SBS: Glynn Johnson found not guilty of injuring baby whose brain bled

​A young father from Keyham has been found not guilty of shaking his 10-week-old son causing bleeding to his brain.

Glynn Johnson sat silent and calm as the jury of eight men and four women returned the verdict to the court.
The jury took less than an hour to return the verdict at Plymouth Crown Court yesterday. Thursday
The 21-year-old was accused of inflicting grievous bodily harm on Alfie, leaving him with four bleeds in the membrane around the brain.
On Wednesday he told the court he ‘violently’ shook his son to ‘jolt’ him after the baby collapsed and vomited.
Johnson denied the charge, and also the lesser charge of actual bodily harm offered to a jury as an alternative verdict at Plymouth Crown Court on Wednesday.
On Wednesday the court heard that Alfie was admitted to Derriford Hospital in July 2008. Johnson allegedly found Alfie collapsed in his baby bouncer and had shaken the child to revive him.
Johnson told the court that on the afternoon in question, Alfie had started to ‘whinge’.
Johnson, of Royal Navy Avenue, had picked Alfie up; the baby projectile-vomited and went limp. Johnson said he panicked and shook Alfie before going to the kitchen, collapsing to his knees and then spotting the neighbours who came to help.
The court heard from doctors that Alfie had suffered subdural collections of blood.
During a court hearing on Tuesday Dr Neil Stoodley, a consultant neuroradiologist who studied CT and MRI scans of Alfie, told the court he believed the child’s damages were ‘non-accidental injuries caused by shaking’.
The defendant, the court heard, was in a relationship with Stacey Neville for six weeks when she found she was she pregnant.
When Alfie was born the couple were no longer together but Johnson was keen to be involved as a father.
The trial lasted four days.
http://www.thisisplymouth.co.uk/news/Youg-father-guilty-injuring-shaken-baby/article-2915472-detail/article.html

SBS: Josiah Taylor, New York

STATEN ISLAND (WABC) -- A two-year-old Staten Island boy died on Tuesday after police found him unconscious at his family's home.

Josiah Taylor was discovered unconscious and unresponsive inside the home on Mosel Avenue just before 1:00 p.m.
He was rushed to Staten Island University Hospital North, where he was pronounced dead.

The medical examiner's office has ruled the death a homicide. The boy suffered from battered child syndrome. He had injuries in various stages of healing, which the medical examiner said took place over a period of time.

Detectives are questioning the boy's mother and father. No charges have been filed yet against his parents.
The 18-year-old mother told detectives that the boy was already unresponsive when she shook him. She then made statements that may implicate the father, police said.
http://abclocal.go.com/wabc/story?section=news/local/new_york&id=7807730

SBS: Tiffani Calise; Ohio; Autopsy rules toddler's death a homicide

By Ed Meyer
Beacon Journal staff writer
POSTED: 08:36 p.m. EST, Nov 18, 2010
Defense lawyers for a 20-year-old babysitter charged with murder in the death of a toddler during a sleepover at her Green apartment this summer plan to challenge law enforcement findings that it allegedly was a case of shaken baby syndrome.
Tiffani D. Calise, who is being held in the Summit County Jail in lieu of a $500,000, 10-percent cash bond, appeared Thursday before Common Pleas Judge Alison McCarty with a defense team now in place.
William T. Whitaker, an Akron attorney with previous experience in suchcases, informed McCarty that he will be assisting Calise's court-appointed counsel, Donald R. Hicks, and will do so on a pro-bono basis.
Attorneys from both sides agreed on a Jan. 12 trial date in McCarty's court.
In other developments, the cause of the Aug. 12 death of 23-month-old Aaliyah Nevaeh Ali has been reported by the Summit County Medical Examiner's Office as ''complications of blunt impact(s) to the head.''
The ruling on manner of death was ''homicide: assaulted by another person(s).''
Deputy Medical Examiner Dorothy E. Dean, who performed the autopsy, wrote in the ''Opinion'' section of the autopsy report that Aaliyah died ''from the severe injuries to her brain that she sustained during the assault.''
Dean stated that the agency's opinion was based on the ''findings at autopsy'' and ''investigative information,'' apparently from law enforcement officers and medical staff at Akron Children's Hospital where the child was taken by an emergency squad and admitted in the early hours of Aug. 10.
A list of injuries found by Dean during the autopsy included: internal pressure on the brain; bleeding in the area between the brain and skull; optic nerve and retinal bleeding; bleeding of the right-sided gel in the eye; and damage to central nervous system cells from reduced oxygen supply to the brain.
Full skeletal X-rays performed at Children's Hospital showed no fractures, according to the autopsy report.
Calise, who is six months pregnant, was with Aaliyah and her own daughter on the night of Aug. 9 inside her Mayfair Road apartment.
At some point, Calise gave the child a bath. She told sheriff's deputies and family members that she left Aaliyah alone momentarily in a nearly empty bathtub to retrieve a towel.
When she was away, Calise said she heard a thud and returned to find the child unconscious.
Minutes after Calise called 911, according to the autopsy's ''Report of Investigation,'' paramedics arrived at the apartment at 11:52 p.m.
'''Aaliyah was found face up on the living room floor with a small amount of vomit on the floor next to her,'' the medical examiner's investigator, Michael McGill, reported.
His report stated that the child was undressed and her hair was wet.
McCarty has approved fees for the defense to hire an independent forensic expert, as yet unnamed, to examine and evaluate the autopsy findings.
''This is a case in which medical testimony is going to be rather crucial,'' McCarty told attorneys from both sides during Calise's court appearance.
Summit County Assistant Prosecutor Gregory Peacock, who is handling the government's case against Calise, told the judge that the prosecution's witnesses will include the deputy medical examiner, Dean; Children's emergency room physicians; and Dr. R. Daryl Steiner, who heads the Children's Hospital child abuse center.
Calise's lawyers and family members, who were present in court for the hearing, declined to comment on details of the case.

---

Ed Meyer can be reached at 330-996-3784 or emeyer@thebeaconjournal.com.

An autopsy finds Aaliyah Nevaeh Ali (above left ) died as a result of homicide. Tiffani Calise is charged with murder.

Defense lawyers for a 20-year-old babysitter charged with murder in the death of a toddler during a sleepover at her Green apartment this summer plan to challenge law enforcement findings that it allegedly was a case of shaken baby syndrome.

Tiffani D. Calise, who is being held in the Summit County Jail in lieu of a $500,000, 10-percent cash bond, appeared Thursday before Common Pleas Judge Alison McCarty with a defense team now in place.

William T. Whitaker, an Akron attorney with previous experience in suchcases, informed McCarty that he will be assisting Calise's court-appointed counsel, Donald R. Hicks, and will do so on a pro-bono basis.

Attorneys from both sides agreed on a Jan. 12 trial date in McCarty's court.

In other developments, the cause of the Aug. 12 death of 23-month-old Aaliyah Nevaeh Ali has been reported by the Summit County Medical Examiner's Office as ''complications of blunt impact(s) to the head.''

The ruling on manner of death was ''homicide: assaulted by another person(s).''

Deputy Medical Examiner Dorothy E. Dean, who performed the autopsy, wrote in the ''Opinion'' section of the autopsy report that Aaliyah died ''from the severe injuries to her brain that she sustained during the assault.''

Dean stated that the agency's opinion was based on the ''findings at autopsy'' and ''investigative information,'' apparently from law enforcement officers and medical staff at Akron Children's Hospital where the child was taken by an emergency squad and admitted in the early hours of Aug. 10.

A list of injuries found by Dean during the autopsy included: internal pressure on the brain; bleeding in the area between the brain and skull; optic nerve and retinal bleeding; bleeding of the right-sided gel in the eye; and damage to central nervous system cells from reduced oxygen supply to the brain.

Full skeletal X-rays performed at Children's Hospital showed no fractures, according to the autopsy report.

Calise, who is six months pregnant, was with Aaliyah and her own daughter on the night of Aug. 9 inside her Mayfair Road apartment.

At some point, Calise gave the child a bath. She told sheriff's deputies and family members that she left Aaliyah alone momentarily in a nearly empty bathtub to retrieve a towel.

When she was away, Calise said she heard a thud and returned to find the child unconscious.

Minutes after Calise called 911, according to the autopsy's ''Report of Investigation,'' paramedics arrived at the apartment at 11:52 p.m.

'''Aaliyah was found face up on the living room floor with a small amount of vomit on the floor next to her,'' the medical examiner's investigator, Michael McGill, reported.

His report stated that the child was undressed and her hair was wet.

McCarty has approved fees for the defense to hire an independent forensic expert, as yet unnamed, to examine and evaluate the autopsy findings.

''This is a case in which medical testimony is going to be rather crucial,'' McCarty told attorneys from both sides during Calise's court appearance.

Summit County Assistant Prosecutor Gregory Peacock, who is handling the government's case against Calise, told the judge that the prosecution's witnesses will include the deputy medical examiner, Dean; Children's emergency room physicians; and Dr. R. Daryl Steiner, who heads the Children's Hospital child abuse center.

Calise's lawyers and family members, who were present in court for the hearing, declined to comment on details of the case.

http://www.ohio.com/news/top_stories/109074884.html

SBS: Ole Bakken; Washington

By Brad Wood

A Remarkable Thanksgiving Story

Monday, November 22 2010

When he came into the world six years ago, Ole Bakken, as he is now named, was a normal 8-pound-10-ounce boy. A healthy baby born to young parents; a life filled with promise. But by best estimates, Ole’s perfect, promise-filled world lasted a mere three weeks. That’s when his parents noticed his body had stiffened and his head had locked into a thrown-back position. They took him to the small hospital in rural Washington, but any signs of trouble were gone by the time a doctor examined him. A mystery ailment, or so it seemed. Then, Ole started having seizures. This time, doctors at that same small hospital recognized immediately what was wrong, and with heavy hearts, sent Ole to Seattle Children’s Hospital. Doctors there confirmed the diagnosis: bilateral hemorrhaging of the brain and bilateral retinal hemorrhaging. In terms we know: shaken baby syndrome. Blind at 2 months old, Ole also had a broken leg, a left arm he could not use, and eight broken ribs in the process of healing. Doctors think Ole’s ribs were broken before that first inconclusive doctor visit. Ole’s family denied any abuse. No one was prosecuted. Broken, and battered, 2-month-old Ole endured two surgeries over the next weeks. One of the procedures placed a shunt in his head to allow blood to drain into his stomach; a new permanency in a life not yet lived. Calling All Angels For Ole, the hope of normal was all but gone. His potentially bright future was now dimmed by the clouds of severe and seemingly insurmountable injuries. Doctors were unsure if he would even survive. The only certainty: Ole couldn’t return to his parents. A judge’s ruling ensured that. The battered baby needed a new home. He also needed an angel. And as luck would have it, he didn’t get one—he got two. A week before Ole’s release from the hospital, Collette Bakken’s phone rang. A little boy needed big help. Collette, a labor and delivery nurse, was one of the first people to meet Ole when she tended to him in the hospital nursery. “I wasn’t surprised when I got the call,” she said. “We all knew what had happened to him.” Collette and her husband, Lyle, were used to taking care of kids in need. Collette, as a nurse. Lyle, as security officer with the Washington State Detention Department, handling juvenile delinquents. They were veteran foster parents who had cared for more than 50 kids. And, between the two of them, they had nine children of their own. Three months into an already hard life, Ole’s fate had turned to fortune. Lyle and Collette took Ole in, knowing the overwhelming challenges they were likely to face, and understanding those challenges could be short-lived. “We were told he may not survive,” Lyle said. If Ole managed to survive, odds were overwhelming that challenges would be enormous. “We were told he would probably be profoundly retarded and that he would not speak or walk due to brain atrophy,” Collette said. But nothing could stand in the way of their fostering the little boy with so much need. A Miracle Begins From the very moment they met Ole, that second time, Collette and Lyle cared for him as if he were one of their own. Collette kept Ole moving—exercising his arms and legs and manipulating his fingers. Ole offered little, if any, feedback. But Collette believed the movement and stimulation could help rewire his synapses. With steadfast love and determination, Ole’s angels were working to rebuild him from the outside in. With little to encourage them, they worked and prayed unwaveringly, month after month. Then, in one defining moment, their prayers were answered. Ole suddenly, miraculously, rolled over. “From then, we were on our way,” said Collette. Ole then underwent speech therapy, physical therapy and overcame a swallowing disorder. more follows in this remarkable story

http://www.ioanthem.com/index.php?option=com_content&task=view&id=812&Itemid=1

SBS: Tylar Hokanson; Minnesota

Associated Press

November 23, 2010

HASTINGS, Minn.

Jurors in southeastern Minnesota are deciding whether a 24-year-old man caused the injuries that led to the death of his young stepson.
Tylar Hokanson has pleaded not guilty to accusations he repeatedly shook the 17-month-old boy, then refused to get him medical treatment. A 12-member jury in Dakota County District Court began deliberating the case Monday.
Prosecutors allege Hokanson shook his stepson in June 2009, causing bleeding in his brain, a broken back, blunt force trauma and other injuries. Nicholas Miller died several days later at a relative's house in Pierce County, Wis.
The St. Paul Pioneer Press reports defense attorney Lauri Traub says the prosecution didn't prove that Hokanson's actions caused the child's death.
http://www.chicagotribune.com/news/chi-ap-mn-shakentoddler,0,2344546.story

SBS: Diane Honaker; Omaha

A tearful Diane Honaker sits in the Sarpy County Jail courtroom this morning after just learning her bond on child abuse charges wouldn't be reduced.
It still sits at ten percent of $75,000.
She was arrested Saturday at her in-home daycare.

"She was interviewed and based upon the results of the investigation she was arrested Saturday for child abuse intention which is a felony."

Captain Dan Williamson with the Sarpy County Sheriff's Department says the child's parents took her to the doctor Friday.

"That's when it was determined the child had some blood on the brain and blood on the eyes which is indicative of shaken baby syndrome," said Williamson.

While the Sarpy County Sheriff's office might be convinced this is a case of shaken baby syndrome, at least one of Honaker's friends says that simply isn't the case.

The friend didn't want to appear on camera, but told Honaker's side of the story outside the Sarpy County Jail today.

"There's a lot of facts on this case that have not been told. The media has been told one side of the story," said the friend.

She added, "There are medical conditions (referring to the child) that have not been brought to the media's attention. Accusations have been made and investigation has been poor."

"There's always two sides to every story. And Miss Honaker's version of what's going on has not been out there yet because we haven't had the opportunity to sit down and do an extensive interview," said Honaker's defense attorney Chris Lathrop.

Lathrop said he hadn't had a chance to look at the case but authorities are jumping to conclusions with the shaken baby charge.

"To say it's shaken baby syndrome at this point is absolutely speculative and there's plenty of experts out there who would testify to that."

Honaker's friend also says Honaker wanted to call 911 and have the baby taken to the hospital right away but the parents didn't do that.

http://www.kptm.com/Global/story.asp?S=13531944

AHT: cephalhaematoma, misdiagnosis

A TEN-day-old baby was put in care and his young mother arrested when a bump on his head was misdiagnosed as child abuse, it was reported today.
Dee Crawford, 19, was told to take her newborn Michael back to hospital after she noticed a swelling, which she believed might have happened when he fell against scales at her home in Chester-le-Street, County Durham.
A doctor at the University Hospital of North Durham examined the baby and reported the injury as new, leading to the police and social services being informed.
Ms Crawford was arrested on suspicion of assault and questioned by police before being released on bail.
Meanwhile, Michael was taken away and placed in care, as his mother collapsed in tears.
He had been born by caesarean section just ten days previously on January 19, weighing 9lb 8oz.
Police allowed Ms Crawford to read the doctor's report and, when she was allowed home, she used the internet to research what was claimed against her.
She challenged the doctor's assertion that Michael's swelling could not be a cephalohematoma - regularly caused during labour - as, according to him, they never occur with caesarean section births.
The authorities sought further expert advice, and a paediatric specialist from the Royal Victoria Infirmary ruled the swelling was undoubtedly the result of the difficult labour.
Michael was returned to his mother after spending two-and-a-half weeks apart.
Ms Crawford said: "What happened to me I wouldnt wish on my worst enemy.
"I have lost time with my baby when I should have been bonding with him, and Ill never get that back."
She admitted the authorities had put Michael on the Child Protection Register before he was born, saying that was due to her depression.
A Durham Police spokesman said: "We can confirm that a 19-year-old woman has been arrested on suspicion of assault on February 4, but no further action has since been taken against her."
A Durham County Council spokeswoman said: "For reasons of confidentiality, it is not appropriate for us to comment on individual cases.
"However, we would never consider removing a child from a family in the context of a suspected injury without first taking expert medical advice."
http://www.thenorthernecho.co.uk/news/4139918.Baby_placed_in_care_after_bump_on_head_misdiagnosed/

SIDS: Griffin, New Jersey, charged with murder

Authorities in southern New Jersey say a man smothered his 4-week-old son with a pillow when the infant would not stop crying, then left him alone when he realized the child wasn’t breathing. ~ Burlington County Prosecutor Robert Bernardi said Sunday that 25-year-old Erik D. Griffin of Burlington City was charged with murder. He was being held in the county jail on $750,000 bail. ~ Bernardi said Griffin put the pillow over his son, Nyir, on Thursday to stop him from crying. Griffin removed the pillow once the infant stopped, but then left the home when he noticed the boy wasn’t breathing. ~ Robin Rieger
http://www.buzzbox.com/news/2010-11-15/death:infant/?clusterId=2446492

SIDS: Bed Sharing Among Black Infants and Sudden Infant Death Syndrome: Interactions With Other Known Risk Factors

Objective
Bed sharing has been associated with sudden infant death syndrome (SIDS) and may contribute to the racial disparity seen in infant mortality. It is unclear how bed sharing interacts with other factors to impact SIDS risk. We aimed to measure the effects of bed sharing on risk of SIDS in blacks and to determine whether the risk is modified by other characteristics of the sleep environment.
Methods
Characteristics of 195 black infants who died of SIDS were compared with matched controls. The moderating influence of known SIDS risk factors on the effect of bed sharing on risk of SIDS was examined using logistic regression.
Results
Almost half (47.4%) of the study population bed shared during the last/reference sleep (58% cases and 37% controls). Bed sharing was associated with 2 times greater risk of SIDS compared with not bed sharing. The deleterious effect of bed sharing was more pronounced with a soft sleep surface, pillow use, maternal smoking, and younger infant age. However, bed sharing was still associated with an increased risk of SIDS, even when the infant was not using a pillow or sleeping on a firm surface. The strongest predictors of SIDS among bed-sharing infants were soft sleep surface, nonuse of a pacifier, and maternal smoking during pregnancy.
Conclusions
Bed sharing is a common practice among black infants. It is associated with a clear and strong increased risk of SIDS, which is even greater when combined with other known risk factors for SIDS. This practice likely contributes to the excess incidence of SIDS among blacks, and culturally competent education methods must be developed to target this high-risk group.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B94TX-51FPWXP-7&_user=10&_coverDate=12%2F31%2F2010&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=163e6d677f1f9da57f4161d4c6b87aeb&searchtype=a

SIDS: Is Shock a key element in the pathology of Sudden Infant Death Syndrome (SIDS)?

In developed countries Sudden Infant Death Syndrome (SIDS) is the most common cause of death for infants between the age of 1 month and 1 year. The etiology of SIDS is likely to be multifactorial, and current paradigms often describe three overlapping elements of risk. Those elements are a critical developmental period, a vulnerable infant and one or more exogenous stressors.

In the “Triple-risk Model”, SIDS infants are described as having an underlying vulnerability in cardio-respiratory control in the central nervous system during a critical period when autonomic control is developing. This vulnerability might affect the response to exogenous stressors, including prone sleep position, hypoxia and increased carbon dioxide.

In the “Common Bacterial Hypothesis” and “Fatal Triangle”, the focus is on the stressors. A combination of common respiratory infections can cause SIDS in an infant during a developmentally vulnerable period. This theory also includes three factors of vulnerability: a genetic predisposition, vulnerable developmental age and infectious stressors. In the “Fatal Triangle” theory, infection, inflammation and genetics each play a role in triggering a SIDS fatality.

From our work in an animal model we have found that rat pups die from a combination of infectious insults, during a critical time of development. This is exacerbated by perinatal nicotine exposure, a condition shown to alter the autonomic response in exposed offspring. We are proposing that shock and cardiovascular collapse is a key element that links these theories.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989240/

SIDS: Genetics of the sudden infant death syndrome

The sudden infant death syndrome (SIDS) is currently defined as ‘‘the sudden unexpected death of an infant less than 1 year of age with onset of the fatal episode apparently occurring during sleep, that remains unexplained after a thorough investigation’’. SIDS, whose etiology remains rather vague, is still the major cause of death among infants between 1 month and 1 year of age in industrialized countries with varying incidences in different populations. Herein, after touching on definitory approaches and several current hypotheses concerning SIDS etiology, we focus on the triple risk model of SIDS and discuss two large classes of genetic factors potentially contributing to or predisposing for the generation of a vulnerable infant that, when encountering an environmental trigger, may succumb to SIDS. We conclude by acknowledging that for the integration of the vast and complex genetic evidence concerning SIDS, a lot more research will be required and we briefly discuss the potential use of recently presented animal models for functional studies of SIDS pathology
<http://posterous.com/getfile/files.posterous.com/arritmias/fC9ZO24zyLlTt7WhQG60OY3fqQXlCCGfFVoJhr04yORqVcGzNQfZcCz2qSNa/Genetica_de_Sx_de_MS_infantil_.pdf>

SIDS: Texas Infant Sleep Practices

Sudden Infant Death Syndrome (SIDS) is the third leading cause of death to infants in the United States and Texas. SIDS accounts for approximately 10% of all infant deaths in Texas. According to the American Academy of Pediatrics, infant sleep practices, such as choice of infant sleep surfaces and sleep position, have been identified as risk factors associated with SIDS. In 2009, the Texas Department of State Health Services conducted a study to collect data on infant sleep practices in Texas. Approximately 51% of women giving birth during this time period were Hispanic, 33% White, 11% Black and 5% were of other racial/ethnic background. Additionally, 6% were younger than 20 years old, 54% were between 20 to 29 years, and almost 40% were 30 years of age and older. Approximately 30% of study participants were college graduates, 64% were married, and 46% of those with a reported annual income, made at least $35,000 or more a year. Of the women who reported their place of birth, 68% were born in the United States. Additionally, 12% of the women lived in a county along the Texas/Mexico border.
<http://www.dshs.state.tx.us/mch/pdf/TISS%20Fact%20Sheet.pdf>

SIDS: Maternal and Child Health Library

Maternal and Child Health Library
MCH Alert: Focus on Infant Mortality is developed by the Maternal and Child Health Library in collaboration with the National Sudden and Unexpected Infant/Child and Pregnancy Loss Resource Center at Georgetown University. This and past issues are available online at http://www.mchlibrary.info/alert/archives.html and http://www.sidscenter.org/alert/archives.html.

SIDS: Māori breastfeeding practices under spotlight

23 November 2010, University of Auckland

Māori breastfeeding practices under spotlight in new book
The baby formula industry has been likened to the tobacco industry, for its serious effects on Māori health in a new book co-authored by a University of Auckland academic.
Dr Marewa Glover from the University’s School of Population Health contributed a chapter on Māori breastfeeding in a new resource book for researchers and health practitioners – Infant feeding practice: A cross-cultural perspective.

Dr Glover says the practice of breastfeeding has undergone a huge ideological shift since colonisation, resulting in fewer Māori women breastfeeding.

“The actual contribution of the artificial baby milk industry to Māori babies having the lowest rates of breastfeeding in New Zealand has yet to be studied, but traditional Māori infant care practices have been lost as the ‘benefits’ of western and modern practices have been sold to Māori mothers,” said Dr Glover.
“Sudden Infant Death Syndrome (SIDS) rates are higher and have been known to be higher for some decades, bedsharing and its attendant risks are more frequently seen for Māori, yet the knowledge and practice of Māori traditions by contemporary Māori mothers is poor.”
Dr Glover’s chapter looks at the growth of the baby formula industry in New Zealand, the destruction of Māori traditions, influences which divert Māori women from breastfeeding, and smoking as a significant barrier to breastfeeding.
http://www.scoop.co.nz/stories/GE1011/S00123/maori-breastfeeding-practices-under-spotlight.htm

SIDS: Kozlof & Riddell charged with manslaughter in Ontario

ERICA BAJER

They seem like the perfect parents.

That's why manslaughter charges against Justin Kozlof and Candice Joy Riddell are incomprehensible to family and neighbours. Kozlof, 25, and Riddell, 26, are charged in connection with the death of their three-week-old son Kavan Riddell-Kozlof on Thursday. "This blew me away because he's so good with kids," said Tom, Kozlof's step-father, who attended the couple's brief court appearances Monday. They are scheduled for bail hearings Tuesday. "I can't see him doing it," said Tom, who didn't wish to have his last name published. "You can't make a judgment — who knows what really happened. "I don't want nobody to judge either one of them. The truth will come out." He said Kavan is the couple's second child together. They also have a one-and-a-half-year-old daughter named Kyra. "He was a cutie," Tom said of Kavan, who was eight pounds and nine ounces when he was born on Oct. 26. "He was a long baby — with long fingers and toes." Tom, who raised Kozlof since the time he was an infant, said he'll stand by his son throughout this ordeal. Neighbours Megan Davis and Joanne Vanovereek can't believe the couple is charged.

"I've never seen a dad like Justin," Davis said. "He was always with his kids." She said the family could often be seen going to the park and for walks. "This is hard to wrap your head around," she said. Vanovereek said everyone around the couple's Sheldon Avenue apartment complex believed the baby died of Sudden Infant Death Syndrome. "I would never have dreamed (they would be charged)," she said. "I don't believe that, I can't believe that." Neighbour Debra Donaldson was also shocked to hear of the charges.
"They are a really nice couple," she said. "They looked like they just totally loved each other." Her heart goes out to the family. "The hardest part is it's a parents' worst nightmare come true," she said. "I couldn't imagine what they are going through or how they're feeling — devastated." Donaldson said she heard that the parents went to check on Kavan early Thursday morning and he wasn't breathing. "The child was in distress when our officers arrived," said Insp. George Flikweert, head of the Chatham-Kent Police Service's major crime unit. "There were attempts to revive the child." He said the 911 call was made from inside the home and the baby was taken to Chatham-Kent Health Alliance where he was later pronounced dead. Police said an autopsy was conducted by a forensic pathologist in London on Thursday and Friday. The parents were arrested Saturday. The inspector said this was the first time police were called to the couple's home. Flikweert said while police know the cause of Kavan's death, it isn't being released. Information about the circumstances surrounding the death also weren't released. "Manslaughter means there's culpability in a death . . . that a person had a hand in someone else's death," he said. Flikweert said information about the charges wasn't released sooner because police wanted to canvass the area first. "We didn't want to compromise our investigation," he said. "We want people's pure recollections." The case remains under investigation.
http://www.chathamdailynews.ca/ArticleDisplay.aspx?e=2856849#

SIDS: The Effect of In Utero Cigarette Smoke Exposure

PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY

Volume 23, Number 3, 2010

Hemant Sawnani, M.D., Erik Olsen, B.E., and Narong Simakajornboon, M.D.

Maternal cigarette smoking is the most modifiable risk factor for sudden infant death syndrome. Although the

mechanism underlying the association between maternal smoking and sudden infant death syndrome is unknown,

the effect of

important causative mechanism. In human, several studies have linked maternal smoking and alterations in

breathing pattern, ventilatory, and arousal responses in infants during the early postnatal age. Cigarette contains

many compounds, but nicotine has been identified as the main culprit underlying changes in respiratory control.

Further investigations in animal models have demonstrated that perinatal nicotine exposure results in alteration

in baseline ventilation, ventilatory response to hypoxia, arousals, and autoresuscitation processes in developing

animals. The mechanisms underlying the effect of nicotine exposure on respiratory control may be related to

modulation of neurotransmitters and signal transductions mediating ventilatory control and arousal responses.

Findings from these studies will help to understand how perinatal cigarette smoke exposure interferes with

respiratory control development, and may lead to more effective preventive strategies and therapeutic intervention

for this significant health problem.
http://www.liebertonline.com/doi/pdfplus/10.1089/ped.2010.0036in utero cigarette smoke exposure on respiratory control development is speculated as the

SIDS: Cot death tragedy of Cumbrian baby

23 November 2010

A healthy 20-week-old baby from Cleator Moor tragically died in his cot of sudden infant death syndrome.

Lucas Howland was said to be a “normal, bouncing baby” when he was put to bed by his mother, Alana Newton, on the evening of July 27 this year.
Lucas was fine when Ms Newton checked on him at 11pm, an inquest heard yesterday, but when she woke in the morning it became clear that her son had died during the night.
The baby’s grandfather, William Newton, tried to resuscitate him at his home at Greenthwaite, Cleator Moor, but Lucas was pronounced dead after being taken to the West Cumberland Hospital.
A postmortem revealed that Lucas was a “well grown and cared for baby” and there were no suspicious findings.
Coroner David Roberts ruled that Lucas died of natural causes.

http://www.newsandstar.co.uk/news/cot-death-tragedy-of-cumbrian-baby-1.782908?referrerPath=news

SIDS: New SIDS Law to Take Effect in Pennsylvania

SIDS is the number one cause of death in babies, but before the end of the year, new parents in Pennsylvania will be better prepared to prevent this type of tragedy.  A  new law requires all hospitals to educate new mothers about infant safe sleep practices.
More than 80 babies died in Pennsylvania in 2008, due to Sudden Infant Death Syndrome, but  the number of  SIDS deaths has dropped 50 percent since the start of the Back to Sleep campaign in 1994.
Most parents,   grandparents and other caregivers should know by now that you must place a baby on his or her back to sleep and keep   blankets, bumper pads and stuffed animals out of the crib.  According to Blair County Respiratory Disease Director Betsy Hurst, "an empty crib is a good crib and every parent will be taught that now."
The Society has been teaching that lesson for years and it sounds simple enough.  But Blair County Coroner Patty Ross said,  not enough people have been following those guidelines.   She was called to three preventable baby deaths this year, including this one.  "It was a baby in a crib with netting and soft  toys and bumper pads and actually the sheet had wrapped around the baby's head, " Ross said.
The coroner says co-sleeping ---basically putting your baby in bed or on a couch with you is also a dangerous practice.  This year, Ross investigated the deaths of two babies who suffocated in this way.
Ross added, "I'm sure there's times that people have slept with their children nothing has ever happened, but when they have  to see me when I have to share their story, when I have to investigate their home and I have to help bury their babies, it makes a difference".
Ross and Hurst hope that under the new law,   more parents and grandparents learn and use  safe sleep practices so that more babies get to celebrate their first birthdays.
Hospitals across the state are required  to begin this new SIDS education program by mid-December.
Unsafe cribs are also a danger to babies.   To get a free safe crib, call the Blair County Respiratory Disease Society at 814-944-8222.
http://wearecentralpa.com/fulltext-healthcast/?nxd_id=225066

SIDS: Army investigates another baby death at Fort Bragg

 

Fort Bragg, N.C. — Army investigators on Monday were looking into the death of an infant who lived in military housing at Fort Bragg – the 11th such death in less than four years.
A 5-month-old girl died Saturday at Cape Fear Valley Medical Center, Fort Bragg spokesman Tom McCollum said. The Army's Criminal Investigative Command is examining the circumstances of her death, he said.
Ten other children, ages 8 months to 2 years, have died in military housing on post since 2007, including one house where two infants died within three months.
One of the deaths has been ruled a case of Sudden Infant Death Syndrome, while the cause of death for the other nine children remains undetermined.
The cause of the 5-month-old girl's death hasn't been determined yet, but there were no obvious signs of trauma and foul play isn't suspected, McCollum said.
Fort Bragg has tested 10 homes connected to the deaths for carbon monoxide, mercury vapor, mold, lead, asbestos and toxins in the drywall.
All the tests were negative or were at levels well below the standard for human exposure set by the federal Occupational Safety and Health Administration, said Col. Stephen Sicinski, Fort Bragg's garrison commander. Those levels, however, are based upon adults, he said.
McCollum said tests on the air quality in the house where the 5-month-old girl lived also came back negative. Results on tests for mold and volatile organic compounds haven't come back yet, he said.
The Consumer Products Safety Commission is conducting its own tests of the homes for Chinese drywall, which has reportedly sickened people across the nation. Those tests are not yet complete.
http://www.wral.com/news/local/story/8670229/

SBS: Scotland: Simpson

Catriona Webster: 13/11/2010

Baby ‘could have died from medical condition’ Brain surgeon tells murder trial of ‘abnormalities’

A brain surgeon told a court yesterday that a baby allegedly murdered by her mother’s boyfriend could have died from an “underlying medical condition”.

Consultant neurosurgeon Dr Helen Fernandes told the High Court in Aberdeen that she could not be certain that the injuries of six-week-old Alexis Matheson were inflicted.

Dr Fernandes, of Addenbrooke's Hospital in Cambridge, told the jury that in her medical opinion there were many “abnormalities” in Alexis that could point to an underlying illness.

She was giving evidence as an expert witness at the trial of Mark Simpson.

Simpson, 29, is accused of assaulting the baby at Deansloch Crescent in Aberdeen between November 8 and December 9, 2007, when he was in a relationship with her mother, Ilona Sheach.

He denies murdering the child by seizing her, shaking her and compressing her chest, injuring her so severely that she died in hospital in Edinburgh on December 10.

Dr Fernandes said that some of the injuries in Alexis’s brain, including blood clotting, could have been caused by infection, dehydration or a bleeding or collagen disorder.

She said: “The distribution of blood seen on the baby’s CT scan is not typical of the distribution of blood we would expect to see in a baby who has been shaken.”

She also said she found the baby to have an abnormal bone structure and cells, which could point to a medical problem.

Dr Fernandes said: “The ribs are not of a totally normal construct for an infant of six weeks.”

She told the court that “normal handling” of a child with a collagen or bone disorder could cause injuries or fractures.

She said: “I do feel that there are many pointers in the evidence that’s available to us that things were not normal, and I think one should be careful about drawing such certain conclusions about shaken baby syndrome, for which the evidence is inconclusive.”

Dr Fernandes added: “It was the number of abnormalities that I found, and also the fact that the abnormalities were found within the collagen bone group and within the clotting group, the two main areas where we look for underlying medical conditions.

“I found those very difficult to ignore and come to a certain conclusion of inflicted injury. There was too much else going on here.”

Defence agent Herbert Kerrigan QC asked: “This tipped the scale against it being non-accidental injury?”

“Yes,” she replied.

Dr Fernandes also criticised an Aberdeen GP who saw Alexis a week before her death when she is said to have had red eyes.

She said the explanation given that Alexis was constipated was not, in her opinion, acceptable and the baby should have been referred to a paediatrician.

Mr Kerrigan also asked about the possible effects of a game called “fishy” on the baby.

The court had previously heard Simpson, of 2 Dunbennan Road, Dyce, say that Miss Sheach had played a game with the baby that involved a shaking motion.

She said: “I think in a vulnerable infant one would worry about the consequences of such a game.”

http://www.pressandjournal.co.uk/Article.aspx/2008139?UserKey=#ixzz15e9yv2W1

SBS: Tylar Hokanson: Minnesota

JOY POWELL, Star Tribune

November 13, 2010

Hastings jury heard part of stepfather's confession to shaking 17-month-old. The boy's mother told of his final days when he stopped eating, moving.

The photos of her dying toddler were too much for Melissa Hokanson, who viewed them on the stand as she testified Friday against her husband in his first-degree murder trial in Hastings.

A Dakota County prosecutor told jurors the 19-year-old mother lost her child to shaken-baby syndrome at the hands of stepfather Tylar Hokanson.
He's been indicted on three counts of first-degree murder, including for allegedly failing to stop the slow death by telling nobody that he hurt 17-month-old Nicholas Miller. Hokanson, 24, also faces three counts of second-degree murder in the death last year in Pierce County, Wis. The trial will continue this week.
Melissa Hokanson, of Greenvale Township in southern Dakota County, where the injuries allegedly occurred, did not look at her husband while testifying.
She told of Nicholas' bruises and broken clavicles after she met Tylar Hokanson in summer 2008. She also told of his punishment of the boy and about hearing Nicholas' "terrified scream" on June 19, 2009.
Authorities say his death four days later could have been prevented with medical care.
An autopsy found bleeding on the brain. The state alleges shaking caused Nicholas' brain to hit his skull, and bleeding then pressured his brain.
His spine was severed, as were blood and lymph vessels. His lung cavity filled with fluid, squishing his lungs. He had bruises and cuts including to his mouth and tongue.
He also had five ribs broken in prior weeks and fractures of his clavicles in recent months.
Three of the photos were taken two days before the toddler died at his stepgrandmother's house. In the photos, he lay on a couch from which he did not move, according to his mother's testimony.
http://www.startribune.com/local/south/107806364.html?elr=KArks7PYDiaK7DUvckD_V_jEyhD:UiD3aPc:_Yyc:aU7DYaGEP7vDEh7P:DiUs

SBS: Honiker, Nebraska: Child Care Provider Charged With Abuse

PAPILLION, Neb. -- A Sarpy County woman is charged with intentional child abuse, a felony, related to an alleged incident in her home child care.

Diane Honaker, 50, was arrested after parents of a six-month-old child discovered the baby was injured.

According to Sarpy County investigators, the parents of the unnamed child took the six-month-old to the hospital on Nov. 12 An examination determined the child's injuries were the result of being shaken.

"Our investigators went to the hospital and interviewed the doctors there and the family, and it was determined that most likely, the injuries occurred at an in-home day care," said Sarpy County Lt. Mark Trapp.

Honaker was arrested following an interview with investigators.

The child's current condition is unknown, but investigators told KETV NewsWatch 7 it did not appear the baby's injuries were life threatening. The baby was throwing-up blood before the parents took the child to the hospital. Doctors found blood on the child's brain.

Trapp said the injuries were consistent with shaken baby syndrome.

The Nebraska Department of Social Services issued an emergency order on Monday to close Honaker's child care, at 15821 Briar Street. Emergency orders are issued when necessary to protect the immediate safety of a child, according to the state.

Trapp said the baby girl may have had allergies and that may be what have led to what happened in the day care.

"It's not uncommon to see a child of that age that's fussy and people that are trying to stop that child from crying," Trapp said. "This obviously is not the way to do it and causes some pretty severe injuries."

Honaker was held in the Sarpy County jail on $75,000 bond, with a court appearance set for Thursday. Copyright 2010 by KETV.com. All rights

http://www.ketv.com/news/25831965/detail.html

SBS: Shaken baby abuse is on the increase

Zack Ottenstein November 11, 2010

TOLEDO, OH (WTVG) --

Defenseless babies in our community are suffering abuse more often.

Doctors have confirmed an increasing number of shaken baby syndrome cases and they don't know why it's happening.

Shaking can kill a baby. Others suffer lifelong debilitating conditions.

Dominik Dewitt plays like any other toddler. He's happy, energetic, and lucky to be alive.

Dominik's father shook him at three months old. His mother Stefany says the resulting brain damage caused epilepsy and learning disabilities. "He may never be able to drive a car because he has epilepsy. He may never be able to hold a respectable job because of his disability. That person that shook him was the one that ruined his life."

Shon Forant lives with that guilt everyday. One morning he lost control and shook his daughter Chelsea while she was crying.

Chelsea now suffers from cerebral palsy. Forant told us, "It's not that I never loved my child. It's not that I didn't want my child in my life."

Shaking and injuring a child isn't an accident according to Dr. Randy Schlievert. He demonstrated to us how violent shaking can be. Brain damage can happen in seconds. Dr. Schlievert says, "That may be all it takes for the child to be permanently damaged or killed."

Dr. Schlievert says there was a cluster of shaken baby cases over the summer. In a period a six weeks, he says northwest Ohio had 6 months' worth of cases.

He told us, "My gut's telling me that the summer heat played a large role, because this really did peak in the summer" because babies can be agitated when it's hot outside.

He also believes the economy caused parents more stress and anxiety. Lucas County Children Services expects to receive about 400 more reports of abused and neglected children than last year.

We met Stefany and Dominik at a fundraiser for the shaken baby syndrome support network. It's one of many groups providing support and education about child abuse.

It's something Shon Forant has made his mission in the wake of abusing his daughter.

Stefany Dewitt says for Dominik, it was a couple of seconds that changed his life forever and that she cannot forgive.

We contacted Dominik's father who is in prison and we did not receive a reply.

While we have found an increase in abuse cases, some experts believe as many as 50 percent of child abuse cases in our area go unreported.

Here are some steps experts say can reduce child abuse.

• Have a crying plan so you know what to do when your baby won't stop crying.
• If you need help with a parenting issue, you can call this number anytime day or night: 1-877-251-5437.
• Have a family member or trusted friend on call, so you can get away if you're getting frustrated

http://abclocal.go.com/wtvg/story?section=news/iteam&id=7783759

SBS: Karl Aspelin, California

Ari Burack, Bay City News
A San Francisco man accused of causing the death of his infant son was charged today with felony assault on a child, though his attorney maintained it was a tragic accident.
Karl Aspelin, 39, is suspected by police of violently shaking his 4-month-old son Johan on Nov. 8 at their home in the 500 block of Vicente Street. The boy was hospitalized and was taken off life support over the weekend.
Aspelin was arrested two days after the incident, and prosecutors today charged him with felony assault on a child causing death, which carries a potential sentence of 25 years to life in prison, according to the district attorney's office. He is also charged with felony child endangerment.
He was being held today under psychiatric observation at San Francisco General Hospital.
His attorney, Stuart Hanlon, said his client would be released from the hospital and brought to jail soon, so his arraignment was postponed until Wednesday. He is being held on $2 million bail.
"It's a tragic case," Hanlon said by phone this afternoon. "Every piece of evidence we have is that he's a loving and wonderful father. It just seems the prosecution has jumped the gun here as to what occurred."
According to Hanlon, Aspelin runs his own software company in San Francisco and had just returned home that day from day care.
He trying to calm the infant, who was crying, when he heard a crash in the kitchen, where his other child, a 2-and-a-half-year-old, and the family dog were, Hanlon said.
In the kitchen, Aspelin saw the older child and the dog on the floor in the middle of some spilled food, and when he bent down with his infant in his arms, slipped and fell backwards, and the baby tumbled to the floor, Hanlon said.
Aspelin then called 911, according to Hanlon.
The call "will show that he was totally freaked out and hysterical" about the incident, Hanlon said.
Prosecutors were not immediately available to respond today to Hanlon's contentions.
Hanlon also questioned the accusation by police of "shaken baby syndrome."
"We're being contacted already by numerous doctors in the field that say the theory has been debunked," he said. "We'll get our experts to look at the evidence and try to figure out what happened."
In the meantime, Hanlon said he will file a motion to reduce bail for his client, whom he said has not had the chance to begin grieving the death of his son.
"When a child dies, I think the process of a family is just devastating," Hanlon said. "And without any real evidence...they've taken his family apart."
http://sfappeal.com/news/2010/11/lawyer-for-man-charged-in-shaken-baby-death-says-it-was-accidental.php

SBS: 2003 Article: Shaken baby syndrome in Canada: clinical characteristics and outcomes of hospital cases

Abstract

Background

Shaken baby syndrome is an extremely serious form of abusive head trauma, the extent of which is unknown in Canada. Our objective was to describe, from a national perspective, the clinical characteristics and outcome of children admitted to hospital with shaken baby syndrome.

Methods

We performed a retrospective chart review, for the years 1988–1998, of the cases of shaken baby syndrome that were reported to the child protection teams of 11 pediatric tertiary care hospitals in Canada. Shaken baby syndrome was defined as any case reported at each institution of intracranial, intraocular or cervical spine injury resulting from a substantiated or suspected shaking, with or without impact, in children aged less than 5 years.

Results

The median age of subjects was 4.6 months (range 7 days to 58 months), and 56% were boys. Presenting complaints for the 364 children identified as having shaken baby syndrome were nonspecific (seizure-like episode [45%], decreased level of consciousness [43%] and respiratory difficulty [34%]), though bruising was noted on examination in 46%. A history and/or clinical evidence of previous maltreatment was noted in 220 children (60%), and 80 families (22%) had had previous involvement with child welfare authorities. As a direct result of the shaking, 69 children died (19%) and, of those who survived, 162 (55%) had ongoing neurological injury and 192 (65%) had visual impairment. Only 65 (22%) of those who survived were considered to show no signs of health or developmental impairment at the time of discharge.

Interpretation

Shaken baby syndrome results in an extremely high degree of mortality and morbidity. Ongoing care of these children places a substantial burden on the medical system, caregivers and society.

Abusive head trauma accounts for 95% of fatal or life-threatening injuries attributed to child abuse.^1,2 Accidental intracranial injury is rare in children aged less than 1 year.^3,4 In a report from the United States, child abuse cases represented 1.4% of admissions and 17% of deaths in a pediatric intensive care unit.⁵ All these children had sustained head trauma, had the youngest age (average of 9 months) and had the highest trauma severity index and mortality rate (53%) compared with other children admitted to the intensive care unit who had not been abused. Most life-threatening cases of abusive head trauma in children aged less than 2 years have been reported to be associated with shaken baby syndrome (SBS).⁶

SBS is an extremely serious form of abusive head trauma that occurs when a child is subjected to rapid acceleration, deceleration and rotational forces, with or without impact, resulting in a unique constellation of intracranial, intraocular and cervical spinal cord injuries.^3,7,8,9,10 Presenting complaints are often nonspecific, hence, it is important that all health care providers are able to recognize the clinical features that constitute SBS.^9,11 The outcome is often devastating with 15%–27% of children dying as a result of their injury and more than one-third having serious neurological consequences.^12,13,14 Survivors often require long-term multidisciplinary medical care, specialized education, adaptive housing, vocational training and the involvement of child welfare authorities.⁴ The consequences for those infants exposed to SBS who do not come to medical attention are unknown.

Our knowledge of SBS, derived from child welfare and hospital cases, has focused on relatively small populations of injured children in the United States or the United Kingdom. Barlow and Minns estimated an annual SBS incidence of 24.6 per 100 000 children aged less than 1 year.¹⁵ Estimated numbers of cases of SBS, however, represent the “tip of the iceberg” of a much larger group of injured children, because many cases, with less severe forms of injury, may not be identified or brought to medical attention. Our objective was to describe the key characteristics and outcomes of children admitted to hospital with SBS in Canada.

We evaluated all cases of SBS for the years 1988–1998 that were reported to the child protection teams at 11 tertiary care pediatric hospitals. These hospitals are responsible for a large part of pediatric care in Canada with over 90 000 admissions annually, representing an estimated 85% of tertiary care pediatric beds.¹⁶ The institutional review board of each participating centre approved the research proposal.

SBS is a recognized diagnosis.^8,9 In this study, SBS was defined as any form of intracranial, intraocular or cervical spine injury as a result of a substantiated or suspected shaking, with or without impact, in a child aged less than 5 years. We relied on the diagnosis assigned by the physician responsible for child protection at each hospital and/or that recorded on the discharge summary. These health care providers are responsible for managing cases of suspected child maltreatment, working in association with community child welfare authorities and the police. The diagnosis of SBS made according to the records at the treating hospital was accepted as noted. ICD-9 codes (1988 to March 1996 — 995.5, E967.0, E967.1, E967.9; April 1996 to 1998 — 995.55, 995.54, E967.0, E967.9) were also examined at each hospital to confirm that we had identified all cases.¹⁷

We used a structured data collection form developed and piloted at the Children's Hospital of Eastern Ontario (CHEO). From the medical records we reviewed and abstracted the admission history and physical examination, physician and nursing progress notes, child protection team/welfare authority notes, consultation notes and clinical reports (discharge, radiology). Data on patient demographics, clinical presentation, injury characteristics, past medical history, investigations, family composition, perpetrator and outcome were also extracted. Outcome definitions were developed for the health of the child at discharge (“well” meaning no documented health or developmental impairment; “neurological impairment” meaning documented abnormal neurological findings on physical or developmental assessment; “visual impairment” meaning documented proven or suspected visual impairment).

A single research assistant was trained to review and abstract the information from the medical charts (with the exception of data from the Hôpital Sainte-Justine, Montréal, Que., where a second research assistant abstracted the medical information documented in French) and to enter the information in duplicate into the database. Ten randomly selected cases of abusive head trauma at CHEO were reviewed by the research assistant and an independent assessor (W.J.K.) for the diagnosis of SBS, clinical features and outcome (κ = 0.79). The final data collection form was then revised and the research assistant travelled to each institution to complete the form.

We measured severity of the injury using the modified Pediatric Cerebral Performance Category (PCPC) 6-point scale (from 1 = normal to 6 = brain death).¹⁸ The PCPC scale provides outcomes for functional morbidity and cognitive impairment after critical illness or injury for pediatric intensive care patients when more extensive psychometric testing is not feasible. The scale is reliable and valid and is associated with several measures of morbidity (length of stay in the pediatric intensive care unit, total hospital costs and discharge care needs), severity of injury (pediatric trauma score) and functional outcome at 1-month and 6-month follow-up of pediatric intensive care patients.¹⁹ Ratings on the Glasgow Coma Scale (GCS) on presentation that measures patient performance in 3 areas, eye opening, verbal ability and motor ability, were also collected.^20,21

Summary statistics were tabulated for the whole group and for each study site. Descriptive statistics are presented for continuous variables, with frequency counts and percentages presented for categorical variables. Subjects' characteristics were compared using the Mann-Whitney test for ordinal or interval scale variables and the χ² test for categorical variables for children who died as a result of SBS and in cases in which the certainty of the perpetrator was coded as definite. Using results from the univariate analysis, 2 independent models were developed using backward stepwise logistic regression for the association between children who died and certainty of perpetrator with presenting complaints, injuries, previous maltreatment and outcome.

Results

The 364 children identified with SBS (median age 4.6 months, range 7 days to 58 months), 56% of whom were male, are presented by pediatric centre in Table 1. Clinical features and past medical history (Table 2) revealed nonspecific presenting complaints (seizure-like episode, decreased level of consciousness or respiratory difficulty), and most of the children (95%) did not have an underlying chronic medical or physical problem. The 307 charts containing perinatal information (mean gestation 37 weeks, mean birth weight 2880 g) noted a difficulty with the pregnancy for 16% of the children (88% were born at < 36 weeks' gestation) and 17% were discharged from hospital after their mother.

Table 2

Of the 364 children, 86% had subdural effusion, 42% had cerebral edema and 76% had retinal hemorrhages, of which 83% were bilateral (Table 3). Retinal hemorrhage was associated with more severe injury such as death (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.9–2.6), subdural hemorrhage (OR 3.2, 95% CI 2.8–3.5) and neurological injury (OR 1.7, 95% CI 1.3–2.0). Cervical spine injuries were infrequently recorded (4%). The Glasgow Coma Scale on admission was documented for 86 (24%) children (median age 5.2 months, range 14 days to 38.6 months) with a median value of 6 (normal ≥13 on a scale of 3–15). Imaging studies performed included CT scanning (96%) and MRI (24%). In 98% of cases, an abnormality was reported: subdural hemorrhage/effusion (CT: 79% of scans, MRI: 87% of images), subarachnoid hemorrhage/effusion (CT 32%, MRI 23%) and/or intracranial hemorrhage (CT 63%, MRI 44%). A skeletal survey, that is, a comprehensive radiographic evaluation, was performed in 301 children (82%) and a bone scan in 105 children (29%), as a result of which in 46% of cases and 51% respectively an abnormality was reported.

Table 3

The mean household size was 3.4 people, and the mean number of children per family was 1.7. The mean age of the primary caregiver was 23.7 years (range 15–40 years), with 68% of the parents being either married or living as common-law spouses. Incomplete chart documentation did not allow an estimate of socioeconomic status, employment history or level of education. The medical chart documented poverty (undefined) in 87 families (28%), and an unsafe or inappropriate environment was noted in 73 (20%). A past medical history and/or clinical evidence of previous maltreatment was noted in 220 children (60%), and 80 families (22%) had had previous involvement with child welfare authorities. The biological father (43%), followed by the biological mother (26%), was most often identified as the responsible caregiver with the child at the time of the injury, even though the primary caregiver was usually the biological mother (67%), followed by “other” (35%: 18% babysitter, 17% unknown) and then the biological father (18%).

The perpetrator was identified in 240 cases (66%), with the biological father being the most common (50%), followed by the stepfather/male partner (20%) and then the biological mother (12%). Overall, the perpetrator was male in 72% of the cases; 15% of perpetrators had a previous charge or suspicion for maltreatment of a child in their care. Although the degree of certainty about the perpetrator was considered definite in 96 (40%) cases (where the perpetrator was seen to shake the child or admitted to the assault), this was not associated with the presenting complaint, injury, previous maltreatment or outcome. In almost two-thirds of cases (64%), there was an ongoing police investigation, 26% of the perpetrators had criminal charges laid and 7% were convicted for the assault.

Sixty-nine children died (19%) as a direct result of the shaking injury. Children who died were slightly older than survivors (median age 7.8 v. 4.3 months), and death was associated with a decreased level of consciousness (OR 3.2, 95% CI 2.4–4.0) or respiratory difficulty (OR 2.5, 95% CI 1.8–3.2) on presentation; bruising (OR 2.3, 95% CI 1.5–3.1) on examination; and cerebral edema (OR 3.9, 95% CI 3.1–4.7) or subdural hematoma (OR 2.5; 95% CI 1.7–3.3) on imaging. Of the 295 survivors, only 65 (22%) were felt to be “well” (absence of health or developmental impairment) at the time of discharge, with 162 (55%) having a persistent neurological deficit and 192 (65%) having visual impairment. The PCPC scale, assessed at both the time of admission and at discharge, revealed that only 21 children (7%) were rated “normal,” whereas 143 children (48%) had a moderate or severe degree of disability and 34 (12%) were in a coma or vegetative state. Of the survivors, 251 (85%) required ongoing multidisciplinary care. Review of placement at discharge revealed that 42% of the children were taken into foster care, whereas 43% returned home with their biological parent(s) and a further 14% were placed with a close family member.

Interpretation

Our findings are consistent with previously published data on SBS^10,11,12,13 in highlighting the young age of the victims, the slight preponderance of boys, the high rate of male perpetration and the extremely high degree of mortality and morbidity. Presenting signs and symptoms are often nonspecific, which means that health care providers must have a high index of suspicion when infants and young children present with subtle neurological signs such as lethargy or decreased level of consciousness. Although a significant number of children had evidence of severe trauma with external bruising or fractures, or both, up to 40% of children had no external sign of injury.

Many of these injured children have serious neurological and developmental consequences including profound mental retardation, spastic quadriparesis or severe motor function impairment. These children require long-term involvement of multiple specialists and child welfare authorities. At the time of discharge, the PCPC scale, which is associated with functional outcome at 6-month follow-up,^{19,22,23,24,25} revealed that 60% of survivors had a moderate or greater degree of disability. This outcome, though already cause for concern, may be an underestimate, because there may be a symptom-free interval of 12–18 months before the development of neurological or developmental difficulties.²⁶ Further, the long-term outcome, especially with regard to subtle neurological injury, and for those exposed to SBS who do not come to medical attention, is unknown.

Although this study highlights the devastating effects of SBS, there are several limitations that should be noted. First, the SBS cases are a highly selected sample from admissions to tertiary care pediatric hospitals. These results may not reflect the number of shaken children in the community. Therefore, we are not able to estimate the incidence of SBS. Second, the data collection was retrospective and lacked a comparison group, making it difficult to identify factors that may be associated with SBS. Third, SBS was defined and classified at each participating hospital, and we did not perform an independent assessment to confirm the diagnosis. Fourth, the information obtained was limited to the quality of the documentation in the medical record. Many of the children described here were extremely ill when admitted, and certain elements of the admitting history may not have been reviewed in detail or documented, including sociodemographic and perinatal information. Fifth, the data collection occurred during a time period when the recognition and diagnosis of SBS was evolving and it is possible, especially early in the study, that SBS cases were not identified. Finally, while we have probably accounted for most of the more serious injuries, as these were children admitted to hospital in tertiary care pediatric centres, cases that resulted in death before hospital admission may not have been included.

A major challenge for researchers is to develop approaches to measure the incidence and risk factors for SBS, given that the injury and its circumstances are often clouded in secrecy. Our study suggests that a minimum of 40 cases of SBS occur annually in Canada, from which 8 children will die, a further 18 will have permanent neurological injury requiring life-long assistance and 17 will be taken into foster care. We also believe that this represents only the tip of the iceberg and that many other cases are not detected.¹⁴ The magnitude of this injury requires a national strategy, such as that recommended in the recently released Canadian Joint Statement on Shaken Baby Syndrome.²⁷ This strategy should include population-based surveillance to establish the incidence of SBS and address risk factors by comparing SBS cases with carefully chosen controls. Prevention strategies, based on incidence data and vulnerability factors, may then be developed, implemented and assessed at the community level.

In summary, the outcome of SBS is devastating to the child; ongoing care of these children places a substantial burden on the medical system, caregivers and society. Physicians need to be aware of the nonspecific clinical presentation. Further work is required to establish the true incidence of SBS, identify vulnerable children, and to develop and evaluate prevention strategies.

β See related news article page 207

Acknowledgments

We thank Corinne King, Joanne Blagdon and Elaine Orrbine for their administrative support and Ron Ensom and Doris Lariviere for review of the manuscript and editorial comments.

Footnotes

This article has been peer reviewed.

Contributors: Dr. King was responsible for the study conception and design and oversaw the acquisition, analysis and interpretation of data. Ms. MacKay was involved in the study conception and design and assisted with the acquisition, analysis and interpretation of data. Dr. Sirnick was involved in the study conception and design. Dr. King drafted the manuscript; all of the authors revised the article for important intellectual content and gave final approval of the version accepted for publication. All members of the Canadian Shaken Baby Study Group were involved in the study design and data acquisition, revised the article for important intellectual content and gave final approval of the version accepted for publication.

This study was funded by the Rick Hanson Institute, the Neurotrauma Foundation and the Ontario Ministry of Health and Long-Term Care (grant no. ONPR-10). The report was presented at the Pediatric Academic Society Meeting held in Boston in May 2000.

Competing interests: None declared.

Correspondence to: Dr. W. James King, Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Rd., Ottawa ON K1H 8L1

References

1. Levitt CJ, Smith WL, Alexander RC. Abusive head trauma. In: Reece RM, editor. Child abuse: medical diagnosis and management. Philadelphia: Lea and Febiger; 1994. p. 1-22.

2. Coury DL. Recognition of child abuse. Notes from the field. Arch Pediatr Adolesc Med 2000;154:9-10. [PubMed]

3. Billmire M, Myers PA. Serious head injury in infants: Accident or abuse? Pediatrics 1985;75(2):340-2. [PubMed]

4. American Academy of Pediatrics, Committee on Child abuse and Neglect. Shaken baby syndrome: rotational cranial injuries [technical report]. Pediatrics 2001; 108(1):206-10. [PubMed]

5. Irazuzta JE, McJunkin JE, Danadian K, Arnold F, Zhang J. Outcome and cost of child abuse. Child Abuse Negl 1997;21(8):751-7. [PubMed]

6. Bruce DA, Zimmerman RA. Shaken impact syndrome. Pediatr Ann 1989; 18: 482-94. [PubMed]

7. Duhaime AC, Alario AJ, Lewander WJ, Schut L, Sutton LN, Seidl TS, et al. Head injury in very young children: mechanisms, injury types, and ophthalmologic findings in 100 hospitalized patients younger than 2 years of age. Pediatrics 1992;90:179-85. [PubMed]

8. Caffey J. On the theory and practice of shaking infants: its potential residual effects of permanent brain damage and mental retardation Am J Dis Child 1972;124:161-9. [PubMed]

9. Duhaime AC, Christian CW, Rorke LB, Zimmerman RA. Nonaccidental head injury in infants — the “shaken-baby syndrome.” N Engl J Med 1998; 338:1822-9. [PubMed]

10. Case ME, Graham MA, Handy TC, Jentzen JM, Monteleone JA. Position paper on fatal head injuries in infants and young children. Am J Forensic Med Pathol 2001;22(2):112-22. [PubMed]

11. Jenny C, Hymel KP, Ritzen A, Reinert SE, Hay TC. Analysis of missed cases of abusive head trauma. JAMA 1999;281:621-6. [PubMed]

12. Duhaime AC, Gennarelli TG, Thibault LE, Bruce DA, Margulies SS, Wiser R. The shaken baby syndrome. A clinical, pathological, and biomechanical study. J Neurosurg 1987;66:409-15. [PubMed]

13. Ludwig S, Warman M. Shaken baby syndrome: a review of 20 cases. Ann Emerg Med 1984;13:104-7. [PubMed]

14. Sinal SH, Ball MR. Head trauma due to child abuse: serial computerized tomography in diagnosis and management. South Med J 1987;80:1505-12. [PubMed]

15. Barlow KM, Minns RA. Annual incidence of shaken impact syndrome in young children. Lancet 2000;356:1571-2. [PubMed]

16. Law B, MacDonald N, Halperin S, Scheifele D, Dery P, Jadavji T. The immunization monitoring program active (IMPACT) prospective five-year study of Canadian children hospitalized for chicken pox or an associated complication. Pediatr Infect Dis J 2000;19:1053-9. [PubMed]

17. International classification of diseases, 9th revision (clinical modification). 5th ed. Washington: US Department of Health and Human Services; 1996. Cat no 86-72897.

18. Fiser DH. Assessing the outcome of pediatric intensive care. J Pediatr 1992;121:68-74. [PubMed]

19. Fiser DH, Long N, Roberson PK, Hefley G, Zolten K, Brodie-Fowler M. Relationship of pediatric overall performance category and pediatric cerebral performance category scores at pediatric intensive care unit discharge with outcome measures collected at hospital discharge and 1- and 6-month follow-up assessments. Crit Care Med 2000;28(7):2616-20. [PubMed]

20. Jennett B, Teasdale G. Aspects of coma after severe head injury. Lancet 1977;1:878-81. [PubMed]

21. James HE. Neurologic evaluation and support in the child with an acute brain insult. Pediatr Ann 1986;15:16-22. [PubMed]

22. Fischer H, Allasio D. Permanently damaged: long-term follow-up of shaken babies. Clin Pediatr 1994;33:696-8.

23. Ewing-Cobbs L, Brookshire B, Scott MA, Fletcher JM. Children's narrative following traumatic brain injury: linguistic structure, cohesion and thematic recall. Brain Lang 1998;61:395-419. [PubMed]

24. Barlow KM, Thompson E, Minns RA. Neurological outcome of non- accidental head injury. Eur J Paediatr Neurol 1999;3(A):139-40.

25. Duhaime AC, Christian CW, Moss E, Seidl T. Long-term outcome in infants with the shaking-impact syndrome. Ped Neurosurg 1996;24:292-8.

26. Bonnier C, Nassogne MC, Evrade P. Outcome and prognosis of whiplash shaken infant syndrome: late consequences after a symptom free interval. Dev Med Child Neurol 1995;37:943-56. [PubMed]

27. Health Canada. Joint statement on shaken baby syndrome. Ottawa: Minister of Public Works and Government Services; 2001. Available: www.hc-sc.gc.ca/hppb/childhood-youth/cyfh/child_and_youth/physical_health/shaken_baby.html (accessed 2002 Dec 9).

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC140423/