Wednesday, 17 November 2010

SBS: Useful references to development of terminology

Shaken baby syndrome theory, by whatever name it morphs into, which holds that a small dead child displaying certain limited soft tissues pathologies but no other injuries was shaken to death by the last person who held the child when he or she was conscious. Of all the questioned forensic theories and practices, this is the one I would put at the top of the list for the threshold examination. Of all the currently questioned practices, this is the only one asserted by a respectable minority of specialists to be completely invalid. While a vitriolic dispute continues between the pro and con groups, defendants continue to be sentenced to exceedingly long prison terms based on the theory. While the theory’s supporters accuse the doubters of profiting from defending baby-killers, the doubters label the supporters as zealots lacking any knowledge of physics or of the scientific method. It is long past time that an authoritative body outside the adversarial system examined the underpinnings of the theory and published its results.


The Shaken Baby Syndrome is a fabricated diagnosis. It was fabricated by doctors who do not understand the pathophysiology of haemostasis and osteogenesis.
Vitamin K is a fat soluble vitamin and is a co-factor for an enzymatic conversion of
glutamic acid (Glu) to γ-carboxyglutamic acid (Gla) by γ-glutamyl-carboxylase  and
along with other essential nutrients including Vitamins C and D is  necessary for the
biological activity of the blood coagulation factors and the formation of bone.
A reduction or abnormality of Vitamin K is known to cause  Haemorrhagic Disease of the New Born and fractures in children with Cystic Fibrosis.
Subdural and retinal hemorrhages, encephalopathy and fractures in children which have hitherto been attributed to Shaken Baby Syndrome, Non-accidental injury, Abusive Head Trauma or Inflicted Brain Injury are features of Vitamin K and/or C deficiency and other essential nutrients – Innis’ Syndrome would be an appropriate name change for this combination of signs and symptoms.
Commencing in the mid 20th Century with the publication of a report by an American Radiologist on fractures and haemorrhages in infants1  a Neurosurgeon in England suggested that the cause of the lesions was  violent shaking of the infant by an adult2  a claim echoed by the Radiologist3.  This was the first mention of the “Shaken Baby Syndrome”.
When it was realized that skull fractures could not be explained by shaking, a Professor of Paediatrics in England suggested that a violent impact of the skull against a hard object was the most probable cause of this type of fracture4.  The Shaken Baby Syndrome morphed into “Shaken –Impact  Syndrome”.
Retinal haemorrhages  seen in these children were claimed to be conclusive proof of abuse and Ophthalmologists  added  acceleration –deceleration of the head  as it is violently rotated by the abuser as the cause of the retinal haemorrhages5.
Throughout Academia the current teaching is,  it is the  triad of subdural and retinal haemorrhage with brain damage, as well as the characteristics of each of these components that allow a reconstruction of the mechanism of injury, and assessment of the degree of force employed. Academics claim it is the application of rotational acceleration and deceleration forces to the infant’s head which causes the brain to rotate in the skull. Abrupt deceleration, it is claimed, allows continuing brain rotation until bridging veins are stretched and ruptured, causing a thin layer of subdural haemorrhage on the surface of the brain6-17.
Maguire et al;17  claim that their review, the largest of its kind, offered for the first time, a valid “statistical probability of Inflicted Brain Injury” when certain key factors are present. The “key factors”  included retinal hemorrhages and apnoea both of which are known to be associated with vitamin K deficiency18,19 .
Michael Innis
1. Caffey J. Multiple fractures in the long bones of infants suffering from chronic subdural hematoma. Am J Roentgenol 1946;56:163–173.
2  Guthkelch AN. Infantile subdural haematoma and its relationship to whiplash injuries. BMJ 1971;ii:430-1.
3.  Caffey J. The whiplash shaken infant syndrome: manual shaking by the extremities with whiplash-induced intracranial and intraocular bleedings, linked  with residual permanent brain damage and mental retardation. Pediatrics  1974;54:396-403.
4. David TJ. Shaken baby (shaken impact) syndrome: non-accidental injury in infancy. J R Soc Med 1999;92:556-561.
5.  Update from the Ophthalmology Child Abuse Working Party Royal   College  Ophthalmologists Eye (2004) 18, 795-798. doi:10.1038/sj.eye.6701643  Published online 25 June 2004
6.    American Academy of Pediatrics: Shaken Baby Syndrome. Rotational Cranial Injuries.- Technical Report. Committee of Child Abuse and Neglect  PEDIATRICS:2001:198:206-210.
7.    Hoskote A, Richards P, Anslow P, McShane T.  Subdural haematoma and non-accidental injury in children. Child’s Nerv Syst 2002; 18:311-317
8.  Duhaime AC, Christian CW, Rorke LB, et al.  Non-accidental  head injury in infants – the shaken baby syndrome. N Engl J Med 1998;338:1822-1829
9.  Joint statement on Shaken Baby Syndrome.Paediatrics & Child Health
2001;6(9) 663-7
10.  Minns RA.  Busuttil A. Patterns of presentation of the shaken baby syndrome Four types of inflicted brain injury predominate BMJ  2004;328:766
11. Harding  B, Risdon RA, Krous HF Shaken baby syndrome
BMJ, Mar 2004; 328: 720 – 721
12. Green MA. A practicle approach to suspicious death in infancy – a  personal view. J Clin Pathol 1998, 51; 561-563
13  Reece RM. The evidence base for shaken baby syndrome: Response to editorial from 106 doctors. BMJ, May 2004; 328: 1316 – 1317 ;  doi:10.1136/bmj.328.7451.1316
14. Alexander RC, Sato Y, Smith W, Bennett T. Incidence of impact trauma with cranial injuries ascribed to shaking. Am J Dis Child 1990;144: 724-6
15   Protocol for the investigation of sudden and unexpected deaths in children under 2 years of age [Memorandum No 631].Ontario: Ministry of the  Solicitor General and Correctional Services, 1995.
16.  Kempe CH, Silverman FN, Steele BF, et al. The battered child syndrome. JAMA 1962;181:17–24.
17.Maguire SA,  Pickerd N, Farewell D,  Mann MK, Tempest V, Kemp AM. Arch Dis Child. Which clinical features distinguish inflicted from non-inflict brain injury? A Systematic Review Published Online First: 15 June 2009. doi:10.1136/adc.2008.150110
18. Innis MD. Vitamin K Deficiency Disease Jour OrthoMol Med 2008:23;15-20
19.  Innis MD.  Inflicted Brain Injuries: Don’t Disregard Differential Diagnosis. Jour  Amer Phys an d Surg;2010:15  11-12

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