Monday, 5 December 2011

SBS: Review article with useful pictures

Mark Hansen

Is Audrey Edmunds an otherwise kind and caring wife, mother and neighborhood child care provider who snapped into a homicidal rage one day under the stress of caring for a sick baby?
Or is she an innocent woman who spent 11 years behind bars for a horrific crime she not only didn’t commit, but that may not have even been a crime?
You decide. We can’t. And neither, apparently, can the courts or the scientific community.
Fifteen years ago, Edmunds, then a 35-year-old stay-at-home mom, was convicted of reckless homicide in the 1995 shaking death of a neighbor couple’s infant daughter. She was sentenced to 18 years in prison.
In 2008, however, a Wisconsin appeals court granted her a new trial on the grounds that a shift in mainstream medical opinion as to the cause of the girl’s injuries now casts doubt on Edmunds’ guilt.
Prosecutors subsequently dismissed the case against Edmunds—not because they think she is innocent but to spare the victim’s parents the agony of having to revisit their daughter’s death.
Three years later, Edmunds’ culpability remains a hotly contested topic of conversation in criminal justice circles. And her case has reignited a fierce debate in the forensic community over the science behind what’s called shaken baby syndrome.
To be sure, the vast majority of doctors still regard it as a valid and reliable diagnosis, one whose scientific basis has been proven time and time again by decades of peer-reviewed research, clinical experience and caregiver confessions.
But a small and apparently growing number of forensic experts have begun to question many of the assumptions upon which the diagnosis rests—like whether shaking alone can produce the kind of traumatic head injuries attributed to SBS in the absence of other injuries, like a broken neck, or whether a child who has been shaken violently would immediately be rendered unconscious.
The decision marks the first time that an appeals court has questioned the scientific basis for a shaken baby conviction, and some hope the Wisconsin ruling will lead to a systematic court review of the evidence in other shaken baby cases, or even an independent examination of the underlying science by some neutral third party like the National Academy of Sciences.
imageLeft to right: A brain MRI showing blood—indicated by the white crescent—between the skull and brain of a baby alleged to have suffered a violent shaking, photos of the right and left retinas of the same baby, a normal retina. Photo courtesy of Jonathan Trobe, MD, University of Michigan Medical System.
Shaken baby syndrome is a term coined in the early 1970s to describe what adherents contend is a characteristic set of head injuries found in infants who have been subjected to violent shaking: swelling of the brain, bleeding around the brain and bleeding in the retinas.
The theory was first espoused by a pair of pediatric specialists as a possible cause of the otherwise unexplained head injuries sometimes seen in infants with no visible signs of physical abuse. It quickly took root in the medical community.
Before long, SBS became widely accepted as a clinical diagnosis for head injuries inflicted on small children. And a nationwide educational campaign to alert the public to the dangers of shaking was launched.
In fact, SBS is now so firmly ingrained in the public consciousness that the World Health Organization has a diagnostic classification for it; the American Board of Pediatrics offers a subspecialty in it; and last year, for the fifth year in a row, the U.S. Senate designated the third week in April as National Shaken Baby Syndrome Awareness Week.
To this day, there is widespread consensus among medical professionals that shaking a baby is dangerous and often lethal. The American Academy of Pediatrics, the American Academy of Ophthalmology and the National Association of Medical Examiners have all issued position papers embracing the theory, although the NAME paper, which was published despite failing peer review, was later withdrawn. The Centers for Dis ease Control and Prevention publishes SBS prevention guides for public health departments and community organizations. And several states, including Ohio, New York and Texas, require prospective parents and child care providers to learn about the perils of shaking.
An estimated 1,200 to 1,400 children are injured each year by shaking, about one-quarter of them fatally, according to the National Center on Shaken Baby Syndrome, a nonprofit organization offering SBS prevention and training programs. The actual number of victims may be much higher, it says, because many such cases are misdiagnosed or go undetected.
But a growing chorus of critics says the entire theory rests on an uncertain scientific footing that continues to erode under the weight of scientific scrutiny, raising the specter that hundreds if not thousands of innocent people—parents, grandparents, baby sitters, nannies, boy friends—have faced criminal charges and even been imprisoned in the past three decades for crimes they may not have committed.
No one apparently keeps count of shaken baby prosecutions, though some experts estimate that about 200 people a year are convicted of shaking-related offenses based on the number of reported appeals. While some of those cases include corroborating medical evidence of abuse, such as cuts, bruises, burns or broken bones, others do not. And though some of the accused have admitted their guilt, others have steadfastly maintained their innocence. So Edmunds’ case was, in many respects, a typical one.
Because she loved kids—by 1995 she had two of her own and was pregnant with a third—and wanted to help out her neighbors, Edmunds quit her secretarial job and started caring for a few children in her home in the Madison, Wis., area. One of her newest charges was 7-month-old Natalie Beard.
Natalie, by all accounts a fussy baby, was particularly irritable on the day in question, Edmunds recalls. She tried to get the girl to eat, but Natalie refused, so she placed her in a car seat in the master bedroom and propped a bottle of formula in her mouth while she got her oldest daughter ready for preschool. She checked on Natalie once and everything seemed fine. But when she went back a second time, the girl was limp and unresponsive. Natalie was airlifted to a nearby hospital, where she died later that night.
Nobody saw Edmunds shake Natalie. There were no external signs of injury on the girl’s body. And Edmunds swore up and down she hadn’t done anything to harm the baby. But the doctors who treated Natalie concluded that she died from brain trauma caused by a violent shaking or a shaking with impact, citing among other things severe brain and eye damage peculiar to shaking and evidence of an impact injury to the girl’s scalp.
Edmunds defended herself as best she could. Her lawyer, Stephen Hurley, couldn’t find any experts who didn’t think Natalie had been subjected to a violent shaking, though he found one doctor who thought the girl had been shaken before she was dropped off at Edmunds’ home that morning. And the lawyer concedes that Edmunds made a terrible witness while testifying in her own defense.
“She was like a deer in the headlights on cross-examination,” he says. “I think that really hurt her.”
An army of prosecution experts testified that Natalie exhibited all the telltale signs of a severe shaking. This was no accidental shaking either, they testified, but one that was the equivalent of a fall from a two- or three-story building, or a car crash at 25 to 30 mph. And Edmunds must have done it, they insisted, because Natalie’s injuries were so severe she would have lost consciousness as soon as she was shaken.
The prosecutors also depicted the defendant as some kind of Jekyll and Hyde figure who reacted violently under the pressure of caring for a sick baby while five months pregnant and in the process of moving. She was convicted and sentenced to 18 years in prison.
Keith Findley, a law professor and co-director of the Wisconsin Innocence Project, got involved in Edmunds’ case after realizing that the medical community could not agree on whether Natalie Beard’s injuries were caused by shaking alone or other factors were involved. Photo by James Schnepf.
Edmunds’ first appeal, in 1999, went nowhere. But her luck changed in 2003 when the Wisconsin Innocence Project took an interest in her case.
The project’s co-director, Keith Findley, who teaches law at the University of Wisconsin, doesn’t remember exactly how he got involved in the case, but he does recall that both Edmunds’ trial and appellate lawyers had been deeply troubled by her conviction and were convinced of her innocence.
Findley knew very little about the subject at the time, other than what he had read about the 1997 Boston trial of British au pair Louise Woodward in the apparent shaking death of 8-month-old Matthew Eappen, the first high-profile courtroom battle over a shaken baby diagnosis. (A jury ultimately convicted Woodward of second-degree murder, but the judge reduced her conviction to involuntary manslaughter and sentenced her to time served.)
But Findley soon realized there were already raging debates in the medical community about whether shaking alone could produce the head injuries Natalie Beard suffered; whether such injuries could be due to other causes, both natural and inflicted; and whether a child with the kind of injuries Natalie had could remain lucid for hours or even days before dying or becoming noticeably impaired.
Then he discovered that one of the state’s key witnesses—Robert Huntington III, the pathologist who had done the autopsy on Natalie—had written a letter in a medical journal contradicting his testimony in the case against Edmunds.
Huntington had testified at Edmunds’ trial that it was “highly probable” Natalie’s injuries were sustained while she was in Edmunds’ care. But in his letter he wrote about a 1999 case he observed in which a child with head injuries similar to Natalie’s remained lucid in a hospital for more than 15 hours before she died.
When Findley contacted Huntington and told him why he was calling, Findley says, Huntington replied, “Oh, Audrey Edmunds. What are we going to do about that?”
Armed with that information, the defense prepared a motion for a new trial on the grounds that medical research developed in the decade since her 1996 trial constituted new evidence establishing a reasonable probability that a different result would be reached the second time around.
At a hearing on that motion, Huntington testified that he was no longer sure that Natalie had been shaken or that her injuries had been inflicted while she was in Edmunds’ care. Other defense experts testified that research advances in the previous 10 years had undermined the scientific basis for SBS and legitimized the views of critics once regarded as being on the fringe.
Prosecutors, however, contended that the case against Edmunds was even stronger than it had been in 1996, saying the intervening years of study and research had only reaffirmed the cause and timing of Natalie’s death. They argued that none of the six defense experts who testified on Edmunds’ behalf could provide an alternative explanation for Natalie’s injuries. They said the evidence the defense cited as new—whether shaking alone can cause such injuries and whether a child with such injuries could experience a lucid interval—had been the subject of an ongoing debate in the medical community that began long before her first trial. And they claimed it didn’t matter whether shaking alone can produce the kinds of injuries Natalie sustained because the state had also produced evidence of an impact injury to her scalp.
A Texas Child Protective Services specialist poses with a doll used for educating about the danger of shaken baby syndrome. Photo by Tyler Morning Telegraph, David Branch.
The trial court judge found that both sides had presented credible evidence. But he denied the defendant’s motion on the grounds that the state’s evidence was more persuasive.
However, the Wisconsin Court of Appeals reversed, saying that a “significant and legitimate debate” had developed in the medical community in the previous 10 years as to whether babies can be fatally injured through shaking alone, whether a baby with a traumatic head injury can experience a significant lucid interval prior to death, and whether other causes may mimic the symptoms traditionally associated with shaken baby syndrome. And those are issues for a jury, not a judge, to decide, the court said.
“The newly discovered evidence in this case shows that there has been a shift in mainstream medical opinion since the time of Edmunds’ trial as to the causes of the types of trauma Natalie exhibited,” the court wrote, noting that the debate reflects “a fierce disagreement between forensic pathologists who now question whether the symptoms Natalie displayed indicate intentional head trauma, and pediatricians who largely adhere to the science as presented at Edmunds’ trial.”
The decision prompted DePaul University law professor Deborah Tuerkheimer, a former child abuse prosecutor in Manhattan, to take a closer look at the science underlying the syndrome—which she, to put it mildly, found wanting.
Tuerkheimer published her findings in a 2009 Washington University Law Review article called “The Next Innocence Project: Shaken Baby Syndrome and the Criminal Courts.” She concluded that scientific advances in the past two decades have cast doubt on an entire category of SBS defendants—namely those convicted of shaking-related crimes based solely on the three key symptoms known as the “diagnostic triad.”
“While we cannot know how many convictions are ‘unsafe’ without systematic case review, a comparison of the problematic category of SBS convictions to DNA —and other mass exonerations—reveals that this injustice is commensurate with any seen in the criminal justice arena to date,” she wrote.
With the publication of Tuerkheimer’s article, an already divided scientific community appears to have become even more polarized.
Defenders of the SBS diagnosis complain that she leaves the impression that thousands of innocent people are sitting in prison due to a flawed scientific diagnosis. But critics of the SBS diagnosis, already galvanized by their legal victory in Edmunds’ case, view Tuerkheimer’s analysis as vindication of their complaint: That the research basis for shaken baby syndrome was flawed from the start.
The origins of SBS date back to 1968, when a prominent neurosurgeon conducted an experiment on rhesus monkeys to see whether brain and neck injuries would result from the whiplash forces of a simulated 40 mph rear-end car crash. The monkeys were strapped into a sled mounted on a 20-foot-long track, leaving their heads free to rotate, and the sled was struck from behind with a mechanical piston.
About a third of the monkeys suffered cerebral hemorrhages. Eleven of them also suffered injuries to the brain stem or cervical cord.
The experiment had nothing to do with babies or shaking. But in the early 1970s, two pediatric specialists, writing separately, pointed to the results as evidence for the proposition that a violent shaking with out impact, which one of them dubbed “the whip-lash shaken infant syndrome,” could cause permanent brain damage and mental retardation in infants and small children.
Ever since, critics say, the mainstream medical community has held to the belief that the presence of subdural bleeding, retinal hemorrhages and brain swelling in a child with no other injuries suggestive of an accident or abuse must have been shaken. And that the person with the child when he or she lost consciousness must have done it.
But those beliefs have been steadily undermined by subsequent research showing just the opposite, critics say.
The first big blow to conventional SBS wisdom was struck in 1987. That’s when a neurosurgery resident at the University of Pennsylvania, working with a group of biomechanical engineering students, devised an experiment designed to compare the forces generated by a violent shaking with established injury thresholds. To do so, they created models of 1-month-old babies equipped with sensors to measure acceleration, which were then shaken and slammed against both padded and unpadded surfaces.
Researchers found they couldn’t shake the dummies hard enough to generate the kind of force known to cause even a mild concussion. In fact, the most force they could muster was about one-fiftieth the amount of force generated by dropping the dummies onto a padded surface.
Another big blow to mainstream medical opinion on the subject came in 1998, when a forensic pathologist at East Carolina University School of Medicine studied the interval between injury and the onset of symptoms in 76 alleged child-abuse head injury deaths. In one-quarter of the cases, the interval was more than 24 hours; and, in four cases, it was more than 72 hours, apparently contradicting the conventional belief that a child with traumatic head injuries would be immediately symptomatic.
Further research in the past decade or so has shown that there are many other causes of the three key symptoms associated with SBS, including: short-distance falls, congenital malformations, genetic and metabolic disorders, various forms of childhood strokes, accidental injuries, infectious diseases, poisons, medical and surgical complications, and autoimmune conditions. And the list, now two pages long, continues to grow.
Some critics question the very existence of shaken baby syndrome. “There’s no such thing,” says retired forensic pathologist John Plunkett of Welch, Minn., an early critic of the diagnosis who has gone on to became a leading defense expert in shaken baby cases. “It doesn’t exist.”
Thomas L. Bohan, a lawyer and physicist who is a past president of the American Academy of Forensic Sciences, says he doesn’t know of a single physicist or biomechanical engineer who supports what he calls “this cockamamie notion” of shaken baby syndrome.
“It’s not something I can disprove,” he says, “but I can say that there’s no evidence to support it, and that every attempt to prove it has failed.”
In 2009, during his year as academy president, Bohan convened a blue-ribbon panel to review four areas of forensic science about which serious questions have been raised, including SBS.
The panel called for an independent investigation of the science behind the theory, to be undertaken by a qualified scientific organization amenable to both sides, which it said was “particularly crucial,” given the number of respected doctors on each side of the issue and the number of people who are sentenced to long prison terms each year for shaking-related offenses.
Another critic, Cyril Wecht, a lawyer and former Allegheny County, Pa., coroner, wouldn’t go so far as to suggest that SBS doesn’t exist. But he believes it’s one of the most overdiagnosed and misunderstood concepts in forensic science.
So much so that he wouldn’t want his four children or 11 grandchildren to baby-sit someone else’s kids.
British au pair Louise Woodward sits with her attorney, Barry Scheck, during prosecution testimony in 1997. Woodward was accused in the alleged extreme-force-injury death of infant Matthew Eappen. Photo by AP/Bizuayehu Tesfaye.
“When you come into a hospital emergency room in America today with an injured child, it’s automatically assumed you’re responsible for whatever happened until you prove otherwise,” he says.
Yet defenders insist that the scientific basis for SBS is not only sound but getting stronger every day.
Dr. Robert Block, president of the American Academy of Pediatrics, says there are now decades of ever-accumulating research, clinical observations, individual case reports and other data showing that babies can be injured through shaking, impact or a combination of the two.
Critics “say you can’t shake a baby hard enough to hurt it,” he says, “which they themselves would never do because they know damn well they’d end up with a dead baby or one with significant neurological injuries if they did.”
Block and other defenders say the only controversy over SBS in the medical community is the one that has been created out of whole cloth by a small group of defense-oriented experts who ignore the known science, discount the clinical experience of doctors who treat injured kids every day, and excuse the voluminous confessional literature in an effort to sow confusion and create doubt. They call them denialists.
Denialists, to these SBS defenders, typically use rhetoric to give an appearance of legitimate and unresolved debate about matters long considered to be settled by the medical or scientific communities. Or they are simply inflexible, like those who insist—despite all evidence to the contrary—that childhood vaccinations can be linked to autism and mental retardation.
Dr. Alex Levin, a pediatric ophthalmologist in Phila delphia who studies the eye manifestations of child abuse, says the only real way to find out whether SBS exists is to shake a baby and see what happens. But short of that, all available evidence—computer models; animal models; studies of children with diseases that mimic some of the symptoms of shaking; perpetrator confessions; and child abuse victims, both living and dead—shows that babies do get injured and die at the hands of otherwise well-meaning and loving caretakers who momentarily lose their temper.
“Shaken baby syndrome is real,” he says.
Levin, who testified for the state in Edmunds’ appeal, was reluctant to discuss his testimony without reviewing his notes. But prosecutors say he testified that Natalie sustained a type of severe retinal damage that indicates either a violent shaking or a crushing injury, about which there had been no evidence.
SBS defenders also say the so-called triad of symptoms—as often described by critics—are never the sole basis for a shaken baby prosecution but only the starting point in a diagnostic process. That process includes the medical findings, X-rays, the baby’s prior medical history, law enforcement and child welfare reports, interviews with the caregiver, and various tests to rule out other possible causes of the child’s condition before a final diagnosis is made.
“The medical findings are not presented in a vacuum,” says Leigh Bishop, a senior trial attorney in the special victims bureau of the Queens County, N.Y., district attorney’s office. “Juries base their decisions on all of the facts and circumstances of a case, not on some far-fetched defense claim that a short fall, a vaccine, meningitis, the West Nile virus or CPR may have caused the child’s injuries.”
Defenders concede that there are other potential causes for each of the symptoms associated with SBS, but say there is nothing else that mimics the symptoms in all of its manifestations. And while they acknowledge that people with certain types of brain injuries may experience a lucid interval before the onset of symptoms, they say that’s not the case in babies with the kind of injuries characteristic of a violent shaking.
“It’s like pulling a plug out of the wall,” Bishop says. “Once the plug is pulled, the lights are off.”
SBS defenders also discount the significance of the decision in Edmunds’ case.
“It’s one opinion by one court,” says Randell Alexander, a professor of pediatrics at the University of Florida in Jacksonville and director of the state’s child protection team. “There are plenty of other courts that see it differently.”
Moreover, they suggest that the legal system facilitates irresponsible expert testimony, which they claim was the case in Edmunds’ appeal. They argue that the Wisconsin court allowed the defense great leeway: setting a low bar for the qualification of expert witnesses; allowing experts to offer opinions without stating a basis; and permitting experts to rely on inadmissible evidence, including hearsay.
And both sides say the courts often seem ill-equipped to exercise control over the admissibility of complex medical evidence.
“Legitimate controversy exists in some areas of the medical research, and reasonable medical opinions may differ over select issues,” says Brian Holmgren, a veteran child abuse prosecutor in Nashville, Tenn., who teaches other prosecutors how to handle such cases. “But seldom do these controversies reach the core science of shaken baby syndrome or attack the legitimacy of the medical criteria used to diagnose this form of child abuse.”
In the wake of the decision in Edmunds’ case, a few other courts have followed suit. But those cases are the rare exceptions. Most shaken baby convictions have not been revisited. And new cases are being prosecuted every day.
That’s why critics of SBS are calling for an objective review of the evidence on both sides, to be conducted by a credible scientific organization like the National Academy of Sciences, which published a comprehensive report on the state of forensic science in the U.S. in 2009.
Such a study is not without precedent. In 2005, Great Britain’s attorney general, Lord Goldsmith, ordered a review of 88 shaken baby cases after an appeals court had ruled that triad-only cases “cannot automatically or necessarily” lead to the conclusion that an infant has been shaken. The review identified three convictions that warranted revisiting, in addition to nine others that had previously been identified as suspect.
And in 2007, the Canadian province of Ontario convened an inquiry into 48 shaken baby convictions. The vast majority of those convictions, 44 of them, were found to be of no concern. The remaining four have been referred to the attorney general for further possible action.
Many SBS defenders say they would welcome such a study. But some suggest it would be a complete waste of time.
“To do such a study suggests there’s an issue to be dealt with,” Alexander says. “And I don’t think there are any issues to be dealt with.”
Meanwhile, Edmunds, now 50, maintains her innocence. She says she would never do anything to hurt a child. And she can’t believe that anybody could think she would.
Assistant District Attorney Shelly Rusch says all the evidence in Natalie’s death indicates a violent shaking or other “high-energy traumatic event.” Photo by James Schnepf.
“I’m not the monster they made me out to be,” she says.
Edmunds, whose husband divorced her while she was in prison, moved to the Minneapolis area after her release, where she rents a room in a friend’s house and works in a convenience store until something better comes along.
Though she’s still angry about what happened to her, she’s determined not to be bitter.
“Bitterness will destroy you,” she says.
But Dane County Assistant District Attorney Shelly Rusch—who represented the state in Edmunds’ appeal —still believes that, in a fit of rage, Edmunds killed Natalie.
Rusch says that all of the medical evidence points to either a violent shaking or some other “high-energy traumatic event” like a car crash, which didn’t happen.
“Babies don’t just die for no reason,” she says.


Sunday, 4 December 2011

SBS: Washington: Mark Stanger loses second child, faces second manslaugher charge

OKANOGAN — An Okanogan man who was acquitted of shaking his six-month-old daughter to death 11 years ago is now charged with letting his nine-month-old son drown in a bathtub this summer.
Mark A. Stanger, 34, was charged in Okanogan County Superior Court Nov. 18 with first-degree manslaughter. Prosecutors say he recklessly caused the death of his son, Marcel, who was flown to Sacred Heart Medical Center on July 17 after nearly drowning in the family’s bathtub at 237 Spruce St.
Marcel died at the Spokane hospital a month later.
A preliminary autopsy found that Marcel died of asphyxia due to partial drowning, according to a report by Okanogan County Sheriff’s detective Debbie Behymer, filed with the charges.
According to that report:
Stanger told deputies that he put his son in the tub in about 6 inches of water at about 3:30 p.m. He then yelled up to his Marcel’s mother, Lanni — who was upstairs and on medications due to a vehicle accident — that Marcel was in the tub and she needed to take care of him. He told deputies he went into the living room to watch television, and fell asleep. When Lanni woke him up about 15 or 20 minutes later asking where Marcel was, he ran to the bathroom to find him limp, lying on his back in the water. When deputies asked why there was no water in the tub, he told them that he had drained it after finding Marcel.
The preliminary autopsy found no physical injuries, the report said.
The charges come 13 years after Stanger lost a baby girl, Mercedes Chapa, who was also flown to Sacred Heart Medical Center in Spokane following injuries she received while under Stanger’s care.
He told authorities that his daughter fell off their bed while he was cleaning their Riverside apartment. He was later charged with first-degree manslaughter after the Spokane County medical examiner found the baby died of shaken infant syndrome.
But an Okanogan County jury found him not guilty in December 2000. Stanger’s Spokane attorney, Bevan Maxey, said at the time that the jury told him there was insufficient proof to convict Stanger of either first- or second-degree manslaughter.
“The evidence indicated he was a good father, a loving father,” Maxey told The Wenatchee World after the verdict, adding “One can only imagine what it would feel like to lose a child, to be blamed for it, and then to face the potential of getting wrongfully prosecuted.”
K.C. Mehaffey: 997-2512

SBS: Nebraska: Kendra Fritsche pleads no contest

Nov 30, 2011
By Nina Harrelson

A Holdrege woman who pleaded not guilty last summer to child abuse charges stemming from an incident at her daycare has changed her plea to no contest after the charges were amended.
Kendra Fritsche, 39, entered the plea Nov. 21 in Phelps County District Court. She was originally charged with committing child abuse intentionally with injury -- a Class 2 felony -- but the charges were amended to committing child abuse intentionally with no injury -- a Class 3 felony.
Fritsche was arrested in February after a 3-month-old girl in her care was taken to the emergency room at Good Samaritan Hospital in Kearney on Oct. 15, 2010, with a skull fracture.
Doctors say the infant also showed signs of shaken baby syndrome.
Fritsche told authorities that she may have put the child down in a carseat "too hard."
Sentencing has not yet been scheduled. She could serve up to 5 years in prison and/or be fined up to $10,000 if convicted. Under the original charges, Fritsche was facing up to 50 years in prison.

SBS: Virginia: Brian Walker sentenced

Nov 26 2011: Nancy Drury Duncan
ACCOMAC -- A man convicted of the involuntary manslaughter of his girlfriend's 11-month-old baby was sentenced to spend five years in the penitentiary.
Brian Terrell Walker, 26, of Nassawadox was charged with murder in the March 2010 death of Isaiah Russell, but was convicted of the lesser charge of manslaughter by a jury earlier this year.
Walker was at home with Isaiah and his two-year-old sister while his mother worked at a local chicken plant, said Deputy Commonwealth's Attorney Matthew Brenner. He told the court of the severe injuries suffered by the child, who arrived at Riverside Shore Memorial Hospital in critical condition. Isaiah Russell was airlifted to Children's Hospital of the King's Daughters in Norfolk, where he was removed from life support two days later, Brenner said.
Dr. Verena Wyvil, a child abuse specialist from that hospital, testified that the child had three skull fractures as well as multiple bruises and lacerations. She told the court he was a victim of shaken baby syndrome.
Defense attorney Benjamin Sample said his client gave up vacation time to stay with the boy and save the child's mother the money she would have spent on day care. He said Walker was a heavy sleeper and was awakened by the two-year-old, who told him her brother was not breathing right. He said Walker found the baby on his back on the floor, "gasping for air." Walker did not know how the baby sustained his injuries, he said.
"Walker is a very deep sleeper," said Hamlet. He said Walker ran to a neighbor's house and called 911 right away.
A medical examiner described the cause of death as a "blunt-force head injury."
Circuit Judge Stephen C. Mahan denied a defense request to set aside the jury's verdict and a motion to strike the evidence prior to the sentencing. "There is ample evidence the defendant committed the offense beyond a reasonable doubt," he said.
He sentenced Walker to five years as was recommended by the jury and also imposed a three-year probation after release.

Thursday, 24 November 2011

SBS: Oklahoma: Raven Koch death homicide

November 16th, 2011,

DAVIS, Okla. -- An Oklahoma mom is seeking justice. Her 11-month-old daughter is dead. Raven Koch was at a babysitter's house when police reports show something went horribly wrong. The OSBI has investigated the case; however, so far they have not been able to name any suspects or make any arrests.
In fact, the family is starting to believe no one will ever face charges.
According to the Medical Examiner, Raven died of accute subdural hematoma due to shaken baby syndrome.
The case was ruled a homicide but to this day no arrests have been made.
Taryn Koch, Raven's mom, said, "It's very discouraging to know my daughter was murdered violently and no one will ever pay for it."
The Medical Examiner's report shows there was not only hemorrhaging on her brain, but that she had been shaken so violently her eyes were no longer attached.
The M.E. also said the abuse was recent.
While doctors at Children's Hospital told Taryn the injury was fresh, a doctor at the first hospital to treat Raven said it could have happened anytime within the two weeks leading up to that day.
Because of that doctor's analysis, investigators have to look at anyone who had contact with Raven in her last two weeks of life.
Taryn said, "Everyone has basically told me their hands are tied. Without a confession, nothing can be done."
The district attorney here in Murray County refused to do an on-camera interview with us.
However, he did tell us there are numerous people who could be potential suspects in this case.
He also said there is not enough evidence to prove any one person did this, which means there may never be justice for Raven.
Taryn said, "Crying myself to sleep the rest of my life isn't going to work."
Taryn said she doesn't want just anyone convicted, but she does hope the person responsible will some day come forward.
She said, "I miss Raven dearly and she deserves justice and I deserve closure."
Investigators are hoping someone out there has more information that could lead to an arrest and charges in this case.
If you have information, you are asked to contact the OSBI or the Murray County District Attorney's Office

SBS: AlabamaL Scott Durham arrested

 Wednesday, 23 Nov 2011, Candace Murphy

BALDWIN COUNTY, Ala. (WALA) - A 6-month-old infant is on a ventilator after authorities said her father, Scott Durham, bounced her on a bed out of anger. Baldwin County Deputies said the alleged abuse happened November 18 in Foley.
They said Durham admitted to losing his temper due to stress and being tired. He told deputies he aggressively bounced the infant on the bed.
“Once we started the interview process and started to talk with him about it, within just a limited amount of time he ended making a statement and confessing to it,” said Baldwin County Sheriff Huey Mack. “What we find is even though these people assault children, in the back of their mind, they realize that’s not the proper thing to do, and so the guilt does starts to take over, and I think that was the case in this.”
The 6-month-old girl suffered a hemorrhage on the brain and severe retinal hemorrhage. She was air lifted by Life-Flight to Sacred Heart Hospital in Pensacola, where she is still in intensive care.
“The nature of the injuries fall in line with what we call shaken baby syndrome, and that’s simply where a child’s head is moved about so violently that it causes an internal injury,” said Mack.
Durham has been charged with first degree domestic violence and is at the Baldwin County Corrections Center under no bond.
Officials said this is the third time Durham has been arrested in the past two years for domestic violence. They want to keep him in jail as long as they can.
“We're hoping not only for the judge to set for a high bond, but we typically ask for conditions [in addition to] bond, such as no contact with the family, can’t return to the residence - those type of things,” said Mack.
Neighbors FOX10 spoke with said the child's mother just got back from being with her daughter in Pensacola. She was too upset to speak with us.

SBS: Rioc Edwards-Brown false accusation

By Beth Hale 24th November 2011

Devoted: Rioch Edwards-Brown now helps other families who are wrongly accused of hurting their children
Devoted: Rioch Edwards-Brown now helps other families who are wrongly accused of hurting their children
Cradling her baby son, TV researcher Rioch Edwards-Brown stared in disbelief at the two social workers standing before her in the hospital room. Their lips were moving but she could barely make sense of what they were saying.
It was a moment that would fill any loving parent with horror. Rioch had just been told her six-month-old son Riordan — the baby she and her husband Ian had longed for — would be removed from her care in three days’ time.
Paralysed with shock, all she could focus on was the tiny bundle curled up against her chest and the voice inside her head telling her to breathe.
The memories of that Friday afternoon are as sharp today as they were 16 years ago.
‘For a split-second I couldn’t remember how to breathe,’ says the 46-year-old mother-of-four. ‘I couldn’t even tell you my name.’
Rioch and Ian found themselves thrust into a nightmare after a doctor decided their son’s ill health from birth — culminating in an unexplained fit — was caused by shaken baby syndrome. In other words, the caring parents were suspected of  shaking Riordan until his brain bled.
The suspicions were unjustified. Medical notes would later back up the fact Riordan had suffered a brain bleed during his premature birth, but by that time child protection proceedings had started — and seemed unstoppable. There were three court hearings and Rioch and Ian fought for nearly a decade to clear their names.
Today, that tiny fragile baby is a strapping young man who loves sport and is studying for A-levels after gaining 12 GCSEs. As for Rioch, she gave up her job working alongside her TV producer husband and started helping other parents facing similar ordeals.


For 15 years, without pay or outside funding, she has run The Five Percenters, a support group that takes its name from the fact that one in 20 cases of shaken baby syndrome is misdiagnosed. From a desk in the living room of her family home in New Cross, South-East London, Rioch, runs the 24-hour free advisory service.
Rioch and Ian’s fight for justice cost £50,000, but since then they have remortgaged their home and spent £250,000 funding the support group in the hope that other parents accused of shaking their babies or other abuse are spared the agony they faced.
Longed for son: Rioch with Riordan when he was two-years-old. She had to launch a legal batle to keep him after being falsely accused of shaken baby syndrome
Longed for son: Rioch with Riordan when he was two-years-old. She had to launch a legal batle to keep him after being falsely accused of shaken baby syndrome
Rioch — who also battled a benign brain tumour in 2009 — never imagined the nightmare ahead when she met Ian in 1990.
Their early hopes for children were cruelly crushed when she suffered a series of miscarriages caused by a cervical condition which doctors cured. She went on to have Riordan in 1995. He was born six weeks early, weighing 6lb 3oz.
The couple were delighted, although Rioch soon doubted his health. ‘He’d cry then suddenly stop,’ she said. ‘He looked beaten up, like he’d gone 10 rounds with Mike Tyson.’
Over the following months Riordan’s fragile health meant frequent tests.
‘Eventually, a doctor said he had suffered a brain bleed commonly associated with premature babies,’ recalls Rioch. ‘As we were leaving she said, “You haven’t ever dropped him have you?” I laughed and said, “No.” ’
But Rioch had a niggling doubt something more serious was wrong.
A week later, Riordan suffered a fit and ended up back at King’s College Hospital, London.
Days of tests and questions followed. ‘When the consultant told us Riordan had suffered the sort of bleed they would expect to see in a child with a lot of trauma I just couldn’t take in.
‘Ian said, “Do you mean like a boxer’s punch?”
She replied, “Yes, or Riordan being shaken and swung around by the ankles against a hard surface.”
‘I was told that if I made any attempt to leave the ward the police would be called.’
Mother and son today: Riordan has grown up to be strong and healthy despite his health problems as a child
Mother and son today: Riordan has grown up to be strong and healthy despite his health problems as a child
Rioch suddenly realised the finger of suspicion was pointing at her and Ian — and they were devastated when two social workers revealed they would apply to take Riordan into care within days.
Reeling with shock, they sought legal help and were able to keep Riordan. Three months later, with clear medical evidence pointing to injuries caused by birth trauma rather than abuse, a High Court judge threw out their case.
However, it took eight years before the shaken baby accusation was removed from council and hospital records.
Rioch and Ian went on to have three more children, but were terrified each time one fell sick, fearful they could be accused again.
‘I couldn’t afford for Riordan to get as much as a bruise,’ she says.
‘It was after I did a television interview and 40 families got in touch that I thought about starting the Five Percenters. I found myself wondering how a family without the support and contacts we had would ever stand up against this?’
Over the past 15 years Rioch has helped more than 4,000 families worldwide facing a similar ordeal. ‘Of course, it is disgusting that genuine abuse exists,’ she adds.
‘There will always be people who say they are innocent and are not. But I feel we have a duty to people like us who are wrongly accused. We were told we were a “one-off”, a mistake. But if they can make a mistake once, they can do it again.’
 Rioch’s vision, called 24:14, is for a nationwide hospital protocol ensuring all children suspected of being abuse victims are seen by paediatric specialists within 24 hours of admission and for the case to be reviewed within 14 days — sparing the agony of misdiagnosis and cases slipping through the net.
‘Doctors said Riordan wouldn’t walk, talk or swallow,’ she says. ‘But he is now built like a rugby player, eats me out of house and home and never stops talking. He’s amazing.
‘When people say to me, “Why do you do what you do?” I tell them that I have my kids when the majority of families who come to me don’t. I consider myself very fortunate.’

SBS: New York State: Asa Madsen arrested

11/21/2011  Dan Levy

Bill Phelps
Bill Phelps

SCHENECTADY - The father of a baby who police say was abused to the point where she is now blind says the mother is also partially to blame.
Troy police arrested the mother's boyfriend, 30-year-old Asa Madsen of Averill Park on Friday. Now Bill Phelps, who lost all parental rights with his daughter Lia several months ago, although heartbroken, hasn't given up hope that his daughter will one day recover from her injuries or that he'll one day regain custody.
Even though Phelps hasn't been able to establish the kind of father-daughter relationship he would like, in the limited time he's been able to spend with Lia he's learned quite a bit.
"She's very smart," he boasted proudly. "She's lovable. She loves to snuggle and she loves to kiss daddy."
On Tuesday of this week, Phelps got a call from the baby's mother, Beth Taber, telling him Lia had fallen in the bathtub and hit her head and was then rushed to Albany Medical Center.
"When the final report came back from the neurosurgeon, they said that there was no possible way that the baby just fell," Phelps said. "That's when they came up with the shaken baby syndrome."
On that diagnosis, police arrested Madsen and charged him with shaking little Lia so violently she is now blind.
"I tried to say to Beth, you're just as guilty as him. If he's hitting you what makes you think he's not going to hit the children?" is what he posed to his ex-girlfriend of eight years with whom he fathered two children.
Phelps says he's well aware of Madsen's violent past. As a teenager, he was charged with killing his then-girl friend's cat. Earlier this year Madsen was slapped with a court order to stay away from Taber and her children after he allegedly tried to choke her.
"I have tried to work things out several times to get her away from the situation, but it never worked out," Phelps said. "She always wanted to be back with him for what ever reason I don't know."
He continued, "In my opinion, just be her covering and the events that happened from that day until now, she's just as guilty as he is. Whether she did it or not, or he did it, she covered for him to save her own hide, while the baby is sitting in the hospital."
Phelps says Lia is making progress every day and that she's playing and alert and may be released later this week.
He and Taber also have a 2-year-old son who is now staying with relatives. Phelps says he intends to be at Rensselaer County Family Court on Monday morning to file for custody of his children.
Madsen remains in the Rensselaer County Jail unable to make bail.
Police say the investigation is continuing.

SBS: South Africa: Makinda and Bradley Connor's child dies

1st December 2011
Baby Michael, blinded and crippled both physically and mentally after ferocious assaults in the family home only months after his birth, has died, aged eight.
Baby Michael
Michael’s death – of broncho-pneumonia, on 16 October – came just a month before his parents, Malinda Marshall and Bradley Connor, were due to face judgment on November 21 in the Johannesburg Regional Court, on charges of attempted murder and assault on their infant son.

Their case, which has been extensively reported in Noseweek (noses108, 121, 130 etc) has been dragging on for years, with one legal ploy after another used to delay the day of reckoning.  Magistrate Frans Booyens has had to come out of retirement to conclude the case in Court 17.

Senior prosecutor Carina Coetzee says it was too late to change the assault charges to murder as Michael’s death came long after the original assaults.

Baby Michael, born on 11 July 2003, was taken into care in 2007 at Avril Elizabeth, a private residential home in Germiston for the mentally disabled. He lived in a section of the home called the Nursery, where he received 24-hour care. He attended physiotherapy daily, and although he didn’t progress much, did not deteriorate.

Officially, after his beatings at age two to four months, Michael had Shaken Baby Syndrome. In addition to being blind he was spastic, quadriplegic and was profoundly mentally handicapped. He was confined to a wheelchair but after prolonged physiotherapy was able to hold up his head without support, albeit for short periods of time.

Nursing sister Stephanie says: “Although profoundly mentally and physically handicapped, he was comfortable and had a reasonable quality of life for four-and-a-half years at Avril Elizabeth. He seldom cried for no reason and seemed content.”

Michael had a host mother, Gwen Hedges, who has a mentally challenged child. Gwen visited Michael frequently at Avril Elizabeth, and took him out for family birthdays and celebrations. “We were shattered by the news, but we rest in the peace that Mickey is finally free,” she says.

Michael’s parents never saw him again – Avril Elizabeth only agreed to accept him on condition they were banned from the premises.

Because of Michael’s mental and physical condition he was unable to move. This immobility caused build-ups of phlegm in his lungs, leaving the boy susceptible to chest infections, resulting in bronchitis or pneumonia. As with many mentally-handicapped people who are unable to communicate other than by crying, it was often difficult to establish what the problem was, and nursing staff would go through a process of elimination.

From August this year, Michael had not been well, and spent several sessions in Avril Elizabeth’s sick bay, the Life Healthcare Roseacres Hospital (where he had a CT scan), and at Charlotte Maxeke Academic Hospital. Staff remember Michael as a generally happy little boy, “our treasured little angel” much loved by all.

Baby Michael’s story has highlighted the dedication and commitment of charitable institutions such as Avril Elizabeth and their belief that every life has value, even that of a grievously brain-damaged child – if only for his uplifting smile.

A Noseweek staff member who visited Baby Michael recalls the boy’s beautiful smile. “Look!” would cry the nursing attendant, “he knows it’s you!”

SBS: Oklahoma: Helen Terrell charged

Monday, 7 November 2011

SBS: North Carolina: Cheryl Alston trial


HILLSBOROUGH – After calling two doctors and a biomechanical engineer who questioned the theory that shaking a baby can cause traumatic brain injury, the defense rested its case Friday in the trial of Cheryl McAdoo Alston.
The state began its rebuttal evidence Friday morning, and it is expected that closing arguments will begin early next week.
Alston is facing charges in connection with injuries to a 5-month-old baby that was in her care in Chapel Hill on May 1, 2009. The state contends that Alston shook or otherwise injured the baby, who suffered serious brain injuries that have left him with permanent disabilities requiring him to undergo nearly constant therapy.
Assistant Public Defender Susan Seahorn began her defense of Alston by calling Alston to the stand. Alston adamantly denied hurting the baby in any way, but during cross-examination, Assistant District Attorney Lamar Proctor pointed out several inconsistencies in the story she told about what happened that day.
The prosecution focused on where the baby was just before Alston claims she noticed something was wrong with him.
During questioning by investigators, which the jurors saw on videotape, Alston insisted that she had put the baby in a bassinette in a room for his afternoon nap and when he woke up, he was cheerful and happy.
Alston said she changed his soiled diaper and was washing her hands when she realized something was wrong with the baby and he began having a seizure. She was on the phone with the 911 operator when the father arrived that afternoon to pick his son up.
On the videotape, however, after the investigator told her about evidence that called into question her story about where the baby had been sleeping, she then admitted the baby had been in the car seat before she changed his diaper.
The investigator suggested that she had been keeping the baby in the car seat, which is against day care regulations, because she had previously injured the baby and was keeping a close watch on him by carrying him around in the car seat while she went about her other business.
Seahorn, however, in her cross-examinations of the state’s witnesses, which included the baby’s father, focused on inconsistencies in their statements, including a radiologist who changed his report just before the trial.
Seahorn’s expert witnesses testified that in the last decade, some doctors have begun to question whether the theory of shaken baby syndrome is correct. Treating doctors have diagnosed the syndrome based on injuries they’ve seen on babies’ brains, and then investigators, armed with that knowledge, have gone looking for the person who most likely shook the baby and charged that person with a crime even though there was no other evidence other than the doctor’s diagnosis that the baby had been shaken.
Seahorn’s theory of the case is that the treating doctors don’t really know what caused the injury on the baby’s brain. She presented one witness, a biomechanical engineer who conducted tests on a doll at his home, who contended that shaking a baby does not produce enough force to cause those types of injuries.
During the trial, Proctor and Seahorn have periodically sparred angrily with each other, raising their voices and jumping up out of their seats to interrupt the other, both in front of the jury and outside the jury’s presence.
Each has offered multiple objections to the other’s evidence and witnesses forcing Superior Court Judge Michael Morgan to repeatedly send the jury back to the jury room so he could hear their arguments outside of the jury’s presence.

: The Herald-Sun - Defense claims shaken baby syndrome theory is wrong

SBS: Virginia: Amy Hunter charged

Kari PughThe Naval Criminal Investigative Service has charged a 25-year-old Quantico woman with shaking to death a baby in her care.
Amy Hunter, 25, admitted to violently shaking a 9-month-old girl she regularly babysat at her home on Quantico Marine Corps base on April 26, according to a criminal complaint filed in U.S. District Court in Alexandria on Oct. 17.
Hunter was watching the baby, identified in court papers only as C.P., along with her own 10-month-old daughter, the complaint said.
Hunter called 911 at 9:23 a.m. reporting the baby girl was unconscious after taking a fall and hitting "the back of her head really hard," the complaint reads.
The infant was airlifted to Inova Fairfax Hospital, where she was pronounced brain dead. Her family took her off life support on April 28.
An autopsy revealed the baby suffered from skull fractures, soft tissue swelling, a subdural hematoma and severe retinal hemorrhages consistent with shaken baby syndrome, the complaint stated. She also had a healing rib fracture that appeared to be several weeks old.
Hunter first told investigators she had gone to the bathroom and the infant had fallen backwards and hit the back of her head on a lower chair rail, the complaint stated. She said she picked up the unconscious baby and called her mother, who told Hunter to call 911, according to the complaint.
During a second interview investigators conducted with Hunter on April 27, she "admitted that on the morning of April 26 … she repeatedly shook C.P., causing C.P.'s head to strike the wall," the complaint stated.
A search of a computer seized from Hunter's home revealed that between January and April, someone with access to the computer conducted several searches related to "shaken baby syndrome" and "baby hits back of head," according to the complaint. The first search was conducted Jan. 6, 2011 and the others on the morning of April 26.

SBS: Coloradfo: Shawna Nacke indicted

LEADVILLE, Colorado — Lake County social services took a 7-month-old boy away from his parents, and the woman they placed him with is now charged with felony child abuse after allegedly inflicting injuries that may leave the child blind.
A grand jury indicted Shawna Nacke, of Leadville, on two felony counts of child abuse and one misdemeanor count. Nacke turned herself in and is free on $20,000 bond.
The case goes directly to Lake County District Court and Judge Karen Romeo.
Nacke faces up to 32 years in prison. The grand jury indicted her on charges of:
• Class 3 felony child abuse. Knowingly or recklessly causing serious bodily to a child.
• Class 4 felony child abuse. Negligently causing serious bodily injury to a child.
• Class 2 misdemeanor child abuse. Negligently causing bodily injury to a child.
District Attorney Mark Hurlbert says they don't know yet whether they'll go for the maximum sentence.
Nacke makes her first court appearance Nov. 28.
The boy was shaken enough that he suffered “significant” brain swelling and had to have surgery to relieve the pressure, Hurlbert said.
“He's alive. There's the potential that he could be blind,” Hurlbert said.
What the police report says
At about 8 a.m. July 15, Leadville police responded to 321 Mount Harvard in Leadville when Nacke called them about an unresponsive baby, according to the arrest affidavit.
When police and paramedics arrived, the baby was taken to Saint Vincent's hospital, and quickly flown by Flight for Life to Children's Hospital in Aurora. Firefighters reported the baby was breathing on its own, that its right eye was partially closed and its left eye was open and the pupil was dilated. Its right leg had multiple bruises, Leadville/Lake County fire fighter John Ortiz said in the arrest affidavit.
Nacke agreed to speak to police and told them a toy being dropped on him by his brother caused the child's bruises, himself a toddler, that the toddler tripped and fell on him, and the leg bruises were caused by a swing.
When the boy woke up that morning, Nacke called 911 when she thought the boy was having a seizure, she told police.
Their father, Donald Nacke, had been to their house the previous night after she had gone to work, so he could put his children to bed.
Social services placed the children with Shawna Nacke and her husband because their mother has substance abuse issues, she told police. The children's father is Nacke's husband's brother.
She told police she would take a polygraph test, the affidavit says.
Dr. Lisa Zwerlinger told police that the child's mother used alcohol and drugs while she was pregnant, and as a result the child “developmentally challenged.” He's nine months old and cannot roll over on his own, according to the doctor's statement in the arrest affidavit.
Grand jury convened
Dr. Andy Sirotnick, associate professor of pediatrics and a member of the child protection team at Children's Hospital, testified that the boy's injuries would not have happened the night before, saying that if the injury had happened the night before the boy would not have survived.
The boy is going to be blind due to being a victim of shaken baby syndrome, and that because Nacke was the only adult at the residence when emergency services were called, “we can conclude that Mrs. Nacke caused the injuries,” according to Sirotnick's statement in the arrest affidavit.
This was only the second Fifth Judicial District grand jury convened since the 1960s, Hurlbert said.
Judge Romeo convened the 12-person grand jury from around the Fifth Judicial District's four counties: Eagle, Summit, Lake and Clear Creek.
They heard five days of testimony before indicting Nacke on Oct. 5.
Staff Writer Randy Wyrick can be reached at 970-748-2935 or

SBS: Physicians required by law to report

SHERRY BOSCHERT, Family Practice News Digital Network
SAN FRANCISCO – The color of a bruise indicates its age. You’ll almost always see bruising when a child has a fracture. Sexual abuse leaves behind physical exam findings.
These are all myths that can get in the way of physicians recognizing abuse of an infant or child. Physicians are required by law to report all suspicions of nonaccidental trauma, a catch-all term for child abuse, shaken baby syndrome, and battered-child syndrome.

Dr. Maureen D. McCollough
Physicians can meet that obligation by ignoring these myths, recognizing red flags for nonaccidental trauma, and being familiar with signs of accidental trauma or medical conditions that can mimic the physical findings of nonaccidental trauma, Dr. Maureen D. McCollough said at the annual meeting of the American College of Emergency Physicians.
Myth: The age of bruises can be accurately determined by their color – red, purple, yellow, green, or brown. In reality, there is no predictable order or chronology of color in bruising, and even in the same person bruises of similar ages may have different colors, said Dr. McCollough of the University of Southern California, Los Angeles, and director of pediatric emergency medicine at Los Angeles County USC Medical Center.
Studies have shown poor interobserver reliability in assessing bruise coloring and poor physician accuracy in characterizing coloring.
Red flags of suspicion should go up if you see multiple bruises or lacerations, or see them in unusual locations. Accidental toddler tumbles can produce multiple bruises, but generally these are on bony prominences. Unusual locations for pediatric bruising include the lower back, buttocks, cheeks, ears, or neck. Bruising anywhere in an infant who is not yet mobile is suspicious.
"Remember, if you don’t cruise, you don’t bruise," she said.
Be suspicious if the pattern of the marks, bruises, or lacerations remind you of an object like a hand, hairbrush, belt, or buckle. Bruises around wrists or extremities may be from the child being tied up. Tight elastic socks can leave a mark around an infant’s leg that mimics this, in which case the parent should be able to provide a sock with dimensions that match the bruising.
Visible injuries around a baby’s mouth or frenulum should raise a red flag for forced feeding. Genital injuries may indicate forced toilet training. Hair pulling produces characteristic marks of traumatic alopecia – an incompletely bald child with diffuse alopecia, broken hairs, and no loose hairs at the periphery.
A wide variety of problems can mimic the visual signs of nonaccidental bruising, including dermal melanosis, vitamin K deficiency, leukemia, hemophilia, millipede secretions, Ehlers-Danlos syndrome, dermatitis, lice, and more.
An equally impressive array of events can mimic the look of abusive burns, bullae, and erythema. These include the cultural practices of coining, cupping, spooning, or moxibustion, skin infections, allergic reactions, herpes or varicella infection, diaper dermatitis, impetigo, and more.
Accidental burns usually have a typical "splash" pattern if liquid is involved, or a child who grasps something hot will have burns on the volar aspect of the fingers and palm. Accidental cigarette burns usually have a streaky appearance.
If there are no splash marks, or there is a sharp line of demarcation, or burns are limited to the perineum, consider that the child may have been forcibly immersed in something hot. Intentional cigarette burns tend to be similar in size – often 5-mm circles – and create injuries from bullae to deep craters that scab over. These usually are on the palms or soles but can be anywhere on the body. Again, be suspicious if you see a burn mark that looks like an object, such as a radiator or an iron.
Myth: Fractures usually are associated with overlying bruising. In fact, children with inflicted skeletal fractures often have no associated bruising. Bruising is present in only 43% of skull fractures and less than 20% of lower extremity fractures in cases of abuse, Dr. McCollough said.
Infants who can’t walk shouldn’t fracture. Spiral fractures caused by the twisting of a long bone such as the femur suggest nonaccidental trauma. Toddler spiral fractures of the tibia, on the other hand, are very common, caused when a leg is trapped under the body during a fall, such as getting a leg caught in a couch. "This is not abuse," she said.
Raise the red flags when you see swelling of a body part that is out of proportion to a described injury; this may indicate an underlying fracture. A diaphyseal (midshaft) fracture in a child less than 3 years old is suspect, and metaphyseal or epiphyseal fractures beyond the newborn period (also called corner fractures or bucket handle fractures) are virtually diagnostic of abuse.
The posterior ribs are the most common area of nonaccidental rib fractures.
Suspect head injuries and possible abuse if the child has unexplained seizures, vomiting, changes in neurological or mental status, or large scalp hematomas. Be suspicious if the parents’ explanation changes over time, if there is intracranial bleeds after "minimal" trauma, or if you find retinal hemorrhages outside of the newborn period, she said.
Myth: Sexual abuse leaves physical findings. More myths: A colposcope is needed to detect sexual abuse, and some girls are born without hymens.
Although hymens come in a wide variety of shapes and sizes, a study of more than 1,100 newborn girls showed that all of them had one, she noted. Reviews of cases of sexual abuse show that physical exam findings of pediatric sexual abuse are rare because the tissue is very elastic and heals quickly.
Physical evidence will be more likely if force was used, if the child resisted, if there are great differences in the sizes and ages of the perpetrator and victim, and if a foreign object was forced into the mouth, vagina, or anus. Bruising or bite marks on a child’s penis may suggest nonaccidental trauma from forced toilet training.
When you see visible clues to what may be abuse, photograph or draw what you see and include something in the image to show size or scale. Don’t just rely on written notes, she said.

SBS: Virginia: Brian Ferris

October 23, 2011

SBS: Virginia: Paul Farthing denied probation

Lorie Love Hailey   
RICHMOND — Family members of a baby killed by her father in 2010 breathed sighs of relief Thursday when a motion to grant shock probation to her killer was denied.
Jean Williamson, grandmother of 3-month-old Rylee Jean Campbell, thanked Assistant Commonwealth’s Attorney Jennifer Smith as she hugged her in Madison Circuit Court.
Paul Sanlan Farthing Jr., 32, was sentenced in May to 10 years in prison after pleading guilty to second-degree manslaughter in his daughter’s death. He originally was charged with murder.
Attorney Jim Baechtold asked Circuit Judge Jean Chenault Logue to consider shock probation because, he said, Farthing is a first-time felon who already has served 544 days in jail.
“I’m sure we’re going to be agreeing to disagree on whether shock probation is appropriate,” Baechtold said.
Farthing is eligible for parole in about 114 days, the attorney said, but if Logue shocks him, she would have control over the conditions of his release.
Smith argued the only reason Farthing is “in the situation that he is” is because there were no witnesses.
“Rylee Campbell was a beautiful little baby and he killed her,” she said.
Farthing was arrested for his daughter’s death on April 14, 2010, after she died at the University of Kentucky Medical Center from what doctors there said was shaken-baby syndrome. She suffered from multiple injuries.
The baby had been in Farthing’s care prior to her injuries.
His mother told the Register the infant’s injuries occurred accidentally, while her maternal grandmother repeatedly disputed the story.
“Who is going to stick up for Rylee?” Williamson asked the Register on multiple occasions.
On Thursday, it seemed that Logue would fill that role.
“In this particular case, and I’ve reviewed it, it is one that I just don’t find appropriate to grant probation,” the judge ruled.
Farthing’s 10-year sentence was left unchanged, but because second-degree manslaughter is not considered a violent crime, Farthing must only serve 15 percent — or 1 1/2 years — of his sentence before being eligible for parole.
Lorie Love Hailey can be reached at or 624-6690.

SBS: Pennsylvania: Kristopher Trescoe hearing

 October 20, 2011
A father accused of shaking his baby was in court on Thursday, where a doctor talked about the boy’s injuries.
Kristopher Trescoe and his wife came to his preliminary hearing together. Police said Trescoe was home alone with his five-month-old twins when his son became unresponsive.
Thursday was the first time the courtroom heard from the doctor who examined the baby. The doctor, from Children's Hospital, read a report she wrote that was several pages long.
The report said the baby needed "aggressive life support" and had several "seizures."
The report also said the baby "was born a healthy child" and the injuries are a result of "shaken baby syndrome."
Trescoe's attorneys disagreed with those findings.
"A lot of medical testing still needs to occur. We're still waiting for that, and Scott and I are both very confident, as well as Richie's mother and father, when all the medical records are compiled and given to us, it's going to be a very different case than the commonwealth presented this morning," said attorney William Brandstetter.
The attorney said the child could suffer from an illness, and that would explain the child's condition. He said the baby is now at home recovering.

SBS: Oklahoma: Raven Koch, 1, was found unresponsive May 3 at a baby sitter's home


Raven Koch, of Davis, was found unresponsive at the home of a baby sitter on May 3 and later died at an Oklahoma City hospital.

FROM STAFF REPORTS     October 22, 2011
A child fatally injured while in the care of a baby sitter died from shaken baby syndrome, the state medical examiner reported Friday. The report ruled the child's death a homicide.

Raven Koch, 1, was found unresponsive May 3 at a baby sitter's home in Davis after reportedly being shaken, the report said. Raven initially was taken to Arbuckle Memorial Hospital in Sulphur on the day of the injury. Later that day, she was transferred to OU Medical Center to undergo surgery to treat an acute subdural hematoma. She died May 4.
A subdural hematoma is a collection of blood outside the brain usually caused by severe head injuries.
Along with the subdural hematoma, Raven was found to have had retinal hemorrhages and a soft tissue hemorrhage in her eyes.
According to the report Raven had no broken bones. Her internal organs, other than her brain, were otherwise healthy and well developed. There were no signs of sexual abuse. The report also said there were no signs of recent vaccinations or reports of an injury by falling.
An obituary published in The Daily Ardmoreite said Raven is survived by her mother, Taryn Koch, of the home, and her father, Derrick Bennett, of Arkansas.
Raven was described as a child with an ever-present smile that brought joy to all who came in contact with her. The obituary said Raven liked to dance, listen to music and play patty-cake.

SBS: Arizona: Casey Brandon Rose chareged

October 26, 2011 3:35 pm
Jackson County District Attorney Charlie Rhodes said Wednesday an investigation is ongoing in a case involving a Scottsboro man who has been accused of severely injuring his two-month old son. 
Casey Brandon Rose, 30, remains in the Jackson County Jail on a $100,000 bond, charged with domestic violence first degree. 
Rose was arrested Oct. 15 after Scottsboro Police Department investigators received a call from Huntsville Hospital and DHR regarding the child's condition after he showed signs of injuries consistent with shaken baby syndrome.
Shaken baby syndrome is a type of inflicted traumatic brain injury that happens when a baby is violently shaken. Shaking makes a baby's fragile brain bounce back and forth inside the skull causing bruising, swelling and bleeding, which can lead to permanent, severe brain damage or death.
According to Scottsboro Police Captain Barry Capps, the baby has been moved from intensive care at the hospital into a regular room.
"He's now able to drink and eat without a feeding tube," said Capps. 
However, the child remains with "significant injuries," according to Rhodes. 
Rhodes said Rose's charge of felony domestic violence remains the same. He said the case will, at some point, likely go before a grand jury.
Rhodes said part of the investigation is seeking all medical records of the child, adding how prosecutors proceed depends on a final diagnosis or prognosis of the child.

SBS: Virginia: Amy Hunter charged

A Quantico woman has been accused of shaking a baby in her care in April, causing fatal injuries to the nine-month-old girl, according to court papers.
Amy Hunter, who lived on the Marine Corps but was not a Marine, was charged earlier in October with second-degree murder in federal court in Virginia.
Hunter was caring for the baby, as well as her own young daughter, on April 26 when she called 911 and said the baby had “hit the back of her head really hard,”according to an affidavit written by Andrea David, special agent for the U.S. Naval Criminal Investigative Service.
Hunter told authorities that she had gone to the bathroom and returned to find the baby standing and holding onto a chair. When she said the child’s name, Hunter said, the baby fell backwards and struck her head on a chair rail.
The baby suffered from skull fractures, swelling and other injuries, according to court papers. She was removed from life support on April 28.
In a follow-up interview, court papers say, Hunter admitted she “repeatedly shook” the child, causing the baby’s head to hit the wall. She said she also had shaken the baby about three weeks earlier.
A search of Hunter’s computer showed that between January and April someone had searched “shaken baby syndrome” and “baby hits back of head” several times, according to court papers.
Hunter’s lawyer could not immediately be reached for comment.