-Shaken-baby-trial-delayed-again?instance=home_Most_popular

SBS: Colorado

A baby is clinging to life while the babysitter is behind bars for allegedly nearly killing the baby girl.
Thirty-year-old Nancy Galvan Hernandez is now charged with child abuse. The 4-month-old girl's mother rushed her to Parkview Hospital when she picked her up from the babysitter and saw the injuries.

The baby was unresponsive and had suffered a closed-head injury. The baby was transferred to Memorial Hospital, where she's fighting for her life. Experts think she may the victim of Shaken Baby Syndrome.
Hernandez had been babysitting the child for about a month.


SBS: Maryland, day care provider guilty of second-degree murder

EASTON, Md.- A jury found a former Trappe, Md., day care provider guilty of second-degree murder, child abuse with a death, and second-degree assault in the death of a 9-month-old infant Friday afternoon, the Talbot County State's Attorney's office announced.
Gail Dobson, 53, was charged last October after investigators concluded that 9-month-old Trevor Ulrich died of injuries caused while under her care.
Prosecutors in October charged Dobson with manslaughter, first-degree child abuse resulting in death, two counts each of second-degree child abuse, reckless endangerment, first- and second-degree assault and one count of first-degree child abuse causing severe injury.
Dobson is being held without bond pending sentencing, but no sentencing hearing has been set, the state's attorney's office said Friday.
Trevor Ulrich, of Dorchester County, was pronounced dead at Children's Hospital in Washington, D.C. on Thursday, Sept. 3. Police say autopsy results revealed the child died of inflicted head trauma, which is an injury associated with shaken baby syndrome.
According to police, on Wednesday, Sept. 2, a 911 call was received from Dobson, a licensed day care provider. She requested an ambulance to respond to her Trappe home. Police say Dobson reported that baby Trevor was having trouble breathing.
Shortly after the call, paramedics from the Trappe Volunteer Fire Department arrived to find the child in full cardiac arrest. The child was transported to Easton Memorial Hospital and later flown to Children's Hospital in Washington for further treatment.
At approximately 10 a.m. on Thursday, Sept. 3, state police investigators from the Easton Barracks received a phone call from the Dorchester Department of Social Services regarding a possible child abuse case. The Department of Social Services was notified by personnel from Children's Hospital that the child had died there.
Police began an investigation into the circumstances that led to the baby's death. Police say investigators conducted scores of interviews and learned that Dobson cared for other children besides Trevor. According to investigators, information received revealed Dobson was Ulrich's day care provider for two days.
Police say the results from the investigation and medical evidence revealed that Trevor's injuries were sustained during the days he was in Dobson's custody.
An autopsy by the Office of the Chief Medical Examiner in Washington, D.C. ruled the infant's death a homicide. According to police, the cause of death was inflicted head trauma, which medical evidence reveals as an injury consistently found with shaken baby syndrome.


SBS: Black River Falls: daycare provider has been charged with child abuse

Black River Falls (WQOW) - A daycare provider has been charged with child abuse. Investigators believe a baby's injuries were consistent with shaken baby syndrome.
Tamara Millis from Black River Falls has been charged.
In January, a ten-month-old was taken to the hospital after being in her care. Investigators said Millis told them another child had run into the boy, knocked him over and then landed on top of him. She said the boy hit his head on the floor. Doctors say the child had brain swelling, and that injury came from abusive head trauma, not because of an accident.
The child was released from the hospital after about two weeks. There's no word on how he's doing. Millis will be in court next month.

SBS: Michigan

Aug 20, 2010
A Blackman Township man was arrested Thursday at the University of Michigan C.S. Mott Children's Hospital after police say medical staff determined his 3-month-old son died of injuries consistent with shaken baby syndrome.
The 27-year-old man is charged with felony murder, second-degree murder and first-degree child abuse, said Jon Johnston, the township's deputy director of public safety.
The father's name will be released after he is arraigned today at 12th District Court in Jackson County, Johnston said.
The baby died at 5 p.m. Thursday after being flown to C.S. Mott Children's Hospital from Allegiance Health in Jackson, police said. An autopsy is scheduled for today.
According to Johnston, officers responded to a report by the baby's parents at 12:50 a.m. Thursday that he was in his crib at his Pheasant Run home and not breathing, police said. The arrest came after interviews were conducted with the man, other family members and medical personnel who tended to the baby, Johnston said.
University of Michigan police officers assisted in the arrest, a university police incident log said.
Lee Higgins


SBS: Canada: Halifax man accused of shaking his two-month-old child

Halifax man accused of shaking his two-month-old child appeared in Halifax provincial court yesterday to hear his charges.Michael McNish, 27, was arraigned yesterday on one count of aggravated assault.According to police, an infant boy was brought into the IWK Health Centre in late June by his parents with injuries consistent with shaken baby syndrome. Police say they were called to the hospital by staff in the early morning hours of June 23 regarding the baby’s injuries, which led to an investigation by the Halifax Regional Police/RCMP Major Crime Unit.Two days later, police issued a release saying McNish had been charged.The child is expected to make a full recovery.McNish has been granted bail on several conditions and will appear in court again on Oct. 22 for election and plea.

SBS: Denmark: 32-year-old father lost his appeal

Man convicted of baby shaking
19 August 2010
Case from 2004 finally comes to close as lower court ruling upheld
A 32-year-old father lost his appeal against the three-year and nine-month suspended sentence he received for shaking his baby daughter so violently she suffered permanent brain damage and blindness.
The Western High Court ruling today upheld the original sentence by the Esbjerg lower court in April. Both the defendant and the prosecution appealed the lower court decision, the father maintaining his innocence and the prosecution calling for a stiffer sentence.
Proceedings and preparations for the case were unusually drawn out, as the incident took place in 2004.
The daughter now suffers from what is known as ‘Shaken Baby Syndrome’, which in addition to blindness can result in severe and permanent motor and cognitive injuries.

Man convicted of baby shaking
Thursday, 19 August 2010 14:14 RC News

Case from 2004 finally comes to close as lower court ruling upheld
A 32-year-old father lost his appeal against the three-year and nine-month suspended sentence he received for shaking his baby daughter so violently she suffered permanent brain damage and blindness.
The Western High Court ruling today upheld the original sentence by the Esbjerg lower court in April. Both the defendant and the prosecution appealed the lower court decision, the father maintaining his innocence and the prosecution calling for a stiffer sentence.
Proceedings and preparations for the case were unusually drawn out, as the incident took place in 2004.
The daughter now suffers from what is known as ‘Shaken Baby Syndrome’, which in addition to blindness can result in severe and permanent motor and cognitive injuries.


SBS: Missouri: Charged with felony child abuse

By Jeff Haldiman
August 24, 2010

A Mid-Missouri woman has been charged in connection with what authorities believe to be a case of shaken baby syndrome.According to Cole County court documents, Shelley Richter, 40, of 6018 Helias Drive at Taos, is charged with felony abuse of a child. She was released from custody after posting a $5,000 bond.The charging document in this case shows Richter struck the victim's head and shook it causing retinal hemorrhages and subdural hematoma.A Cole County Sheriff's Department probable cause statement shows the incident occurred last Thursday afternoon.Investigators talked with the parents of the 7-month-old boy who said their son was in the care of Richter and had been dropped on a linoleum-covered concrete floor.They said Richter had been the boy's baby sitter since he was around 10 weeks old.Richter told investigators that while picking up the boy from a walker where she stated he was being "good," Richter said she took a step backward, tripped over a toddler that she had not seen behind her.Richter went on to say that she started to fall backward toward the ground and as she was falling, she must have let go of the boy, causing him to fall to the ground. Richter also said she picked the boy up almost immediately and the boy went limp. She then put him down on the floor and called 911.On Friday, doctors at University of Missouri Hospital in Columbia, where the boy was taken for treatment, diagnosed the boy with having an old subdural hematoma and a new one, along with severe retinal hemorrhages. The doctors also said it appeared the boy was suffering from shaken baby syndrome.

SIDS: How to choose your baby’s bedding

August 25th, 2010
Having a baby is the most wonderful experience a woman can have as it is a fulfillment of the biological function of the female species. After the giving birth process, the real work begins. Feeding bottles, diaper changes, immunization records are just a few of the things the new mom have to learn quickly.
And one important point to consider inside the arrival from the baby may be the kind of baby bedding he or she will use. According to Dr. Mark Brandenburg, the number one rule to stick to in selecting the proper baby bedding for your precious infant is basic safety. The second rule says safety and also the third rule emphasizes security. We are to conclude that it is not adequate to say it, it has to be emphasized that child bedding is critical for the comfort of the infant.
In his article on the best way to find the best baby bedding, it should be neither too hard nor as well soft. Within the past, sudden infant death syndrome or SIDS was attributed to very soft child bedding. This happened when the baby’s mattress is as well soft that his nose and mouth gets covered and also the air he exhales could be the air he breathes. This is harmful for him because he would breath carbon dioxide rather than oxygen and the effects could lead to drowsiness, coma or even death.
You can find a lot of styles and makes in selecting the baby’s bed. And with that, it follows how the child bedding should be a perfect fit with the chosen gear. The three main selections are: a bassinet, a crib or a cradle. What differentiates one from the other? A bassinet is an oblong-shaped basket that serves as a bed for an infant. But sometimes, round bassinets are also obtainable. A crib is really a bed which is flanked with higher side bars to get a baby or young child’s security. Cribs are normally more economical since the baby can use it from infancy to two years. Although a cradle is a tiny low bed that an infant uses that has rockers on its stand. In all these, the material used to make the gear must alert and signal to the mom how much safety precautions are necessary.
Bassinets are normally lacey and full of trimmings. The infant bedding should fit the bassinet so that the baby’s space is sufficient for him or her to become capable to roll from side to side. The crib is usually square, thus, mattresses could be fitted to the size with the crib. The baby bedding generally is a set of coverlet and small pillows. Hotdog pillows can also be placed within. However, the pillows should not be much more than two or three lest the infant can stand on them and could fall over. The cradle can come in numerous sizes and shapes. Some moms choose cradles to ensure that when the infant is cranky, he or she may be rocked being calmed down. The baby bedding for a cradle ought to stick to the shape of it. Not a lot may be placed within it given that it’s utilized mainly to rock the baby to sleep. Nevertheless, one require not the 3 to keep the child safe, warm and secure. One will do and this would depend on the parent’s preference. One of the most preferred would be the crib because it can be utilized for a lengthy time.
Now that we’ve covered the simple equipment, how do we furnish it with baby bedding? We have already established how the baby bedding should fit the sleeping gear to steer clear of accidents and other untoward incidents. One of the most suitable material to use is cotton as it’s absorbent and cool to the baby’s skin. Various designs has to be utilized to stimulate the baby’s color and pattern recognition. As a result, the baby bedding is a crucial factor in keeping the infant happy and wholesome.
Another common thing during pregnancy is parents becoming concerned about their unborn baby. Its definately natural for parents to be worried during the pregnancy and new developments in baby heart monitor have enabled parents to listen to their baby’s heart beat whenever they like. These new products are available all over the place and give parents reassurance. Every new family should have a baby heartbeat monitor during pregnancy nowadays.

SIDS: Decline In Sudden Infant Death Syndrome Contributed To Overall Decline In Infant Mortality In New Jersey

The rate of Sudden Infant Death Syndrome (SIDS), a leading cause of infant mortality, declined in New Jersey by 45 percent between 2000 and 2006, the most recent year for which final SIDS data are available, report Barbara M. Ostfeld, PhD, and Thomas Hegyi, MD, professors in the Department of Pediatrics at UMDNJ-Robert Wood Johnson Medical School and program director and medical director, respectively, for the Sudden Infant Death Syndrome (SIDS) Center of New Jersey. According to Dr. Hegyi, this decline has contributed to the 17 percent reduction in overall infant mortality in New Jersey between 2000 and 2007 that is described in 2010 KIDS COUNT, the newly issued report of the Annie E. Casey Foundation. The report also notes that the decline in New Jersey's overall infant mortality far exceeds the national trend of a 3 percent decline, placing New Jersey's rate fifth lowest among 50 states. According to Drs. Ostfeld and Hegyi, New Jersey's SIDS rate also falls below the national rate."In 2006, the rate for SIDS in New Jersey fell to 0.3 per thousand live births, the equivalent of three such deaths per 10,000 live births," said Dr. Ostfeld. "By contrast, in 2000, five infants in every 10,000 live births succumbed to SIDS, and a decade earlier, eight per 10,000 live births did so.""Preliminary data from the Center for Health Statistics of the New Jersey Department of Health and Senior Services suggests that the lower rate of SIDS deaths in 2006 was also observed in the period 2007 and 2008," explained Dr. Hegyi, who also serves as vice chair of the Department of Pediatrics.SIDS is defined as the sudden and unexpected death of an infant before the first birthday that remains unexplained even after a complete evaluation consisting of an autopsy, a death scene investigation and a review of the medical history. Many studies now suggest that one of the potential causes of such an unexplained death may turn out to be an abnormality in the brainstem that diminishes an infant's capacity to arouse and respond to breathing challenges such as those posed by sleeping prone (on the stomach) on soft bedding. Other risk factors for SIDS, such as exposure to tobacco smoke or overheating, can further compromise arousal."A comprehensive education program provided by healthcare professionals throughout the state that follows guidelines established by the American Academy of Pediatrics (AAP) has contributed to the improved outcomes for infant mortality in New Jersey," added Dr. Hegyi. "The decline in SIDS has been associated in great part with improved compliance with these recommendations by parents and other caregivers."Referring to the recent study in Pediatrics by Drs. Ostfeld and Hegyi that found that more than that 78 percent of SIDS cases contained multiple concurrent risk factors, Dr. Hegyi commented, "Risk-reduction education of new parents and all other caregivers, such as grandparents and babysitters, should be comprehensive. In addition to education about placing infants 'Back-to-Sleep,' the position associated with the lowest risk, all other recommendations of the AAP should also be described and discussed."The risk reduction education provided by the SIDS Center of New Jersey is all-inclusive, addressing all the risk factors and safe sleep guidelines described by the AAP including those related to prone sleep, sharing sleep surfaces with a sleeping adult, smoke exposure, presence of pillows, and other soft and loose bedding, and overheating. The SIDS Center of New Jersey promotes knowledge and compliance through the education of health and social service providers for infants and families, including providers in hospitals, child care centers, offices of the Division of Youth and Family Services, and health clinics, as well as with families directly."Until the biological causes for SIDS are fully defined and lead to the identification and treatment of living infants who may be vulnerable, the risk-reducing guidelines recommended by the American Academy of Pediatrics are considered by both researchers and healthcare providers to be the most effective interventions to date," says Dr. Ostfeld.

SIDS: Sleep Disorders In Children

Sleep Disorders In Children Often Differ To Those Of Adults.
Sleep disorders in children are more common than is realized by most people, in fact around 42% of children in the US suffer from sleep disorders in one form or another. For instance sleep apnea is recognized as a common disorder amongst children of all age groups, with the most affected being the 3 to 6 years old. Figures show that in the US there are between 1.4 to 2 million children who suffer from sleep apnea alone.
Some different sleep disorders in children, including sleepwalking and bruxism:
* One common sleep disorder in children is sleepwalking also known as somnambulism, this is generally harmless if special care is taken to provide a safe sleeping environment. Sleeping children can some times be heard talking in their sleep or sleep with their eyes open, and strange as these disorders seem, will not harm the child most of the time.
* Sleep disorders in children may also take the form of Bruxism which is a destructive habit of grinding and gnashing the teeth while they are asleep, this can be a very disturbing disorder that can also cause dental problems. Children also often bang their heads or roll their heads, this usually happens when they are about to fall asleep. Again this is another sleep disorder that is usually harmless and they will soon outgrow it, before becoming teenagers.
* Other sleep disorders in children include nocturnal asthma and nocturnal seizures that are often very scary and stressful for everyone, including the child and parents, and needs medical treatment to get it under control. Also, sleep apnea can attack children, including premature newborns and also, the elderly.
* Yet another problem is heartburn which can be dangerous and although not seen as a sleep disorder can often run along side some of the common sleep disorders in children. The danger arises in the sleeping children when stomach acids regurgitates into the throat, whilst this can be due to an underlying medical problem it can also be eating food to close to bed time.
RLS, also known as restless leg syndrome is also a disorder that children can suffer from which is very stressful and irritating, this ailment can help to bring on nightmares, sleepwalking and insomnia.
A few of the sleep problems mentioned above can cause or lead to ALTE which is another name for Apparent Life Threatening Event, which is where a child looks lifeless, limp and pale in color. With this particular sleep problem it will be quite hard to wake the child and once awake they may be very listless, this is not a very nice experience for all involved.
However, the most scary and probably the least understood of the sleep disorders in children is SIDS or Sudden Infant Death Syndrome, unfortunately there aren’t many if any treatments available for this disorder.


SIDS: Central Sleep Apnoea

Central sleep apnea (CSA) occurs when the brain does not send the signal to breathe to the muscles of breathing. This usually occurs in infants or in adults with heart disease, cerebrovascular disease, or congenital diseases, but it also can be caused by some medications and high altitudes.
Central sleep apnea may occur in premature infants (born before 37 weeks of gestation) or in full term infants. It is defined as apneas lasting more than 20 seconds, usually with a change in the heart rate, a reduction in blood oxygen, or hypotonia (general relaxation of the body’s muscles). These children often will require an apnea monitor that sounds an alarm when apneas occur. Central sleep apnea in children is not the same thing as sudden infant death syndrome (SIDS).
Under normal circumstances, the brain monitors several things to determine how often to breathe. If it senses a lack of oxygen or an excess of carbon dioxide in the blood it will speed up breathing. The increase in breathing increases the oxygen and decreases the carbon dioxide in blood. Some people with heart or lung disease have an increase in carbon dioxide in their blood at all times.
When there is a chronic (long term) increase in blood carbon dioxide, the brain starts to ignore the oxygen level and monitors the blood carbon dioxide level to determine when to take the next breath. The control of breathing also becomes slower to respond to changes in carbon dioxide levels; so when a person takes more or deeper breaths and “blows off” carbon dioxide the drive to breathe decreases and the rate of breathing decreases. As a result of slower rate of breathing, the carbon dioxide builds back up in the blood and the rate of breathing increases again. The brain, slow to adjust, continues to signal for more rapid breathing until the carbon dioxide level drops too low. Breathing then slows down or stops until the carbon dioxide level rises again. This pattern of abnormal breathing is called Cheyne-Stokes breathing (after the men who described it). It is characterized by repetitive cycles of fast breathing followed by slow breathing and apnea. This breathing pattern happens when the person is awake or asleep, but becomes more of a problem when asleep. Some patients with heart failure have central sleep apnea associated with a Cheyne-Stokes pattern of breathing.
Central sleep apnea usually occurs in adults with other medical problems. In infants, it usually occurs with prematurity or other congenital disorders. In both patient groups it is usually suspected by the primary care doctor. Central sleep apnea can be diagnosed with a sleep study or overnight monitoring while the patient is in the hospital.
In infants, central sleep apnea is treated with an apnea alarm. This alarm monitors the infant’s breathing with sensors and sounds a loud noise when the infant experiences an apnea. The alarm usually wakes the infant and the parents. Most infants usually “out-grow” the central apnea episodes, so the alarm monitoring is stopped after the episodes resolve. In infants with other congenital problems, apnea monitoring may be needed for a longer period.
In adults with central sleep apnea, the apneas are treated by treating the underlying heart disease, medication interaction, high altitude, or other primary problem.