Sunday, 12 June 2011

SBS: Australia: doubts reviewed

Sunday Herald Sun : June 11, 2011
Undated Thames Valley Police handout of Maeve Sheppard. PRESS AS
Maeve Sheppard died from injuries consistent with shaken-baby syndrome, but her carer denies harming her. Picture: PA Source: Supplied

WE abhor adults who hurt and kill babies - consider them the lowest of the low - and view shaken-baby syndrome as the act of gutless monsters.
It is abhorrent; shaking a baby so violently that its tiny brain swells.
For decades the triad of encephalopathy (brain swelling), retinal haemorrhages and subdural haemorrhage (shallow collections of blood over the surface of the brain) have been used as the telltale signs of shaken-baby syndrome (SBS).
And this constellation of symptoms has put people behind bars - as it should if they are guilty of such violence.
Some experts say SBS is triggered by parents or child minders taking out their frustrations on a defenceless infant whose only "crime" is to cry too much or soil a nappy.
Others question whether SBS should be accepted as fact when it really is just a theory.
Either way, every year hundreds of babies are shaken until their body starts to break from the inside out. The injuries are so catastrophic that one in four dies.
In Australia we do not know how many babies are shaken because SBS is not a legitimate disease classification diagnostic code, so no figures are collected.
Dr Anne Smith, medical director of the Victorian Forensic Paediatric Medical Service, told me that when infants arrived in hospitals with injuries that might have been caused by trauma but there was no history of trauma, care-givers were rightly viewed with suspicion.
"Even when a story about trauma is offered by care-givers, it is important for doctors and nurses to question whether the story accounts for the observed findings and whether other causes might explain, or better explain, the child's condition," she said.
She said the consequences of a misdiagnosis of shaking were as serious as a missed diagnosis.
"On the one hand an innocent person might be jailed and on the other, an infant might be returned to an abusive home, possibly with fatal consequences," she said.
Several cases in the US and UK have put this debate on the radar this month and make us question whether there could be other explanations - perhaps a bump or an infection - for some of these injuries.
The Victorian Forensic Paediatric Medical Service is unique.
It provides evaluations of infants when shaking is suspected and gives expert opinion for child protection and the courts.
Importantly, it is staffed by a team of people who hold qualifications in both paediatric and forensic medicine - a model that could become standard practice worldwide.
Dr Smith said this unique mix enabled the team to consider a broad range of medical conditions that might be confused with shaking, as well as the forces and patterns of injury caused by shaking, impact and other causes of head injury - deliberate and accidental.
Last month, British mother Keran Henderson - who spent 18 months behind bars for the manslaughter of Maeve Sheppard - spoke for the first time as she considers another appeal over her conviction.
And in the US, a woman with an impeccable record in child care is serving 10 1/2 years after she was charged with shaking a baby boy in her care.
Keran Henderson spoke to investigative journalists Peter and Leni Gillman and her story was published in the UK's Sunday Times last month. In the article, there is no suggestion the syndrome does not happen - far from it - but it claims that in a minority of cases there must be room for doubt.
Mrs Henderson has always maintained she did not harm Maeve, but a pathologist gave evidence at her trial saying the injuries - the retinal haemorrhages, bleeding in the brain and bruising or swelling of the brain - indicated "a great deal of force".
There are 250 shaken-baby cases in Britain a year. Most are the result of abuse, but some experts suggest the syndrome is a theory that the legal and medical fraternities have accepted as fact.
The Gillmans wrote: "A second, equally determined group contends shaken-baby syndrome is a deficient theory that results in innocent carers and parents being jailed because of flawed science."
MRS Henderson told the Gillmans that for the two months she cared for Maeve in 2005 she was sickly, often grizzly and reluctant to eat.
Twice, she claimed, Maeve needed urgent medical attention - once seemingly for a seizure. Could that have indicated a previous injury or an illness such as meningitis?
Mrs Henderson was the last person to handle Maeve before the child arched her back and went floppy while her nappy was being changed.
And, as the last person to handle the baby, Mrs Henderson was blamed for her death.
British paediatric radiologist Dr Patrick Barnes testified against British nanny Louise Woodward in 1997 when she was accused of shaking baby Matthew Eappen before he died while in her care.
In the New York Times this year, writer Emily Bazelon said a lasting legacy of the Woodward case was the eventual conversion of Patrick Barnes from an upholder of the medical orthodoxy surrounding shaken-baby cases to one of its strongest critics.
In the US Trudy Rueda was accused of shaking Noah Whitmer when he was four months old.
Noah survived his injuries, though at two years he is still not talking and has vision problems.
Rueda, his carer, was sentenced to 10 1/2 years after six doctors testified that Noah's brain scans showed he had been abused. Another doctor offered it was possibly a rebleed, the result of trauma from birth.
Who do you believe?
And if shaken-baby syndrome confuses the medical and legal professions, how can a jury hope to decide guilt or innocence?
It will take some brave decision-makers and forensic investigators to thoroughly explore this truly terrifying problem so there is justice for all.

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