Thursday, 14 July 2011

SBS: Pennsylvania: Milo Bodnar trial

July 12, 2011 : Laurie Mason Schroeder
The lawyer for a Middletown dad accused of shaking his 3-month-old son so hard that the baby suffered a brain injury says the charges are based on “one big spiraling mistake.”
Attorney Matthew Wilkov told a Bucks County jury in Doylestown on Monday that Milo Bodnar, 46, was wrongfully accused of child abuse because doctors made assumptions about the child’s medical history.
He said he’ll prove Bodnar’s innocence this week with the help of several high-profile experts, including a neurosurgeon from Georgetown University.
“Doctors make mistakes,” Wilkov said. “In this case, assumptions were made.”
Prosecutors disagree. Deputy District Attorney David Zellis told the jury that the child’s injuries were consistent with shaken baby syndrome. He said he’ll put a child-abuse expert from The Children’s Hospital of Philadelphia on the witness stand who will testify that the little boy’s brain was bleeding, and he had blood inside his eyes.
“This was the result of being shaken. We’re talking about violent, vigorous shaking,” Zellis said.
Bodnar was arrested shortly after the May 13, 2010, incident that landed the baby in the hospital. Bodnar was watching the child while his girlfriend was shopping. She called home to check on the boy, Zellis said, and Bodnar said he was sick.
Bodnar then called 911, and the child was rushed first to St. Mary Medical Center, then to CHOP, where he spent more than two weeks in the hospital.
Police say Bodnar changed his story, admitting to doctors that he shook the boy, then telling detectives that he had no idea how the baby was hurt. Wilkov said that his client’s words may have been misconstrued by a physician with a Lithuanian accent.
The little boy has recovered from his injuries. Before the trial began, Bucks County Judge Diane Gibbons ruled that jurors will be permitted to see photos of the boy shortly after the incident, as well as photos depicting how the boy looks today.
Bodnar is free on bail. One of the conditions of his bail is that he can’t have contact with the child.
“This is an innocent man who has not seen his baby in 13 months,” Wilkov said.
Bodnar is charged with aggravated assault, endangering the welfare of children, recklessly endangering another person and simple assault. If convicted, he could spend more than 10 years in prison.
The trial resumes today and is expected to last at least three days.

SBS: Texas: Prosecutors lower charges for Suzanna Harwell

In a Tyler County courtroom on Friday, Suzanna Harwell told a judge she had no intention of hurting her 6-month-old son in 2009 when she left him alone, drinking from his bottle - an incident that ultimately led to his death.
Harwell was home alone with Brandel on Oct. 1, 2009. She claims she propped the baby up on the sofa, placed a pillow on his chest, gave him a bottle and left the room.
When she came back a few minutes later, it appeared Brandel had thrown up. After a few minutes she noticed he wasn't breathing well and he was possibly unconscious.
He died four days later.
Tyler County sheriff's deputies arrested Harwell in March 2010 and charged the 25-year-old mother with capital murder. Her bond was set at $1 million.
An autopsy ruled Brandel's death a homicide and contended he died from blunt force head trauma. The state alleged the trauma resulted from Harwell shaking the infant, Harwell's attorney, Ryan Gertz, said.
Prosecutors studied the evidence in the case, medical experts wrote letters disputing the autopsy findings and her charge eventually was downgraded to criminally negligent homicide, a state jail felony. Harwell pleaded guilty to the charge Friday and was sentenced to two years in jail. She will be released early next year.
Her case is an example of what has become a controversial diagnosis known as shaken baby syndrome. In recent years, new evidence has surfaced that shaken baby syndrome is sometimes wrongly diagnosed, and some people have had convictions reversed because of it.
NPR, PBS Frontline and ProPublica and studied nearly two dozen cases in the U.S. and Canada where people were convicted of killing children but later acquitted or had the charges dropped.
Not enough evidence
After her arrest, a Tyler County grand jury indicted Harwell on the capital murder charge and prosecutors said that although she could get the death penalty, they wouldn't pursue that option.
Tyler County Assistant District Attorney Daniel Hunt said after reviewing the case, prosecutors decided she should be re-indicted on an injury to a child charge. After further review, prosecutors decided to again re-indict Harwell on criminally negligent homicide, Hunt said.
The capital murder and injury to a child charges were dropped Friday, Gertz said.
The only reason prosecutors agreed to lower Harwell's charge is because they were not sure they had enough evidence to convince a jury to convict her, Hunt said.
They did not want to take the chance of bringing the case to trial and possibly have her walk away if jurors did not agree with their presentation, he said. He cited the jurors' decision in last week's Casey Anthony trial as an example of how a jury can sometimes surprise prosecutors.
"I personally am firmly convinced this baby was murdered," he said. "Was I going to be able to convince 12 jurors of that? I didn't think so."

Monday, 11 July 2011

SIDS: American Indian infants suffer higher death rates

By: Patrick Springer, Forum Communications
July 04, 2011,
American Indian infants in North Dakota, South Dakota and Minnesota are roughly twice as likely to die as white infants — a disparity health officials bemoan as “unacceptably high.”
At the tender age of 1 month, the baby is vulnerable to infection — just the sort of pitfall Lutjens is trying to avoid through prevention and education, the front line of defense against infant mortality.
Babies like Wocekiya Oneroad are especially vulnerable.
That’s because American Indian infants in North Dakota, South Dakota and Minnesota are roughly twice as likely to die as white infants — a disparity health officials bemoan as “unacceptably high.”
Visiting nursing programs like those enabling Lutjens’ efforts on the Sisseton-Wahpeton reserva tion, seek to cure the stubborn problem.
The regular home visits, ideally starting before the child is born, blend assessment of risks and health status of mother and child with intensive health and safety education.
Oneroad first met Lutjens at a birthing class days before delivering Wocekiya, which means prayer in Dakota and is pronounced Woe-chee-yah. Reaching the one-month milestone, which coincided with Lutjens latest home visit on a recent day, was significant; 42 percent of infant deaths in South Dakota occur during the critical first month.
The nurse took out her stethoscope and listened to the baby breathe. The lungs were clear, also reassuring. And the mother reported there was no sign of infection, despite the running nose.
Still, Lutjens advised Oneroad, who is a member of the Sisseton-Wahpeton tribe, to keep monitoring her baby’s temperature and get her in to the doctor if she develops a fever.
“Just keep an eye on things,” she said.
Their first visit came after Oneroad spotted an advertisement for Lutjens’ birth preparation class, just days before Wocekiya was born. The breathing and relaxation techniques made her labor more tolerable.
“That really made a difference,” said Oneroad, 24, who also has a 5-year-old daughter. “The breathing really helped.”
First home visit
Days after the baby was born, Lutjens made her first home visit. At birth, Wocekiya weighed a healthy 9 pounds, 1 ounce. “She looked good,” Lutjens said. “She had a very good checkup,” adding her weight had grown to 10 pounds, 13 ounces.
American Indian infants often face greater risks than those of the general population. They are more likely to be born prematurely, have teenage mothers, grow up in poverty, or have a mother who smoked or used alcohol or other drugs during pregnancy.
Another major risk factor: going to sleep and not waking up.
SIDS, or sudden infant death syndrome, and other sleep-related causes, occur at higher rates for American Indians than the general population.
A Minnesota study of American Indian infant mortality attributed half of the reviewed deaths to SIDS or other sleep-related causes during 2005-2007, including being suffocated when the baby is sleeping in bed with a parent and suffocated when the mother or father rolls over the child during sleep.
To guard against that, Oneroad has been provided with a special infant bed that nestles next to her own, preventing the risk of the mother “overlaying” the baby in her sleep.
“With Toshina there’s not risk factors here,” Lutjens said. “She’s doing what she should be doing. She’s doing everything right.”
For her part, Oneroad appreciates the support and advice Lutjens brings with her visits.
“This is really nice,” she said. “With a newborn, it’s hard to get out. It’s nice having Jodi come here.”
Second mother
Mary Becker considered herself a second mother to the infant nephew she helped nurture.
“It really affected me,” she said. “I was in the room when he was born. I took care of him a lot. I tried to be the helpful aunt.”
So after the boy’s death four years ago from SIDS, she vowed to do everything possible to avoid the same fate when she had a child of her own.
That time came more than two years ago, and Becker decided to leave the Turtle Mountain Indian Reservation in north-central North Dakota and move to Fargo.
She was 18 years old, and joined by her boyfriend, now her fiance. Both decided it would be easier to find work and housing in Fargo, where Becker had lived for a time with her father.
She also wanted to escape from an unhealthy family environment; her siblings had repeated their mother’s abuse of alcohol, and she didn’t want that contagion to spread to her child.
Program for mothers
A little more than two years ago, during a visit at the Family Healthcare Center in Fargo, she learned about a public health visiting nurse program for mothers who qualify according to income and other criteria.
She started on the program when she was five months pregnant.
“I’ve been with her ever since,” said Kara Scheer, a nurse with Fargo Cass Public Health’s Baby Steps Nurse-Family Partnership program.
On a recent rainy morning, Scheer met with Becker, 21, and her, Rockyboy Jr., 2. It was a graduation of sorts; this would be their last visit.
The nurse gave a glowing report card to mother and son.
“He’s just done amazing and she’s been amazing,” Scheer said. They’ve just done well through the whole process.”
As they sat on a sofa in Becker’s living room, with Rockyboy playing with wooden blocks, the nurse reviewed health and safety tips.
The Nurse-Family Partnership, a national program in use in both Cass and Clay counties, involves weekly in-home visits for up to 2½ years to guide first-time mothers through the critical period in child development.
The approach fosters good parenting skills and draws upon 30 years of evidence-based preventive health steps and education, with the nurse serving both as health professional and life coach.
On their last visit, Scheer takes final weight and height measurements. Rockyboy’s numbers fall squarely within the normal range.
As Toshina Oneroad found in Sisseton, having a nurse come into your home makes it easy to stay on track to keep the child healthy, Becker said.
“You’re in your own comfort zone,” she said. “You’re in your own home. I’ve learned so much,” including proper breastfeeding guidance and what to expect at each step of Rockyboy’s development.
“She actually taught me patience,” Becker added. “Between the program and the mother instincts kicking in, I could handle it.”
Baby Steps
Unfortunately, many American Indian mothers who have been in the Baby Steps visiting nurse program, who comprise 4 to 5 percent of the families served, have failed to finish, Scheer said. Many end up moving back to their home reservations.
Meanwhile, a collaboration between the White Earth and Fond du Lac Ojibwa bands in Minnesota could bring the Nurse-Family Partnership visiting nurse program to their reservations.
The two tribes have cooperated in a pilot study to adapt the national program, blending national standards and tailoring the approach to work better with Ojibwa culture.
So far, families have embraced the program. “Moms are engaging with that curriculum,” said Pat Butler, a nurse who manages the White Earth Home Health Agency.
Three nurses provide home visits for maternal and child health care, reaching between 40 and 50 families at a time.
Bringing the program to White Earth, located north of Detroit Lakes, Minn., is a priority of the tribe, Butler said.
“Your families are the future, guided by the elders,” she said.
If the Minnesota Ojibwe bands succeed in getting approval to modify the Nurse-Family Partnership program, they will become the first tribes to do so.
José Gonzalez, who directs a program of the Minnesota Health Department that works to end health disparities, said the collaboration between the White Earth and Fond du Lac bands is an example of how tribes are working to address infant mortality and other health problems.
The infant mortality rate for American Indians in Minnesota was 10.3 percent, compared to 4.4 percent for whites during 2001 to 2005, the most recent state comparison available.
Similar disparities were found in North Dakota and South Dakota, according to figures for 1999 to 2008 compiled by the Northern Plains Tribal Epidemiology Center, based in Rapid City, S.D.
In North Dakota, the infant mortality rate for American Indians is 11.9 percent, almost double the 6 percent rate for whites. In South Dakota, 13 percent of American Indian infants die, more than twice the 5.8 percent of whites.
North Dakota health officials are watching the experiment at Minnesota’s White Earth and Fond du Lac reservations.
“We’re aware of that pilot,” said Kim Mertz, director of the division of family health at the North Dakota Health Department. “We recognize we have to do a better job.”
Home visits
Nurse Jodi Lutjens started making maternal and child health home visits on the Sisseton-Wahpeton Dakota reservation three years ago.
She’s one of five visiting public health nurses with the Indian Health Service clinic in Sisseton, and the only one focusing on maternal and child health. She drove 14,000 miles to make her appointments last year.
Before Lutjens and several colleagues were hired, two visiting nurses tried to cover the entire service population, about half of the reservation’s 12,000 residents.
“I feel there’s been a big improvement in what I’ve seen,” she said, referring to infant mortality, which was 10.1 percent in Roberts County, the heart of the reservation, from 2000 to 2009.
“We’re still seeing infant deaths, but I’ve seen that number going down since I’ve been working here. We can’t prevent it entirely, but we can give education.”
Lutjens and her colleagues with the IHS collaborate with the tribe, including visiting home aides who can take mothers and children to their doctor’s visits.
As the nurse wraps up her visit with Oneroad, she remarks that she’s pleased that Wocekiya is eating well, and now weighs almost 11 pounds.
“This is just a case where mom and baby – they’re good,” she said. Then, turning to Oneroad, she adds, “We’ll be in touch.”

SIDS: British Columbia: Alarming spike in number of sudden infant deaths

Jeremy Deutsch : July 06, 2011

It’s every new parent’s worst nightmare — a child falls asleep for the night and never wakes up.
There’s no reason, no cause and no one to blame.
Though sudden infant death syndrome (SIDS) is very rare, there has been an alarming spike in the number of cases in the province.
According to the B.C. Coroners Service child death review unit, there were 21 sudden infant deaths in the first half of 2011, compared to 16 in all of 2010.
That includes one case in the Interior region.
The spike has prompted the coroners service to urge parents to educate themselves on safe sleep practices in an effort to minimize the risk of SIDS.
Sudden infant deaths occur when a previously healthy baby dies in sleep-related circumstances and no cause of death is found in an autopsy.
“The challenge is that we don’t really know why these babies die,” B.C. chief coroner Lisa Lapointe told KTW.
Some factors that increase the risk of SIDS include placing a baby on his or her stomach or side, having babies sleep on soft surfaces, having soft objects in the sleep environment, having a baby share a bed with an adult and exposing a baby to cigarette smoke during and after pregnancy.
The chief coroner noted in 11 of the 21 cases, the baby was sleeping in an adult bed and, in 10 cases, they were sharing a bed with an adult
Half of the adults sharing a bed with a baby had consumed alcohol prior to the death.
“That’s a huge risk factor,” said Lapointe, adding that, in some cases , none of the risk factors were evident and the baby still died.
The coroner recommends babies sleep in a separate crib with a firm mattress and fitted sheet.
She said toys and blankets should be kept away from the child’s face.
The coroners service will also be working with Ministry of Health officials, health-care workers and First Nations communities to share the information and provide information for parents.
Kamloops pediatrician Trent Smithsaid he’s not sure what to make of the sudden jump in SIDS cases, noting the rate has been cut in half in Canada in the last 20 years.
“In general, SIDS has gone from something you heard about not terribly uncommon to something now that’s quite rare,” he said, crediting a program to get parents to place their babies on their back when they sleep as the reason for the drop in SIDS cases.
Smith also noted B.C. has a traditionally lower rate of SIDS than the rest of the country, possibly in part from a lower smoking rate.
As a pediatrician, Smith said he always explains the SIDS risk factors to parents, but views the B.C. Coroners Service’s warning as a good reminder.
The province’s chief coroner knows how devastating a sudden infant death can be, as she has attended several cases as a coroner in the field.
“As a parent, you do everything you can to keep your child safe,” Lapointe said.
“To discover they they’ve died and there was nothing you could have done to prevent it — it’s just shocking.”

SIDS: South Carolina improved infant mortality rate

Lisa Waddell 
The announcement from the S.C. Department of Health and Environmental Control that our state’s infant mortality rate dropped more than 10 percent in 2009 is an encouraging sign of progress in ongoing efforts to ensure a good start for our state’s youngest residents.
This is the fourth year in a row that South Carolina has seen a drop in the number of babies who die before their first birthday. This is important for all of us as infant mortality is widely used as a marker for the overall health of a society. Those of us at DHEC recognize that importance, and we work hard with our partners to provide the best possible birth outcomes for pregnant women and infants.
In 2009, we have seen a decrease in the number of deaths due to Sudden Infant Death Syndrome, improper sleep position, and complications suffered by mothers during their pregnancies. Improvements in infant mortality require ongoing interventions before, during and after pregnancy. There are many programs and services available to our residents through DHEC, our private physician partners, faith-based and not-for-profit organizations such as the March of Dimes, just to name a few.
DHEC launched a campaign to encourage pregnant women to avoid exposure to secondhand smoke and to seek assistance through the S.C. Tobacco Quitline to stop smoking. DHEC’s county public health department staff continued to promote breastfeeding and provide nutritional services to pregnant women and infants through the WIC programs, preventive immunizations and home visits to new mothers and infants at risk for poor outcomes at home, and reproductive health services to help mothers plan their pregnancies and focus on the importance of being healthy before they become pregnant.
Our agency partnered with the March of Dimes to provide the ABC’s of Safe Sleep campaign (Alone, on the Back and in a Crib) at the state and local level. Educational materials were provided to all new and expectant mothers, and a copy of the Give Your Baby Room to Breathe DVD was provided to hospitals around the state for new parents to view before going home with their newborn. Copies were also sent to community organizations and other state agencies. The March of Dimes grant also supported community awareness trainings in churches informing expectant and new parents, their families and other relatives, about the issue of safe sleep for infants.
The Cribs for Kids program is another safe sleep effort around the state that utilizes local community agencies and organizations to reach out to new parents who may need assistance through safe sleep education and furnishings for their baby to sleep safely.
South Carolina is fortunate to have a committed group of private providers to serve our pregnant women ensuring that they have access to early prenatal care. We also have a very strong and well-coordinated regionalized system of perinatal care for pregnant women and infants. In this system, pregnant women at risk for maternal complications and delivery of a very small, early, or ill infant are referred to and cared for in the hospitals with doctors and their health care teams who specialize in the care of the sickest mothers and babies. This system of care remains essential to reducing maternal complications and improving the birth outcomes all of our pregnant mothers and infants in our state.
While we celebrate the decline in our state’s infant mortality rate for all infants, we also recognize that much remains to be done. Minority women still experience infant mortality rates at two times the rate of white women in the state. This is a complex issue, yet eliminating this disparity must remain a priority. Overall, progress is being made in our state. Effective partnerships between public health, private providers, patients and partner organizations remain as key components in continuing to ensure that our infants are born healthy and develop into the future leaders of our state. We continue to look for innovative ways to reach the people we serve with the resources we have. We and our partners are committed to making sure that the downward trend we are seeing in the state’s infant mortality keeps going down.
We all know the excitement and joy a newborn provides his or her family. Our work is to help ensure a healthy future for our state’s youngest and most vulnerable residents.

SBS: Note of caution on Matshes' findings

I preface this article with a comment on it by Dr. Harry Bonnell, a pathologist from San Diego and also a researcher into the theory of shaken baby syndrome.
A basic finding of the study is that ten of the 12 infants showing the nerve root changes, showed evidence of impact – again indicative of forces greater than those generated by shaking. Also the authors do not point out whether or not the changes they saw could be an effect of keeping the spine in a acid fluid for weeks to decalcify the bone.

Wednesday, 6 July 2011

SBS: Autopsy Study Provides New Theory

Joseph Shapiro : July 1, 2011
A new study suggests that babies can die by violent shaking alone — but not in the way doctors have previously thought.
A team of researchers who conducted autopsies on 35 babies in Miami, Dallas and Calgary, Alberta, report that when children die after being violently shaken, they die of neck injuries and not from brain trauma.
The findings were just published in Academic Forensic Pathology, the journal of the National Association of Medical Examiners.
Shaken baby syndrome is commonly invoked to prosecute child abuse. But growing numbers of medical experts — particularly forensic pathologists — have raised doubts about the diagnosis.
Skeptics question whether it's possible to shake a baby so violently that the child dies from brain injury but without other visible marks or trauma to the neck and spine.
The confusion over the science sometimes results in the conviction of innocent parents and prison. A series of investigative reports called Post Mortem: Child Cases, this week by NPR, PBS Frontline and ProPublica told the stories of the wrongly convicted and looked at the case of Ernie Lopez, who is serving a 60-year prison sentence in Texas.
The authors of the new research did something novel. They looked at a baby's nerve roots. Those are hard to observe, because they are protected by the bone and spine. But by looking, the scientists say they found injuries that no one had observed before. "We contend that up until now, 'neck injuries' have not been seen, not because they were not present, but rather because the appropriate anatomical structures were not dissected," writes lead author Dr. Evan Matshes, a medical examiner in Calgary.
Babies breathe primarily by expanding their bellies. To do this, the diaphragm, the muscle at the base of the lungs, moves to create more room for the lungs to expand. (Adults have an additional way to support breathing: By using chest muscles to to move the rib cage.)
The researchers found that when babies are shaken, the nerve roots get injured and that knocks out the diaphragm. That leads to the brain injuries that are seen in children who are shaken — but it's original injury to those nerves in the neck that caused the death, not the brain injury, according to the new research.
The new findings split a lot of the difference between the warring camps on shaken baby syndrome. For supporters, there's evidence that shaking alone can lead to a baby's death. But it also says skeptics were right to suggest it's not the head injury that causes death and that shaking deaths are likely rare.
The research got an endorsement from the man who is considered the discoverer of shaken baby syndrome. Pediatric neurosurgeon Norman Guthkelch was the first — forty years ago — to connect head injuries in young children to violent shaking. Guthkelch told NPR in an email that the new research is a "most important contribution to understanding" of shaken baby syndrome, adding:
I have little doubt that it will be confirmed by other workers in due course. It will then be possible to say with confidence that if the lesion they described is present, significant shaking occurred—and if not, not. It also explains why in SBS cases a fatal loss of vital functions may not be associated with the degree of traumatic brain damage that one would expect.
In an interview earlier this week with NPR, Guthkelch spoke out for the first time about his worries that doctors and other medical experts are too quick to diagnose shaken baby syndrome when there's suspicion of child abuse, without considering other possibilities.
It's not clear whether forensic pathologists will embrace the findings. For one thing, it's hard work to get at those nerve roots as Matshes and his colleagues did in their small study.
There are extra, time-consuming steps that have to be taken at an autopsy. The spinal column has to be placed in formaldehyde for up to a month in order for the bone to soften before the pathologist can even get at those roots. But the new paper says that's an commitment of time can help pathologist get at the truth of how a baby died.

SBS: New Forensic Patholgy Evidence

July 5, 2011,  EMILY BAZELON

Illustration courtesy of Academic Forensic Pathology Incorporated.

When I wrote about shaken baby syndrome last winter for the magazine, a Canadian pathologist named Evan Matshes was working on intriguing new research that hadn’t yet been published. Matshes’s paper is just out, in Academic Forensic Pathology, the journal of the National Association of Medical Examiners. It opens a new avenue of inquiry for this difficult and fraught diagnosis.
In the most contested cases, shaken baby syndrome is diagnosed based on a triad of internal injuries in the brain: subdural bleeding, retinal bleeding and brain swelling. There is no evidence of impact, like a skull fracture. And there’s also no obvious sign of the kind of neck injury that comes with severe whiplash. In the absence of such external injuries, biomechanical engineers have raised doubts about whether it’s even possible to shake a baby to death. Many doctors who treat abused children, on the other hand, say that clinical observations make it clear that this does happen.
Matshes’s research shows how death from shaking could in fact occur — but not because of the traditional triad of injuries to the brain. As NPR notes: “The new findings split a lot of the difference between the warring camps on shaken baby syndrome. For supporters, there’s evidence that shaking alone can lead to a baby’s death. But it also says skeptics were right to suggest it’s not the head injury that causes death and that shaking deaths are likely rare.”
In investigating the deaths of 35 babies, Matshes did autopsies in a new way. The usual practice is to dissect only part of the spinal column. Matshes dissected the spine down through the neck and into the nerve roots. What he found was striking. He looked at the spinal columns of 12 babies whose history showed evidence of injury from hyperflexion — in other words, severe whiplash, from shaking or, for example, from a car accident. In all 12, he found bleeding in the nerve roots of the part of the spinal column called C3, C4 and C5. Matshes also dissected the spinal columns of 23 babies for whom there was not solid evidence of an injury from whiplash. (Most of the babies in this group died of SIDS, or from being smothered by an adult who was sleeping with them.) Only one baby in this group of 23 had bleeding in the same C3, C4, C5 region, and that child’s history, while inconclusive, made shaking a distinct possibility.
The C3, C4 and C5 are the part of the spinal column that controls the diaphragm. Babies depend on their diaphragms to breathe more than older children or adults. So Matshes thinks that damage to these nerve roots is fatal because by paralyzing a baby’s diaphragm, it stops the baby from breathing. This internal neck injury, previously undetected, could be the missing piece of the puzzle: the causal mechanism that the biomechanical experiments haven’t accounted for.
If Matshes proves correct about this, then his work indicates that pathologists should look beyond the traditional triad of injuries in the brain, and into the spinal column, to determine whether a baby was shaken. In other words, the current standard method of establishing that a child had been killed via shaking may not be reliable. Matshes says he’s no longer comfortable relying on subdural and retinal bleeding alone — no matter how extensive — to rule a baby’s death a homicide from shaking, given other explanations that need to be ruled out. “I just don’t know if I don’t look at the neck,” he says.
I sent Matshes’s paper to four doctors, two supporters of the traditional shaken baby diagnosis and two critics. They all said the paper, while based on a small sample, pointed to a new area worthy of more research. “It’s terribly important to direct us to look at the neck,” said Waney Squier, a pediatric neuropathologist in Britain who frequently testifies for the defense in shaken baby cases. “In terms of ideas, it’s a really interesting paper,” agreed Desmond Runyan, a professor of pediatrics on the other side of the debate, who will soon move to the University of Colorado to direct the Kempe Center for the Prevention and Treatment of Child Abuse and Neglect.
At the same time, Squier and Runyan both pointed to a methodological weakness in Matshes study: he knew the histories of the babies he autopsied when he examined their necks. His study was not “double blind” — the scientific gold standard for ensuring that a researcher doesn’t skew his findings in the direction that will confirm his hypothesis. Matshes says that pathologists doing autopsies are ethically bound to know the subject’s history. “In forensic pathology, since we can’t do randomized controlled double-blinded studies, we have to make certain concessions,” he said.
This week, Frontline, NPR and Pro Publica aired a joint investigation into prosecutions for child deaths blamed on abuse that raised questions much like the ones I raised in my article. (Here’s an online chat with the reporters that I participated in.) Runyan brought up this latest wave of coverage while we were talking about Matshes’ new paper. The latest wave of coverage, he said, “just goes to show we need better research,” he said. Amen to that.

SBS: Dr Norman Guthkelch interview

Interview with Dr Norman Guthkelch, the pediatric neurosurgeon who is credited with first observing the condition in young children

SBS: Forensic Pathology: Dr Jon Thogmartin interview

Interview with Florida forensic pathologist, Dr Jon Thogmartin

SBS: Dr Patrick Barnes' interview

Interview with Dr Patrick Barnes, paediatric neuro-radiologist with special interest and experience in forensic aspects of SBS

SBS: The Child Cases Video

Video: The Child Cases

SIDS: statistics

many website addresses:

SIDS: Good Habits To Prevent Sudden Infant Death

Baby on her back

The recommendations have long changed. Before we had a baby to sleep on his stomach to facilitate digestion and prevent possible regurgitation. But many studies have shown that this position five times the risk of sudden infant death syndrome. In most cases, there was choking because of blankets or a mattress too soft. A baby under six months is indeed not yet capable of turning around.

Now for the safety of your baby, pediatricians recommend your child to sleep on their backs, except in very special cases. Since that measures the rate of sudden death has greatly diminished. Adopt the prone position for the games. And you allow him to see his environment in a different way.

Do not worry if you find your baby in a position a little odd, for example glued to the walls of the bed. He seeks contact, the same feeling of security when he was in your belly. It ensures that his face is well clear When lying on your back, your baby should not be hampered by a blanket or soft toys that may come on his face.
Sleep, the perfect outfit is a pair of pajamas, a frog. You can then install it in a sleeping bag or sleeping bag (sleeping bag closed by straps over the shoulders). If it's really cold, you can add thickness, a T-shirt under his pajamas or a wool jacket over it. Optionally, add a light blanket so he can push it easily if it is too hot.

SIDS: Genetic testing for inherited cardiac conditions

26-Jun-2011 : Contact: Jacqueline Partarrieu :
European Society of Cardiology

Genetic testing for inherited cardiac conditions is 'patchy' in Europe

A new guide, unveiled at EHRA EUROPACE 2011, indicates when and how genetic testing is useful

While genetic inheritance is known to play a role in the multifactorial development of most diseases of the heart, there are also a number of clearly diagnosed cardiac conditions which owe their development to quite specific genetic abnormalities. When these genetic disorders affect the integrity of the heart's muscle they are known as a "cardiomyopathy"; when the disorder affects the heart's "excitability", it is known as a "channelopathy".
Both conditions predispose to arrhythmias and sudden cardiac death - often in the young. A reliable genetic test for the presence of DNA changes in the genes which encode for ion channels and relevant proteins would not only help identify affected patients and reduce these serious risks, but also provide information for personalised treatment.
An expert consensus statement on the value of diagnostic genetic testing for these inherited cardiac conditions will be unveiled today at the EHRA EUROPACE 2011 congress in Madrid. The report, the HRS/EHRA Expert Consensus Statement on the State of Genetic Testing for the Channelopathies and Cardiomyopathies, is a joint development of the Heart Rhythm Society and the European Heart Rhythm Association (EHRA). The latter is the organiser of EHRA EUROPACE 2011.
According to Dr Silvia Priori, who will present details of the consensus statement today, its aim is to provide recommendations on how each of 13 inherited conditions might be tested for and diagnosed using genetic analysis. The guidance makes clear that these recommendations deal with uncommon diseases and are based on the results of studies which are much smaller than those available for more common diseases, such as myocardial infarction or heart failure. But, says Dr Priori, the field is evolving rapidly. In deed, the genetics of inherited arrythmogenic diseases is a recent sub-specialty of cardiology and it's only in the past 25 years that the first causative genes for channelopathies and cardiomyopathies were discovered.
Dr Priori, who is director of Molecular Cardiology at the Fondazione Salvatore Maugeri and University in Pavia, and Director of Cardiovascular Genetics at New York University, describes the penetration of use of genetic testing in Europe as "patchy", with some countries still without even a limited framework for their application.
"The document is intended to provide guidance to cardiologists in the use of genetic testing among patients and family members," she explains. Results may be useful for both the diagnosis and treatment of affected individuals. The appropriate use of these tests, she adds, is critical because they are expensive, and should, therefore, be used in patients with a clinical diagnosis (or high suspicion) of these diseases.
The recommendations focus on testing for 13 inherited conditions, including hypertrophic cardiomyopathy, long QT syndrome, Brugada syndrome, and dilated cardiomyopathy. In addition, the statement includes guidance on the use of genetic testing for out-of-hospital cardiac arrest survivors and post-mortem testing in cases of sudden death, the most dramatic consequence of these conditions.
Dr Priori describes the prevalence of these conditions among the general population as ranging from one in 500 to one in 10,000 - with an average prevalence of around one in 2000. Based on current knowledge, it is still not possible to find genetic abnormalities in all patients affected by these conditions; however, in some - such as hypertrophic cardiomyopathy or long QT syndrome - genetic testing may identify a causative mutation in as many as 70% of cases. In other diseases, however, the yield of testing is much lower, and improvements will depend on the discovery of more genes.
"So genetic testing cannot be viewed as a one-size fits all solution, but its contribution to family screening and management in affected patients should be defined for each disease," says Dr Priori, "and results should defined in the context of a comprehensive clinical evaluation." Counselling, particularly among family members, is essential for reassurance about disease risk and surveillance.
The consensus provides an assessment of the strength of indication for genetic testing in different conditions. In some diseases, such as hypertrophic cardiomyopathy or long QT syndrome, the recommendations to test all individuals with a clinical diagnosis are strong. In other diseases, such as Brugada syndrome or dilated cardiomyopathy, there is a value in performing the test, but the strength of recommendation is lower. And there are some instances - such as atrial fibrillation - where genetic testing cannot yet be indicated.
Similarly, the report does not recommend genetic testing in all cases of out-of-hospital cardiac arrest, but recommends that testing should be performed if there is a clinical sign or suspicion of an inherited arrythmogenic disease. However, genetic testing "may be considered" in all cases of sudden unexpected death, including sudden infant deaths (SIDS), where autopsy yields negative results. Studies suggest that genetic mutations can explain an underlying cause of sudden unexpected death in up to 35% of cases. Even events such as drowning or motor accidents in the young may in fact be attributed to cardiac arrhythmias of genetic cause.
Ultimately, says Dr Priori, the report hopes to lower the risk of sudden cardiac death by promoting the appropriate use of genetic testing - and to ensure their reimbursement from insurance and health care systems.

SIDS: Long Q-T Syndrome

DAVID WAHLBERG : June 23, 2011

 CRAIG SCHREINER – State Journal
Doug Bartow, 56, center rear, is pictured with his children and grandchildren at his house in Montfort, west of Madison. All of them, except for Quinn Hoeper, have Long QT Syndrome — a genetic heart condition that can cause sudden death, though medication and avoiding strenuous activities reduces the risk. From left: Sherri Seitz, 30, and her children Mayleigh Seitz, 1, and Rhylinn Seitz, 3, Jonah Hoeper, 5, Quinn Hoeper, 3, and their mother, Amy Hoeper, 32.
When Doug Bartow learned he had a genetic heart condition that can cause sudden death, he had mixed emotions: fear, blame and relief.
He worried about his two daughters and four grandchildren, then felt guilty after discovering he passed the condition to all but one of them.
But knowing the family has Long QT Syndrome — a cause of sudden death in children and young adults, especially athletes — also brought comfort.
Bartow now almost certainly knows what killed his sister at age 14 and brother at age 5. His daughters and their children, ages 1 to 5, can take steps to try to prevent the same fate.
“They have all the information up front so they can make their choice,” said Bartow, 56. “We didn’t have that before.”
Some in the Bartow family are taking medications and avoiding strenuous activities to ward off dangerously irregular heartbeats, and all are being treated at UW Health’s Inherited Arrhythmias Clinic.
The clinic, which started in 2004, treats more than 100 families with hereditary heart diseases. Doctors and genetic counselors help the families navigate the expanding world of genetic medicine, where knowledge of diseases can bring fear and hope, often at the same time.
A serious syndrome
Long QT Syndrome, in which part of the heartbeat lasts too long, can cause dizziness, fainting, seizures and sudden death, especially during exertion. The condition, found in up to 1 in every 2,000 people, explains some of the rare but visible sudden deaths of young athletes, though two other heart problems are more frequently the cause.
Half of people with Long QT Syndrome have potentially dangerous episodes, including 10 percent who die suddenly, said Dr. Craig January, a cardiologist and co-director of the clinic.
The other half don’t have problems. The longer people live without an episode, the less likely they are to have one, said Dr. Kathleen Maginot, a pediatric cardiologist and the other co-director.
The condition is diagnosed through family history, electrocardiograms and genetic testing. In an example of a typical situation, Maginot said, a child faints while running and then the family realizes other relatives fainted or died suddenly.
Some miscarriages and cases of Sudden Infant Death Syndrome can be attributed to Long QT Syndrome, Maginot said.
Most patients take beta blockers, drugs that lower the risk of problems by preventing the heart from beating too fast. Some receive implantable cardioverter defibrillators, or ICDs, devices that deliver electric currents if they detect abnormal heart rhythms.
Patients are told to avoid competitive sports, especially swimming, football and basketball. That can be a big challenge for children, Maginot said. Some parents heed the advice, but others don’t want to give up such an important part of childhood, she said.
“There’s a lot of family dynamics,” Maginot said. “But we’re pretty cautious with children. We’re trying to protect them and give them as close to a normal life as possible.”
Reacting to the news
The Bartow family has had a variety of responses to Long QT Syndrome.
Doug, from Montfort, about 60 miles west of Madison, learned
he had the condition last year during testing for another ailment, for which he had a liver transplant.
After he tested positive for Long QT Syndrome, his daughters — Amy Hoeper, 32, of Livingston, and Sherri Seitz, 30, of Fennimore — learned they have the condition. Each had a 50-50 chance of having it.
Then their kids were tested. Amy’s son, Jonah, 5, has it. Her 3-year-old daughter, Quinn, doesn’t. Both of Sherri’s kids have it: Rhylinn, 3, and Mayleigh, 1.
Amy, who said she was already “that crazy, protective mom,” was worried about Jonah, wondering if the kindergartner should take swimming lessons and participate in physical education class.
She decided those things are OK as long as she is present or lets teachers know about his risk. But she won’t let Jonah play competitive sports and hasn’t let him sleep over at friends’ houses.
“It’s hard to let go of that control,” she said.
Amy and Jonah are on beta blockers. She and her husband Abe decided against having more children because she doesn’t want to risk passing on the condition again.
‘Kids want to be kids’
Sherri, whose children are on beta blockers, isn’t taking the drugs because they can make her asthma worse. She and her husband Jamie plan to have more kids.
She’s not going to restrict her children from any activities, including sports.
“Kids want to be kids,” Sherri said. “I’ve lived with it my whole life.”
Doug, a volunteer for 26 years with the Montfort Fire Department, continues to go on fire calls despite doctors’ advice against it. “They’ll never take that away from me,” he said.
He takes beta blockers and has an ICD. He’s glad to finally know what likely killed his sister while swimming years ago and his brother as he ran up the basement stairs.
Five of Doug’s nine remaining siblings have been tested, and four have the condition. Some of their children and grandchildren have it too.
As Doug sat at his dining table with his family nearby, he touched on the magnitude of complex feelings Long QT Syndrome can bring.
If he learned he had it decades ago, he said, “I know I wouldn’t have had children.”
Then he looked around. “But I’d never give them up now.”

SIDS: Ohio statistics: dangers of co-sleeping: "Babies aren't supposed to die"

Mark Gokavi June 25, 2011

Each year about 1,000 infants died in Ohio, and the vast majority did not result in criminal prosecution.
In the Miami Valley, just five of 409 infant deaths from 2007 to 2009 in a seven-county area were classified as homicides. Two-thirds of the deaths were from natural causes, most often prematurity.
The numbers depict two things: Most infant deaths do not include criminal behavior; and even when there is suspicion of a crime, it’s difficult to prosecute.
The Dayton Daily News reviewed the most recent available data provided by the Ohio Department of Health regarding infant deaths in Butler, Clark, Champaign, Greene, Miami, Montgomery and Warren counties. All the cases were reviewed by the Ohio Child Fatality Review Board.
Greene County Prosecuter Stephen K. Haller said infant deaths are difficult to prosecute and especially emotional because “babies aren’t supposed to die.”
A Greene County jury on June 16 acquitted a 26-year-old man who faced manslaughter in the death of his 4-month-old stepdaughter. She died while sleeping on an adult bed. The coroner ruled the cause of death as positional asphyxia.
Haller there is no “bright line” that distinguishes which infant death cases to proceed with criminal charges.
He said his office discusses it in-house before presenting to a grand jury.
“When you have caregivers, parents, circumstances where it may be recklessness or may be negligence or it may be purposeful, sometimes you just have to let the jury make the call,” Haller said. “They are very difficult cases, not only legally and factually, but emotionally for all the people involved.
“Babies aren’t supposed to die.”
Varnell Carter, 26, was acquitted by a jury of child endangering and manslaughter charges in the July 6, 2010 death of his 4-month-old stepdaughter, Reagan Merriweather. He had placed the child inside a U-shaped nursing pillow on an adult bed with a sheet and comforter. Greene County Coroner Kevin Sharrett ruled the cause of death as positional asphyxia.
On June 3, a Warren County grand jury declined to indict Sean McClain, 24, of Lebanon on charges he killed his 3-month-old son Micah while sleeping in his bed.
A month before Merriweather’s death, 4-month-old Cadence Gardner of Caesarcreek Twp. in Greene County died from asphyxia when covers were over her head on a 90-degree day and the house was hot.
The coroner ruled the Gardner death accidental and that case was not prosecuted because Haller told detectives there was “no criminal culpability as it relates to the caretaker.”
The Ohio Department of Health data shows that from 2007 to 2009, there were a combined 156 post-neonatal (from 1 month to 1 year old) infant deaths Butler, Clark, Champaign, Greene, Miami, Montgomery and Warren counties.
Other than the five death certificates listing the manner of death (circumstances surrounding it) as homicide, 66 were from natural causes, 50 were accidental, 66 were sleep-related and 33 were undetermined.
The Ohio Department of Health doesn’t release individual county statistics.
In 2008, the 88 Ohio Child Fatality Review boards looked at 1,655 cases for manner and cause of death of children younger than 18. Among the findings:
• Deaths to infants younger than 1-year-old accounted for 67 percent (1,104) of the reviews.
• Sleep-related deaths (including Sudden Infant Death Syndrome or SIDS) accounted for 15 percent (166) of the 1,104 total reviews for infant deaths.
• 66 percent (109) of the sleep-related deaths occurred in unsafe locations such as adult beds and couches.
• 62 percent (103) occurred to infants who were sharing a sleeping surface with someone else.
“It’s very gray,” said Mark McDonnell, the Greene County health commissioner and co-chair of that county’s Child Fatality Review Board. “Even if you do intensive investigation, it’s very hard to pinpoint exactly what caused a child’s death.”
Ken Betz, director of the Montgomery County Coroner’s Office and the Miami Valley Regional Crime Laboratory, said he doesn’t recall any prosecutions of cases in Montgomery County similar to Carter’s — where the defense argued SIDS and the prosecution only had circumstantial evidence involving bedding.
Testimony by police investigators and medical personnel in the Merriweather case centered on how the infant was placed on her stomach and for how long, and if the sheets and comforter were rumpled underneath the child.
A Montgomery County Child Fatality Review Board report about 1997-2008 noted, “Over the years, death scene investigations and forensic tests have become more sophisticated. This has resulted in a decrease in the number of deaths attributed to SIDS and an increase in deaths attributed to unsafe sleep practices.”
Hamilton County Prosecutor Seth Tiger, who handled McClain’s prosecution due to a conflict of interest in the Warren County Prosecutor’s Office, said a grand jury failed to indict McClain because the coroner could not conclusively determine the cause of death.
“Mikah most likely died because McClain rolled on top of him, but the coroner could not rule out a heart condition or something SIDS related so ultimately we could not prove the case beyond a reasonable doubt,” Tiger said. “Does it seem particularly coincidental that McClain and his girlfriend admit to partying and being high on drugs, the next morning their baby is dead? Yes, but the reasonable doubt was still there.”
Both McClain’s grandmother Marilyn Cosgrove and his attorney Charles Rittgers called the death of Mikah a “horrible accident.”
An accident is also how Carter’s defense attorney characterized Merriweather’s death. “I was surprised that they were bringing this case,” said lawyer Jay A. Adams. “And when I said to the jury, but for the grace of God go I, that’s (for) all of us who have had kids who have ever laid them on their stomach.”
Though criminally cleared, Carter said he learned something that he will employ with he and his wife’s infant daughter, who was born this month.
“Never assume. Never assume because anything can happen with a child,” Carter said. “Children are delicate and you never know what can happen in a matter of seconds.
“I wake up, sometimes if she makes the slightest noise, I just wake up out of my sleep. It’s just a reaction. You just never know.”
Staff writers Justin McClelland and Lou Grieco contributed to this report. Contact this reporter at (937) 225-6951 or

Infant safe sleeping policy
Key points include:
Healthy babies should always sleep on their backs. Because babies sleeping on their sides are more likely to accidently roll onto their stomach, the side position is not as safe as the back and is not recommended.
Require a physician’s note for non-back sleepers that explains why the baby should not use a back-sleeping position, how the child should be placed to sleep, and a time frame that the instructions are to be followed.
Use safety-approved cribs and firm mattresses (cradles and bassinets may be used, but choose those that are JPMA (Juvenile Products Manufacturers Association) certified for safety).
Keep cribs free of toys, stuffed animals, and extra bedding.
If a blanket is used, place the child’s feet to the foot of the crib and tuck in a light blanket along the sides and foot of the mattress. The blanket should not come up higher than the infant’s chest. Sleep clothing, such as sleepers, sleep sacks, and wearable blankets, are good alternatives to blankets.
Place babies to sleep only in a safety-approved crib with a firm mattress and a well-fitting sheet. Don’t place babies to sleep on chairs, sofas, waterbeds, or cushions. Adult beds are NOT safe places for babies to sleep.
Sleep only 1 baby per crib.
Keep the room at a temperature that is comfortable for a lightly clothed adult.
Do not use wedges or infant positioners, since there’s no evidence that they reduce the risk of SIDS.
Never allow smoking in a room where babies sleep, as exposure to smoke is linked to an increased risk of SIDS.
Have supervised “tummy time” for babies who are awake. This will help babies strengthen their muscles and develop normally.
SOURCE: American Academy of Pediatrics

SIDS: England: aberrant statistics

28th June 2011
IT is every parent’s greatest fear — the sudden death of their child.
And now a campaign has been launched in Bolton to prevent as many unexpected baby deaths as possible.
About a dozen infants died in Bolton as a result of Sudden Infant Death Syndrome (SIDS) in 2008- 2009.
And there are more baby deaths in the North West than any other part of England and Wales, with Bolton’s rate more than three times the national average.
The latest national rate of unexplained baby deaths is 0.40 for every 1,000 live births in 2008, compared to about 1.4, in Bolton.
Bolton health chiefs have now joined forces with those in Salford and Wigan, where death rates are also high, to launch a Safe Sleeping Campaign.
NHS Bolton, the primary care trust, and Bolton Council are working together to promote safe sleeping messages and cut the number of deaths.
Jan Hutchinson, director of public health at NHS Bolton and Bolton Council, said: “It is tragic to lose a baby and even more so if that death is preventable.
“We know from our analysis of babies who die in the borough that while some do so as a result of severe disabilities or birth injuries, a proportion do die through unsafe sleeping, which is preventable.
“We hope to build up awareness of the best advice to follow to reduce the risk.
“We hope there will be a reduction in the number of infant deaths through unsafe sleeping.”
The campaign was launched yesterday with an event at Oxford Grove Children’s Centre.
It will promote messages around safe sleeping, giving parents and carers advice on things they can do to reduce the risk to their baby, for example, making sure babies sleep in cots, not in bed with their parents.
Hundreds of health and social care workers will also be trained on helping patents and looking out for signs that infants might be at risk.

SIDS: Texas: indictment after second death

June 27, 2011 : JESSICA COOLEY

Vanessa Clark

Mark Clark

A Lufkin couple has been indicted on a charge of child endangerment after their second infant in two years died while sleeping in their bed against Child Protective Services instruction.
Mark and Vanessa Clark, both 32, were formally charged by a grand jury last Thursday in their infant boy’s July 9, 2010, death, according to District Attorney Clyde Herrington. As for the grand jury’s decision to indict the couple, Herrington called it is a peculiar case as the couple lost another baby in a similar sleeping incident 14 months earlier.
“There was a previous investigation with another child by Child Protective Services. The first infant’s death was ruled (Sudden Infant Death Syndrome),” Herrington said. “In the (new) case, the child was about 3 or 4 months old and sleeping in the bed with the parents. They woke up and found him not breathing.”
Following the first infant’s death, the couple was given a course by Child Protective Services in safe sleeping practices, according to CPS spokeswoman Shari Pulliam. That information strictly states sleeping with an infant puts the child at risk for suffocation, Pulliam said.
Herrington went on to say that the infant’s death is neither a negligent homicide nor a murder, but the grand jury felt the parents put the child in danger by sleeping with him.
“We presented the facts to grand jury and they felt the parents put the child in danger,” he said. “It’s a really tragic case.”
The Clarks are out of the Angelina County Jail on $5,000 bonds, according to court records.
Endangering a child is a state jail felony carrying a sentence of up to two years. State jail sentences are served day for day.
According to information on the Texas Department of Family Protective Services website, almost 400 Texas babies die in their sleep each year either suddenly and without a clear explanation or due to accidental suffocation or strangulation.

SIDS: Australia: statistics

Michelle Draper : June 30, 2011
    Six Victorian teenagers who died in the past four years were known to child-protection services and had long histories of neglect, a report has found.
    The report, which reviewed the deaths of 28 children known to child protection from 2007 to 2010, found most died from congenital illnesses or sudden infant death syndrome (SIDS).
    However, seven of the deaths were teenagers, with six having lengthy and complex histories with child protection.
    The six adolescent deaths "occurred in the context of long-term neglect with histories of multiple reports (five or more) to child protection over extended periods", the report said.
    Three of the teenagers committed suicide, while the other deaths were due to drugs, congenital illnesses or accidents.
    The annual report, by the Victorian Child Death Review Committee (VCDRC) and tabled in state parliament on Thursday, analyses the deaths of child-protection clients.
    In many cases, the children who died came from homes with parents suffering from mental illnesses or drug and alcohol problems. Family violence was also a major issue.
    Despite this, many families were not connected with the right services to deal with these problems, the report found.
    "Parental substance use, mental illness and family violence were risk factors known to be present in a significant number of families, however there appear to be few connections by families with the specialist services which might assist in addressing these issues," it said.
    In 2010, 29 child deaths - mostly children under three years of age - were referred by the Department of Human Services to Victoria's child safety commissioner, the report said.
    The figure was three higher than in the previous year.
    Seventeen children were involved with child-protection services when they died, while 12 had their cases closed in the past year.
    Community Services Minister Mary Wooldridge said the report highlighted the systemic failures of the child-protection system which she blamed on the previous Labor government.
    "A key conclusion of the report is that we need to do far better to comprehensively respond to the range of issues these families face given the devastating impact that they can have on the children," Ms Wooldridge said.
    A government-initiated inquiry into protecting Victoria's vulnerable children is due to report in November.

    SIDS: Canada: The issue of poverty

    Dr. Randall F. White, (psychiatrist and medical writer) :  June 28, 2011
    Nine years before, the family was the object of attention when they suffered the death of a 19-month-old girl who was killed by her great uncle. Provincial child-welfare authorities had placed the child in the care of her great aunt and her spouse, although the man was known to be violent.
    Mary McNeil, minister of children and family development, called the infant's death this month tragic. Although the cause of death is under investigation, some media reports suggest sudden infant death syndrome. SIDS is a no-fault condition, but it occurs more often to infants of poor women who are more likely to struggle with drug addiction, lack of prenatal care, and limited education.
    SIDS is rare - in 2009, the year with most recently available statistics, six B.C. babies died of SIDS. Premature birth causes more than ten times as many infant deaths.
    Risk factors for prematurity are largely the same as those for SIDS. Those factors include poverty, teenage pregnancy, poor nutrition and substance abuse.
    Being born into poverty, however, does not usually result in death during infancy. Rather, it sets the stage for chronic illnesses in childhood and adulthood that result in disability, costly medical care and a shortened life span.
    During the years when the body and mind are forming, the influence of an unhealthy environment and habits takes shape. Poverty's effects do not inevitably lead to disease, but the combination of toxic exposures and social problems such as school failure and child abuse create slowmotion tragedies. Unlike the sudden death of an infant, the media and politicians seldom take notice of these losses. For instance, prematurity can result in mental retardation, seizures and lung disease. Premature babies may later have learning disabilities and attention deficit disorder, which require special education interventions.
    Having a child with such problems adds stress to a family struggling to get by; this stress may result in abuse or neglect. But even without dire medical problems that begin at birth, poverty is associated with chronic disease and a higher risk of death.
    Injuries are the most common cause of death in B.C. Disadvantaged children are more likely to suffer from injuries such as burns, vehicle accidents and drowning. Fortunately, only 13 B.C. children died of injuries in 2009; many more were treated and recovered. In the long run, however, most disabilities and untimely deaths result from common diseases of adulthood that have roots in childhood.
    Because severe malnutrition is almost exclusively a disease of dire poverty, it is uncommon in Canada. We are more likely to develop obesity with its complications of diabetes, high blood pressure,and heart disease. In North America, people with low income have a greater tendency to be overweight than people with high income. This probably relates to less physical activity and more unhealthy food intake among the poor.
    The unhealthy influences on children growing up in poor neighbourhoods can be put together by a thought experiment.
    Imagine a low-income corner of town. It's probably near busy roads where traffic contributes to noise and air pollution. The quickest place to get a cheap meal is the convenience store or fast-food restaurant. Access to parks and playgrounds is difficult because children have to cross a highway, and it may not be safe to go outside after dark. Drug dealers may lurk nearby. It's easier and safer to stay indoors and watch TV.
    If the building is not well maintained, children may encounter hazards indoors, such as unsafe stairs, exposed wiring or vermin. If the parents have to work two shifts to pay the bills, who makes sure the children stay out of trouble?
    The economic and human costs of childhood poverty are immense, but the government seems almost blind to this. According to Statistics Canada, British Columbia has had the highest rate of childhood poverty in Canada for 11 years. As of 2009, 100,000 B.C. children lived in poor homes. If politicians really want to reduce childhood deaths and control health care costs, they need to get serious about protecting children from growing up poor.
    Nurse-Family Partnership, a recently announced program in B.C. designed to support at-risk women during pregnancy and after, is a good start. The program has been piloted in U.S. communities and its benefits on the well-being of poor women and their children is documented by research.
    A coalition of organizations has called for a poverty-reduction strategy in B.C. Several other provinces have adopted such plans; B.C. should be the next.

    Monday, 4 July 2011

    SBS: Tennessee: Grand jury to consider Dustin McCord shaken baby case

    June 22nd, 2011
    • photo Dustin James McCord, 22, was charged with aggravated child abuse after what police termed was an incident of shaken baby syndrome. A release from the police department said they had been contacted by staff at Erlanger hospital who said “a 5-month-old baby had been brought in suffering from a seizure and exhibiting past and present shaken-baby symptoms.”
      A judge has sent a case to the Hamilton County grand jury in which a 23-year-old man is accused of shaking his girlfriend’s 5-month-old baby, likely causing permanent neurological injuries.
    In the courtroom of Sessions Court Judge Bob Moon, witnesses testified Tuesday that defendant Dustin McCord told police he was alone with Jayden Bartholomew for about five minutes on June 4 when the child’s limbs stiffened and his eyes rolled back in his head.
    McCord, who said he was bottle-feeding the infant at the time, took the child to Monica Bartholomew, the baby’s mother, who was at the next-door neighbor’s residence. They then called an ambulance.
    McCord is being held on a $60,000 bond on an aggravated child abuse or neglect charge.
    Dr. Marvin Hall, a physician at Children’s Hospital at Erlanger, testified that, when he examined Jayden, the boy had fresh bleeding behind his eyes, around the brain and spinal cord, indicating that the injuries were, at most, only hours old. The injuries also match common factors connected to “shaken baby syndrome,” he testified.
    Hall said he also discovered pools of older blood in the boy’s brain and spinal cord, indicating injuries from days or weeks before.
    The boy has since been discharged, but Hall said the child likely will face permanent neurological damage and possible blindness.
    Chattanooga police continue to investigate the case.
    Monica Bartholomew invoked her constitutional right not to testify in the hearing.
    Her attorney, Ryan Hanzelik, explained to Moon that his client was in a “very difficult position” because she wanted to help the investigation but not put herself in a position to face charges.
    McCord sat with his attorney, Phillip Duval, in a red Hamilton County Jail uniform and nodded at different points during testimony.
    Through his cross-examination of Hall, Duval widened the possible time in which the injuries to Jayden could have happened, noting that the injuries could have occurred before McCord picked up the child.
    “Could the baby have been shaken, put in bed and picked up by someone else?” Duval asked.
    “Yes,” Hall answered.
    Monica Bartholomew had left Jayden with McCord and gone next door about five minutes before the incident, according to testimony.
    Assistant District Attorney Charlie Minor called both Hall and Chattanooga police Detective Galen Fugh to testify.
    Fugh responded to the call and questioned both McCord and Monica Bartholomew. He said the investigation was still ongoing as to the child’s older injuries.
    Moon repeatedly clarified the order of events reported by Fugh reported as well as the doctor’s time frame of possible injuries.
    “I think the time windows are very relevant, they may end up being the crux of the case,” Moon told attorneys.

    SBS: New Zealand: Backlash against Kahui twins book

    Hayden Donnell and NZPA Jun 28, 2011
    Amid an ongoing inquest into the twins' killing this week, mother Macsyna King has announced she is releasing a 'tell-all' book co-written with Ian Wishart. Photo / Brett Phibbs
    More than 1000 people have signed up to a Facebook group urging the mass boycott of a book written in collaboration with the mother of murdered babies Chris and Cru Kahui.
    Chris Kahui Snr was accused and acquitted of inflicting fatal injuries on the three-month-old Kahui twins in 2008.
    His legal team contended Macsyna King, the boys' mother and Kahui's partner, carried out the murders.
    Amid an ongoing inquest into the twins' killing this week, King announced she was releasing a "tell-all" book co-written with Ian Wishart.
    It would give her version of circumstances surrounding the twins' deaths and name who she thought the killer was.
    A Facebook group set up today said the book was King's attempt to "profit from her attrocious deeds".
    It urged people to boycott it, along with all other Ian Wishart books, until it was pulled from shelves.
    By 7:15pm, the group had attracted more than 7400 supporters, many of whom left angry messages accusing King of profiting from the death of her sons.
    Author Ian Wishart previously told TV3 the book was a story of "horror from the streets of South Auckland".
    He agreed to write the book after King approached last year asking him to tell her side of the story.
    It would provide new information on a case that still provokes anger across New Zealand, he said.
    "There's a huge sense of outrage that two twins could be killed and no-one could actually be pinned for their murder.
    "The back cover of the book says it makes Once Were Warriors look like kindergarten - it really does."
    Mr Wishart said he had already started getting hate mail for writing the book.
    Health workers needed to stop similar cases
    Meanwhile, one of the country's preeminent experts on child abuse says the child health workforce needs to be transformed so it is also a child protection workforce in order to prevent further cases like that of the Kahui twins.
    Dr Patrick Kelly, clinical director of the child protection team at Auckland's Starship Hospital, was speaking at the inquest into the deaths of the babies.
    He said the incidence of child abuse in New Zealand is "at least as high and in some cases higher" than other parts of the world.
    "For example, if you look at cases of abusive head injuries, as were suffered by the Kahuis, our rates seem higher than in the United Kingdom. If you look at the World Health Organisation study on sexual abuse, the rates in New Zealand were among the highest in all the countries that were looked at.
    "Although it's hard to be sure about prevalence figures, comparatively speaking, New Zealand's record is not good."
    Dr Kelly said it was clear that there needed to be dedicated child protection teams working in every district health board in the country made up of staff from police, Child, Youth and Family, and the primary health sector. At the moment there were only teams in Auckland, Canterbury and Waikato.
    "Currently, even when you combine information from all three agencies, because they didn't collect their data in any kind of uniformed, systematic way,.. we still can't answer the question: in New Zealand, what particular constellation of risk puts children in a hospital with a head injury?"
    Healthcare workers also needed to be encouraged to ask the hard questions when confronted with possible cases of child abuse.
    To illustrate this, Dr Kelly told the court of an eight-month-old boy who was admitted to hospital with severe head injuries.
    His caregiver had told doctors the baby fell from a high-chair which had became entangled in a vacuum cleaner chord, and no investigation was conducted.
    Two months later the baby was dead from multiple blows to the head. A clear diagnosis was that he had been murdered by his caregiver.
    "I think in retrospect it's fairly clear that this first head injury was unlikely to have happened from a fall from a high-chair. It may have, but what was needed was a much more comprehensive assessment at the time of that first presentation."
    There was also a lack of training for healthcare workers in identifying the subtle signs of abuse, he said.
    "I think most doctors you can expect to manage the obvious things, but it's the subtle things that aren't missed. If a child comes in with a massive black eye and an obvious strap mark from being struck, most GPs aren't going to miss it, even if they've had no training. But most pre-verbal children don't present like that."
    There should be a statutory requirement on the health, and also education, systems to make them responsible child protection, along with Child, Youth and Family, which had a "huge" workload, he said.
    "I think if one had an entire health workforce committed to that degree of quality secondary prevention it would also have an affect on primary prevention because they would be working with families, talking to families about violence, hitting children, keeping children safe and all the other things that come out of good parenting practice."
    The inquest will hear evidence from Mr Kahui's sister, Mona, tomorrow.