Saturday, 12 February 2011

SBS: A new look at shaken-baby syndrome

February 7, 2011
The New York Times Magazine has taken a critical look at assumptions and conflicting data and research on symptons of shaken-baby syndrome -- and the questions they have raised in court as caretakers and others have been convicted of child abuse and more serious crimes.
As the diagnosis of shaken-baby syndrome took hold in medicine, and prosecutors began to bring charges based on it, doctors testified that shaking could generate the same terrible force as throwing a child from a second-­story window. It turned out they were wrong. In 1987, a neurosurgeon named Ann-Christine Duhaime published a paper that included the autopsy results of 13 babies with symptoms associated with shaken-baby syndrome. In all of them she found evidence of trauma that was actually caused by impact. She teamed up with biomechanical engineers to create infant-sized dummies equipped with sensors to measure acceleration.“We shook them as hard as we could, and we thought something was wrong, because the accelerations we measured were unexpectedly low,” Duhaime says. Instead, the force level shot up when the testers released the dummies after shaking them, even if they hit a soft surface like a bed or a couch. Later experiments confirmed this finding and have made some doctors and biomechanical engineers skeptical that shaking alone can cause severe brain damage or death. At the same time, the experiments have not ruled this out, Duhaime says. Among other things, the dummies are not live children, and while their heads and necks can exhibit the effects of acceleration, impact on brain tissue is still hard to model.
Many doctors who treat child abuse say that decades of clinical observation, as well as confessions, show that it’s possible for shaking alone to cause the triad of subdural and retinal bleeding and brain swelling. A 2009 position paper from the American Academy of Pediatrics, written by Cindy Christian, recommends that doctors use the more general term “abusive head trauma” but also calls shaking an “important mechanism” of such trauma. Many doctors who testify for the defense agree that shaking could in theory cause the triad of symptoms but only if there is an injury to the neck or spinal cord, “where the breathing center is,” as one doctor puts it. It’s the absence of signs of this kind of an injury that makes some shaken-baby cases particularly fraught.

It's a sad story all around. The author interviews caretakers accused and convicted of shaking babies, some of whom had died, as well as families who are dealing with the aftermath. Just like the conflicting medical data, there's no easy solution, answer or conclusion when you read this story.

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