Thursday, 16 December 2010

SIDS: Sudden Unexpected Death in Infancy and the Dilemma of Defining the Sudden Infant Death Syndrome

Henry F. Krous
Departments of Pathology and Pediatrics, UCSD School of Medicine and Rady Children’s Hospital-San Diego, La Jolla
CA, USA
Abstract:
Sudden unexpected death in infancy (SUDI) is an umbrella label that some employ to encompass all sudden unexpected infant deaths, whether or not explained, while others restrict its use to cases in which the cause of death is uncertain, but possibly due to asphyxia as may occur, for example, with sleeping prone, face down on a soft sleep surface, and/or being found with the head covered. Since sudden infant death syndrome (SIDS) is a diagnosis of exclusion, there is an inevitable interface between it and those cases whose deaths are potentially caused by unsafe sleep environments. This
interface is especially blurred given the lack of definitive, easily identifiable postmortem marker(s) for SIDS. Therefore,
present SIDS definitions are imprecise and its diagnosis remains one of exclusion. Improved death scene investigation has resulted in a diagnostic shift away from SIDS towards other causes of death such as positional asphyxia or undetermined.
Unfortunately incomplete death scene investigation has hampered evaluation of the real circumstances of death in too many of the cases further contributing to confusion. In this report, the purposes for and primary definitions of SIDS are delineated. Subsequent discussion focuses on the increasing challenge to incorporate risk factors and the underlying
pathology germane to the pathophysiology of SIDS into future definitions. This challenge is matched by the need to develop affordable and widely available testing that will identify pathology relevant to medical examiners and others
charged with certifying the cause and manner of death.
Current Pediatric Reviews,
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http://www.californiasids.com/UploadedFiles/Forms/SIDSDiagnosticDilemmasKrous.pdf>
Blogger's Comment:
An important article that analyses some of the abuse and misuse of the unsatisfactory nature of SIDS as a diagnosis.

SIDS: Missouri: Quintine Schmidt

 December 10, 2010
The Dexter infant found dead inside his home in October died of sudden infant death syndrome. Quintine Jeffrey Alexander Schmidt, the 6-month-old son of Erik and Candice Schmidt, died Oct. 12 at his residence.
Dexter Police officers and Stoddard County Ambulance Service personnel responded to the Schmidt residence in the north sector of Dexter after a 911 call was received regarding a baby in cardiac arrest and not breathing. Upon their arrival, the infant was found unresponsive and subsequently was pronounced dead at the scene.
The Stoddard County Major Case Squad was activated to investigate the infant's death and an autopsy was performed Oct. 14 at Mineral Area Regional Medical Center in Farmington, Mo., by Dr. Russell Deidiker.
Dexter authorities recently received Deidiker's final autopsy report, which listed Quintine's cause of death as sudden infant death syndrome (SIDS) and his manner of death as natural, said Dexter Police Detective Trevor Pulley.

SIDS errors: VIRGINIA: Ashkea Johnson

By Brad Zinn/staff • December 11, 2010
STAUNTON — A jury deliberated for nearly four hours Friday before convicting Staunton teen Ashkea Johnson on a charge of first-degree murder in the suffocation death of her 2-month-old baby.
The 12-person jury also found Johnson guilty of attempted second-degree murder, bringing an end to the two-day trial.
The 18-year-old Johnson, who did not testify, wept softly as the verdicts were read in Staunton Circuit Court.
Johnson's baby, Rosaleeia Johnson, was lifeless when police and rescue personnel responded to the family's apartment at 337 N. Central Ave. the morning of Nov. 15, 2009, after a 911 call from Johnson.
The baby died four days later at the University of Virginia Medical Center in Charlottesville after being declared brain-dead and taken off of life support.
Johnson initially claimed she found her daughter unresponsive in her baby carrier after leaving the child alone for about five minutes.
But under questioning by Investigator Chad Nestor of the Staunton Police Department, two weeks after the baby died Johnson confessed to smothering the child by placing a plastic diaper bag over her face, and demonstrated how she killed her daughter by using a CPR doll. On Thursday, the jury viewed the entire three-hour interrogation and again watched parts of the tape Friday while in deliberations.
Assistant public defender David Smith, who in August lost a motion to have the confession thrown out, argued that Johnson was coerced into confessing. On the stand Friday, Nestor admitted he told Johnson she could get less prison time if she came clean about the killing.
"So misleading is OK?" Smith asked.
"I believe they call it bluffing," Nestor said of the common police tactic.
With no forensic evidence to help support a murder charge against Johnson, the death could have fallen under the category of Sudden Infant Death Syndrome, said assistant Staunton prosecutor Anne Reed. She praised Nestor's work and said the state would not have had a case without the confession.
http://www.newsleader.com/article/20101211/NEWS01/12110332/Teen-found-guilty-in-murder-of-baby

SIDS: North Carolina: Child death investigation training called basic

- The Charlotte Observer
RALEIGH -- The state's top child advocacy task force will urge legislators to require all new police and deputies to take a course in child death investigation as part of basic training, the group voted Monday.
The task force also decided to support regionalizing the state's medical examiner system, which would place trained investigators across the state to respond to deaths. Because the effort could cost a lot, the group doesn't expect it to happen this year. The proposals were spurred by a Charlotte Observer series this year, "Cradle of Secrets," that looked at five years of sudden infant death syndrome cases in North Carolina. The series detailed that police frequently fail to investigate the deaths thoroughly, if at all.
The N.C. Child Fatality Task Force outlined its legislative agenda for 2011. The proposals involving child death scene investigation are designed to help gain "a standard for all death scene investigations," Brett Loftis of Charlotte, one task force committee chairman, said Monday. Currently, courses in proper child death investigation techniques are optional for North Carolina law enforcement officers.Many never take the courses; sometimes police don't respond at all to a child's unexplained death. North Carolina also doesn't have full-time trained investigators to send to most infant deaths, but a growing number of jurisdictions nationally do. Child death investigation is important, organizers say, because learning how children die can help the task force and other groups prevent deaths. Task force Chairman Tom Vitaglione said he was hopeful the N.C. Justice Academy, which trains all new officers, would agree to incorporate the plan. But if not, his group would push for a legislative order. The Charlotte Observer series also looked at the problem of safe-sleep education for parents. It found that at least two-thirds of babies who died of sudden infant death syndrome between 2004 and 2008 were sleeping in risky environments that suggested they could have suffocated. Those situations included sleeping with adults on beds or couches, sleeping among pillows and fluffy blankets or just sleeping on their stomachs. Studies have found that infants are more likely to die in these conditions. The Child Fatality Task Force also voted to ask for $150,000 for safe-sleep education in the coming legislative session, which begins in January. The amount is the same as the state spent last year, and that worried some committee members. The task force had talked this year about urging law enforcement statewide to complete optional checklists at child death scenes, which were designed to provide information about the child's sleep position and many other details. But the chief medical examiner's office decided this fall to stop using the Infant/Child Death Investigation Reports after learning they were public documents. The medical examiner's office had believed, and told law enforcement officers, that the information would be confidential. The task force looked at a wide range of proposals involving children's health. The group was created by statute and is among a few task forces that continue their work year after year.
http://www.newsobserver.com/2010/12/15/862842/panel-child-death-training-ought.html#ixzz18JC4EdTT

SIDS: Pennsylvania: co-sleeping


Officials target infant deaths
An increase in the number of accidental infant deaths in Lackawanna County has led to a new educational campaign by county and medical officials.
There have been six infant deaths in the past two years that can be attributed to accidental suffocation while sleeping with an adult and Sudden Infant Death Syndrome, according to District Attorney Andy Jarbola.
So far this year, three infants have died while sleeping in the same bed as their parents, Lackawanna County Deputy Coroner Tim Rowland said.
Every child's death is investigated by the county's Child Death Review Team. What the group has found is that many infant deaths could have been avoided if more education were available for parents and caregivers.
On Wednesday, the team launched what it is calling the Safe Sleep Initiative, wherein educational information will be distributed at doctors' offices and hospitals and through brochures, posters, billboards and public service announcements.
Having a child die in this way "is one of the worst things that could happen to a parent," said Jeanne Rosencrance, project director for the Child Death Review Team. "There's a tremendous guilt on the part of the parent."
When adults share a sleeping space with infants, they could unknowingly roll over onto the child, cutting off his or her oxygen supply, according to Dr. Stanley Blondek, director of pediatrics and newborn services at Moses Taylor Hospital. The child also could become wedged into small spaces between the wall and the mattress or next to the headboard, officials said.
Parents also could fall asleep while holding or nursing an infant, dropping or accidentally suffocating the child, Mrs. Rosencrance said.
There have been several cases of SIDS in the past few years, too. SIDS is a term used to describe a sudden and unexplained death of a baby, usually between 1 month and 1 year old.
Experts say the best way to avoid SIDS is to place infants on their backs when putting them down to sleep. But many caregivers are not aware that babies should sleep on their backs, Dr. Blondek said.
Mr. Jarbola said new parents still need to be educated on the proper way to put an infant down in the crib - on his or her back and without any toys, blankets or pillows.
"Nothing but a baby should be in the crib," he said. "That's the message we're carrying."
Contact the writer: enissley@timesshamrock.com
http://thetimes-tribune.com/news/campaign-targets-growing-number-of-infant-deaths-1.1077930#ixzz18JB88Z1H

SBS: British Columbia: Avtar Basi

 LOUISE DICKSON,  December 11, 2010  
A Victoria provincial court judge will decide in January whether Avtar Basi violently shook an 11-week-old baby girl in frustration or whether her devastating injuries were caused by his misguided attempt to resuscitate her.
Basi, 33, is charged with the aggravated assault of Baby E on Nov. 26, 2008 in the Central Saanich foster home run by his girlfriend, Micheline Slader.
The trial, which began in September, continued Wednesday with final submissions by Crown prosecutor Nils Jensen and defence lawyer John Green. Towards the end, Basi started to cry. Slader sat behind, patting him on the back.
The evidence clearly established that Basi applied force to Baby E and caused the injuries that resulted in her troubling, sad and permanent disability, Green told Judge Adrian Brooks. But in order to convict Basi, the court must be satisfied beyond a reasonable doubt that the force he used on Baby E was not done for the purpose of caring for her. The court must also be satisfied that excessive force was used, said Green.
At trial, Basi testified that, on the morning of Nov. 26, the baby went limp and, in a panicked reaction, he shook her three times.
“If you accept what Mr. Basi told you, he must be acquitted,” said Green. “This was a resuscitative attempt rather than anger.”
Green reviewed the evidence of medical experts including Dr. Katherine Wambera, who testified about breath-holding episodes. The spells, which are more common in toddlers and might affect about three out of 1,000 infants, are marked by a period of loud crying, followed by a period of 15 to 30 seconds when the baby cannot get his or her breath. Wambera said she would not be surprised by a fearful reaction by an inexperienced caregiver witnessing a breath-holding spell.
Green also reminded the court that infants are physically frail, with their large heads and weak neck muscles.
“You can get significant injury without application of a great deal of force,” said Green. “Not very much force for an adult translates into a lot of force for an infant.”
Both Basi and Slader liked the baby and wanted to adopt her, Green said. Baby E had no annoying or frustrating behaviour. There was no hint of abuse.
“There is simply nothing before you to suggest this man would explosively go off and injure this infant,” said Green. “This shaking occurred in a disastrous, tragic resuscitation attempt.”
Jensen reminded the court that Baby E suffered a life-threatening traumatic brain injuries which destroyed half her brain. Basi knew that shaking could harm a baby, Jensen said.
“Ms. Slader confirmed that he handled her appropriately by holding the back of her head when picking her up,” he said.
At trial, three medical experts testified that any reasonable observer who witnessed the shaking of Baby E would know it would cause death or bodily harm, Jensen said.
He urged Brooks to reject Basi’s evidence that he tried to resuscitate Baby E because she stopped breathing.
“The baby stopped breathing because of the shaking, not before the shaking,” argued Jensen.
Nothing was troubling this child, the prosecutor said. She was a perfectly healthy baby and it is very rare for a baby younger than six months to experience breath-holding spells.
On the other hand, Baby E’s cessation of breathing is completely consistent with very violent shaking. It is clear from the evidence, the more violent the shaking, the more quickly the symptoms of severe head trauma appear, Jensen said.
In court and in conversation with an undercover officer who befriended him, Basi minimized how hard he shook the infant, Jensen said. Even defence witness, Dr. Charles Ferguson, director of the Child Protection Centre at the Winnipeg Children’s Hospital, who watched five videos clips of Basi demonstrating how hard he shook Baby E, said it was unlikely such shaking would result in any injury.
Jensen also observed that Basi did not tell anyone including the dispatcher, Slader, paramedics, doctors or police that he tried to revive Baby E.
Eventually, he told the undercover officer he shook the baby out of frustration.
“When he finally confessed, it was accompanied by heartfelt tears and remorse because it was the truth,” Jensen said.
ldickson@timescolonist.com

http://www.timescolonist.com/Shaken+baby+verdict+January/3964122/story.html#ixzz18HwuwdU8

SBS: Mississipi; Michael and Amanda Voyles

Justin Fritscher:  December 14, 2010
Michael and Amanda Voyles both pleaded not guilty Monday to capital murder and felonious child abuse charges in connection with the July 2009 death of their 2-month-old son. Their trials are set for June.
"Our office has not decided whether to seek the death penalty or not," Madison-Rankin District Attorney Michael Guest said. "That decision won't be made until we get closer to the trial."
Circuit Judge William Chapman ruled the two would be held without bond, despite a defense petition to set a bond for Amanda Voyles.
"A preliminary investigation shows she was not present when the child was hospitalized," Public Defender Bill Townsend said.
An autopsy revealed Elisha Voyles suffered trauma to the body and head, dying from shaken baby syndrome, Guest said. An indictment from the July grand jury describes harsh treatment for the infant including whipping, striking and mutilation.
"These are the types of crimes where you have parents who have poor parenting skills," Guest said. "Both parents were unable to cope with the crying of their child."
Michael Voyles was arrested in July 2009, after the infant died at the University of Mississippi Medical Center. A person at the the Voyleses' residence in the Shady Grove mobile home community called 911, telling authorities an infant was not breathing.
That's when Pearl police began an investigation, said Lt. Butch Townsend, one of the officers who responded to the call.
Amanda Voyles was arrested in July after her husband was indicted. She was indicted in October.
One of the defendants will be represented by the Mississippi Office of Capital Defense Counsel.
http://www.clarionledger.com/article/20101214/NEWS/12140332/Summer-trial-set-in-death-of-baby

SBS: North Carolina: Derrick Michael Allen

State Bureau of Investigation, SBI
After a murder charge was dismissed against a Durham man who spent more than a decade behind bars, prosecutors and defense attorneys said Monday that more criminal cases could be thrown out.
A judge dismissed the case against Derrick Michael Allen after his lawyer argued that the State Bureau of Investigation had violated his constitutional rights by not sharinge everything it found in blood tests.
Allen, 31, was charged in 1998 in the death and sexual assault of a 2-year-old girl. An autopsy showed the girl died of shaken baby syndrome.
His case was among about 200 cases that an independent audit said were mishandled by the SBI. The audit revealed agents failed to report correct blood evidence in the cases.
Allen has maintained his innocence and was released on bond in September after spending more than a decade in prison.
Defense attorneys across the state are hopeful about the potential impact of the decision.
"That will encourage the judges to take a real hard look at cases that otherwise are just being passed through the system," defense lawyer Mike Unti said Monday.
Unti represents Johnny Daughtry, who was convicted in 1993 of killing his former girlfriend and sentenced to death. As in Derrick Allen's case, Unti said, the SBI's process in Daughtry's case was full of inconsistencies and discrepancies.
"There were more tests performed than was reported in the formal lab report," he said. "Only those that showed a positive result ended up in the testimony of the SBI agent at trial."
That agent was Duane Deaver, the analyst involved with many of the cases highlighted in the independent audit. Daughtry's case wasn't listed in the report.
"A lot of us have known all along that there are some real problems with the SBI and with the evidence that's being put on," defense lawyer Sharon Smith said.


Some prosecutors said they are concerned that emotions might play a role in certain cases.
"Decisions ought to be made based on the evidence and the proper criminal procedure, not whether or not someone is upset or doesn't like the way things went 10 or 15 years ago," Wake County District Attorney Colon Willoughby said. "There may be other evidence that overshadows (the SBI analysis). It may not be necessary to use that piece of evidence."
Durham County Assistant District Attorney Mich Garrell tried that tack on Friday in Allen's case. He argued that two doctors found evidence of sexual assault on the child and that the SBI evidence had nothing to do with the homicide charge against Allen.
Daughtry's attorneys said they're prepared to head to federal court if the state court ruling does not go their way. They're also considering similar action for many of their other clients.
http://www.wral.com/news/local/story/8771912/

SBS: Texas: Jose Herrera

Chris Paschenko : December 16, 2010
LEAGUE CITY — After reviewing evidence that prompted the state to accuse a father of killing his only son, a defense expert testified Wednesday the fractures and bruises occurred after the infant died.
During seven days of testimony, prosecutors and defense attorneys have disagreed whether cardiopulmonary resuscitation could have caused 14 rib and spine fractures, bruising, hemorrhages, abrasions and blood in the boy’s abdomen.
Jose Isaias Herrera, 20, was charged with injury to a child causing serious bodily injury, stemming from the Oct. 27, 2008, death of 6-week-old Jose Herrera Jr.
The boy, called Baby Jose at trial, was found dead, face down in a crib in his parents’ League City town home.Evidence revealed Herrera, who has yet to testify, performed CPR on the child’s body after it was cold and rigor mortis had begun.
Prosecutors called three medical examiners, two from Galveston County and another from Bexar County, who all testified the child was alive when the injuries occurred.
They didn’t all agree about whether the child had been shaken or whether the cause of death was blunt-force trauma.
Dr. Thomas Young, a former medical examiner in Kansas City, Mo., used some of the same evidence presented at trial, autopsy photographs and specimen slides, to form his opinion.
Evidence Of Healing?
The state’s experts testified they found evidence of healing, including in a rib that was broken possibly two weeks before death.
The state also showed the jury photographs of blood around the fractured spine and ribs as evidence of blood flow when the injuries were inflicted.
Young disagreed, saying cardiopulmonary resuscitation caused the fractures and the movement of a small amount of blood behind the skin and in the child’s eyes. This could have been confused with tissue hemorrhage, he said.
“Hemorrhagic lividity is not trauma,” Young said. “This is something that happens after death.”
Young agreed with Galveston County Chief Medical Examiner, Dr. Stephen Pustilnik, that the child didn’t die from shaken baby syndrome.
Galveston County Deputy Medical Examiner Nobby C. Mambo, who did most of the autopsy, told the jury in Judge Lonnie Cox’s 56th District Court in Galveston on Tuesday that he believed the child had been shaken violently.
Blood Settled After Death
Blood in the boy’s eyes also was hemorrhagic lividity — blood settled after death, Young said.
“Due to the effect of gravity on blood and blood cells after death, they settle so much in some areas,” Young said. “Blood vessels are engorged and leak a little bit, then you get these areas that look like hemorrhage.”
In cardiopulmonary resuscitation after death, the oozing of blood is expected, Young said.
Young said he would expected more blood loss had the child been alive when the injuries occurred.
Mambo reported finding about 10 percent of the boy’s blood in the abdomen and nine grams of blood clot.
“If you have injuries sufficient to break blood vessels in the abdomen, yet only a small amount of blood-volume loss, that’s consistent with postmortem and CPR,” Young said.
Young said he would have ruled the child’s death a case of Sudden Infant Death Syndrome. He said he would have listed the death as undetermined.
Bexar County Medical Examiner Randall E. Frost, who testified for the state, said he also would have listed the death as undetermined.
Defendant Had Temper?
Herrera’s mother, Irasena Herrera, testified Wednesday. She was the first defense witnesses called after the state rested late Tuesday afternoon.
Prosecutors portrayed the defendant as a hot-tempered man who didn’t believe the baby was his and who didn’t show enough remorse about the baby’s death.
Irasena Herrera testified she and her husband once each had to call police to their home after “discussions” with him.
Irasena Herrera, who came to Texas 15 years ago from Mexico, said she knew her son was devastated by losing his only son. He was quiet, “suffering in silence,” she said.
Herrera was very sad at the funeral, she said.
“There was no consoling him,” Irasena Herrera testified.
Prosecutor Donna Goode asked Herrera about recorded jail conversations with her son.
“You remember saying to your son, ‘Nobody saw you do anything?’” Goode asked. “You were trying to come up with somebody to blame for those injuries?”
No, Herrera said.
Testimony was expected to resume today. Herrera also is expected to testify during the trial, defense attorney Jeth Jones said.
http://galvestondailynews.com/story/198282

SBS: Michigan: Adam Benjamin Stevens

Danielle Salisbury | Jackson Citizen Patriot

ADAMSTEVENS.JPG.jpgAdam Benjamin Stevens
The case against a 28-year-old man accused of murder in connection with the death of his nearly 3-month-old baby is going to Circuit Court.
At the close of a preliminary examination Wednesday, District Judge Michael Klaeren found there was probable cause to believe Adam Benjamin Stevens, 28, committed felony murder and first-degree child abuse. The examination began Dec. 2.
Stevens is accused of shaking Kian Stevens, born May 21, inside the Blackman Township apartment he shared with Kian’s mother, Crystal Anderson, causing the baby to stop breathing.
Anderson, the only witness to testify Wednesday, called 911 about 12:50 a.m. Aug. 19. Kian died about 5 p.m. the same day at the University of Michigan Medical Center in Ann Arbor.
Anderson said she woke about 12:30 a.m. to the baby screaming and found Stevens with the child. Anderson testified Stevens was holding the boy upside down, said Assistant Prosecutor Jerard Jarzynka and Stevens’ lawyer, Michael Dungan.
He then quickly flipped the baby right-side-up, without supporting his head, Jarzynka said, recalling Anderson’s testimony.
Stevens denies shaking his son, Dungan said.
“No one is testifying that could cause a shaken baby,” Dungan said. “(Prosecutors) don’t have any witness that is going to come to court and say that he shook the baby.”
Anderson earlier said Kian was gasping for air when she spotted him with Stevens that morning. She took him from his father and to a bedroom. Eventually, he tried to cry, she said. He made a funny noise and “all the breath went out of him,” she said in August.
Stevens, who initially discouraged calling 911, tried to resuscitate the child, but the baby never regained consciousness, she said.
The boy died of severe and abusive head trauma, two doctors testified on Dec. 2.
Based on her conversations with the parents and a medical examination, Dr. Bethany Mohr, director of the UM child-protection team, said the injuries were caused by shaking, an impact to the head or both.
The whole case, which is expected to go to trial, will be a “battle of the medical experts,” Dungan said. It is not like a shooting or a stabbing where there is little or no question about how the injuries were inflicted, he said.
Dungan said he has three experts who will review the police reports, medical and autopsy records, and transcripts of testimony.
“I suspect that they are going to have an opinion other than shaken-baby syndrome,” Dungan said.
Kian was Stevens’ only child.
“Even Crystal testified that it was his first child. He was excited for his first child. ... He loved that child and truly enjoyed being a father,” Dungan said.
Stevens was a “very physical dad,” who liked to pick up his son and be active with him, Dungan said. He had to be reminded to handle Kian carefully, Anderson said in August.
That same month, days after Kian died, Anderson’s other three children — ages 9, 4, and 2 — were removed from her care. The 9-year-old is with her paternal grandmother; the other two are with their father, according to court records.
Anderson said she witnessed “on more than one occasion” Stevens shaking Kian to the extent his head was flopping backward and forward,” according to a Department of Human Services petition.
A hearing to terminate her parental rights is scheduled for Jan. 25.
http://www.mlive.com/news/jackson/index.ssf/2010/12/murder_case_against_father_of.html

SBS: Iowa:

Being shaken by a caregiver left Carter Keith trapped in his own world. It’s a tragedy that never had to happen.


A preventable tragedy. Christine Keith of Welland, with son Carter, who received severe brain damage after being shaken by a caregiver, hopes other parents won't have to live with shaken baby syndrome.
It’s Monday afternoon, and Niagara is getting hit hard with the first significant snowfall of the season.
A small school bus pulls up in front of the Welland home of Kevin and Christine Keith, and six-year-old Carter Keith is lifted out of the bus on his special wheelchair.
Mom Christine wheels him in through the garage of the house, up a ramp into the cozy living room before lifting him on to his spot on the couch. The family’s little black terrier, Nemo, is abuzz with excitement with the boy’s arrival, jumping up next to Carter with obvious joy.
If Carter notices the dog, it isn’t evident. He stares upward toward the ceiling, appearing lost in his own world.
Outside, Carter’s 11-year-old brother Kevin is arriving home. He and his friends pelt each other with snowballs. The weather might be playing havoc with drivers, many of whom have ended up in ditches in the first winter blast, but it’s a kid’s wonderland.
Christine looks at Carter and wonders if he would have enjoyed making snow forts or snow angels if not for that split second five and a half years ago.
Carter was five-and-a-half months old. The Keith family were living in Iowa at the time, and Christine had just returned to work as a professor of computer science after her maternity leave. They’d found a woman operating a day care out of her home they thought they could trust.
But about 10 days after she returned to work, Christine got summoned to the emergency room of the local hospital.
Something terrible had happened to Carter.
Rushing to the hospital, Christine found her son fighting for his life.
Carter was airlifted to a children’s hospital, where he was placed in the intensive care unit. A battery of tests showed the toddler had suffered devastating brain injuries by being shaken violently by his caregiver.
Carter had shaken baby syndrome. He would never be the same — nor would his family, including sister Kennedy, 10, and dad Kevin.
After 44 days in hospital, including a stint in a brain rehabilitation centre, Carter was sent home to his family. His prognosis was grim.
“When we took him home they told us we were bringing him home to die,” said Christine. “They told us he wouldn’t live to be three.”
Carter has so far beaten the odds, but the Keith family is realistic.
Because of his extensive brain injuries, Carter has had to undergo numerous medical procedures, is on special medication, and is fed through a tube attached to a valve on his abdomen.
He can’t walk or talk. His hips have dislocated. His spine is curving, raising the possibility of his rib cage pressing against his lungs.
He has to get botox injections because he has spasticity, a neurological disorder in which muscles are involuntarily contracted: Carter is unable to bend his knees.
He will be seven years old in March. Christine still has to change his diapers.
“He should be running outside to play in the snow with his brother and sister,” said Christine, cradling Carter. “But you don’t recover from this.”
Shaken baby syndrome (SBS), sometimes referred to as abusive head trauma, results when someone shakes a baby or toddler rapidly. Babies have weak neck muscles and comparatively large heads: violent shaking can cause their brains to slam back and forth against the insides of their skulls, and cause tearing or shredding of blood vessels in the brain.
The damage can lead to death or life-long disabilities such as blindness, paralysis and profound developmental problems, according to the Alberta Shaken Baby Syndrome Prevention Network.
Niagara Region’s public health department has teamed up with community partners to launch a new campaign to raise awareness of, and promote prevention of, shaken baby syndrome.
Amanda Hicks, a manager in family health at the Region, said parents and caregivers can cause the devastating brain damage by just shaking a baby for seconds. In the vast majority of cases, they lose control because they’re pushed to the edge by the baby’s crying, said Hicks.
Exactly how many cases of shaken baby syndrome there are out there isn’t clearly known. A study led by a researcher with the University of Ottawa in 2003, in conjunction with the Canadian Shaken Baby Study Group, identified 364 cases in Canada between 1988 and 1998. But the researchers conceded those cases represent “only the tip of the iceberg,” because many cases are not reported or are misdiagnosed.
There are also worrisome signs the grim economic picture of late may be pushing the cases of SBS up.
In May of this year, the results of a multi-centre study led by Dr. Rachel Berger of the Children’s Hospital of Pittsburgh were presented at a Vancouver conference. Berger’s study found that since the brutal recession hit, the number of SBS cases have spiked sharply.
“This suggests we may need to dramatically increase our child abuse prevention efforts now and in future times of economic hardship,” she said.
Hicks said the new campaign aims to remind parents and caregivers that it’s normal for a baby to cry, and to seek help or coping mechanisms if they’re feeling stressed.
“If you feel like you might lose control, put the baby in a safe place and walk away or ask someone for help,” she said.
Previous experience has shown that education campaigns can have a big impact on SBS rates. A white paper by American researchers in conjunction with the U.S. National Center on Shaken Baby Syndrome found that an education program for new parents in eight counties in western New York State over six years resulted in the number of documented SBS cases plummeting 47 per cent.
At the Keith household, every thing possible is done to bring a sense of normalcy to Carter’s life. He goes with the family on excursions to the mall and swimming, and is a Grade 1 student at Holy Name Catholic School in Welland where fellow students have embraced Carter as one of their own.
“The way they treat my son, what an amazing group of kids,” said Christine. “It makes us so happy.”
Christine, meanwhile, hopes that by raising awareness of SBS she’ll combat a lingering, hurtful stigma. More than once, staff at hospitals have assumed she’s Carter’s foster mom, assuming wrongly that his natural mother — not a caregiver — must have caused his brain injuries.
She also hopes to prevent other families from having to live with SBS.
“We can’t fix Carter,” she said. “But if we can prevent one child from being hurt, that would mean a lot.”
With Christmas just around the corner, it’s a bittersweet time for the Keiths. Instead of shopping for model sports cars or toy dinosaurs for Carter, Christmas typically entails buying ‘gifts’ such a nursing pillows to keep him propped up.
“He should be getting ready for Santa,” said Christine. “He should be getting excited about Christmas.”
And despite brain scans showing little brainwave activity in her son, Christine clings to the belief that Carter is more aware than he appears.
“I’ve never felt my son give me a hug,” she said. “But I know he knows I’m his mom.
“I know he loves me.”
http://www.niagarathisweek.com/community/health/article/914639--i-know-he-loves-me

SBS: Pennsylavania: Jamel Lee Billups

JIM TUTTLE
A Chambersburg man accused of shaking his infant daughter until she suffered brain injury last October told police that he was always "very delicate" with his children.
A jury watched a video Tuesday of Jamel Lee Billups, 32, being interviewed by a detective on the day his daughter was flown to Milton S. Hershey Medical Center.
Chambersburg police Detective William Frisby Jr., who conducted the interview, was the last witness to testify Tuesday in the Billups trial. The prosecution has now called all its witnesses, and the defense is expected to begin presenting its case this morning.
"I promise I won't use any big words or mention any medical lingo," Frisby said to the jury as he approached the witness stand.
In that respect, his testimony was an exception. The other two witnesses heard Tuesday were both doctors who discussed Leiana Trina Billups' brain damage and other physical problems in great detail.
Frisby said he was called in to interview Billups on Oct. 19, 2009 after Chambersburg Hospital notified police about the baby's injuries. The taped interview was played for the jury.
In the video, Billups told Frisby that his daughter had been acting healthy all day, until the afternoon when she awoke from her nap crying. He described her as "tensed up" and arching her back, and said she didn't seem to be breathing normally.
"It just wasn't right," he said in the video.
Using a doll to demonstrate, Billups showed Frisby how he picked up and held his daughter after she began crying. He also re-enacted how he tried to get a response from her using what he called a "wake-up tap" on her face.
"That's the most trauma to the head that I did today, or that I would do to her," he said in the video.
During the interview, Billups described the way he handles his children as "very delicate."
"I love both my kids very much," he said.
Defense attorney Christopher Basner asked Frisby during cross examination if he would agree that Billup's account of the Oct. 19, 2009 has remained consistent. Frisby said he agreed.
Dr. Mark Dias, a pediatric neurosurgeon at Milton S. Hershey Medical Center, Hershey, was the first witness to testify Tuesday. He told the jury that, based on his expert opinion, the baby suffered permanent brain damage as the result of being shaken violently.
He said possible effects of the baby's brain damage include lasting vision problems, stiffness and difficulty moving her limbs, mental retardation and cognitive impairment.
"We don't know the extent, but I can virtually guarantee you that she will have some problems," Dias said.
According to testimony, testing indicated that Billups' daughter suffered 16 rib fractures between four and six weeks prior to suffering head injury, brain hemorrhaging and extensive retinal bleeding consistent with a shaking event
Billups is charged with aggravated assault and endangering the welfare of a child. His defense team contends that the infant's brain bleeding and other problems were the result of a somewhat rare type of stroke called cerebral venous thrombosis.
In his testimony, Dias used a traffic analogy to explain the workings of blood vessels in the head. He compared clotting, also called thrombosis, to car wrecks that disrupt the flow of traffic.
Dias testified that, in his experience and according to the literature he has read on the matter, there is no evidence that CVT "causes a catastrophic loss of consciousness and disorderly breathing," he said.
During cross examination, defense attorney Mark Freeman referred to a scholarly article written by another doctor who contends that the level of force required to cause retinal bleeding by shaking is "biomechanically improbable."
Dias said he disagreed with the statement, and that "a minority of people" in his field would agree with it.
"You're picking one person's point of view, which is fine," Dias said to the lawyer. "That's your job."
The doctor said tests for thrombosis were performed on the baby weeks after she was first brought to the hospital. "Not only did we find no evidence (of thrombosis), we also found evidence of what we would expect with abusive head trauma," Dias said.
At one point during his the cross examination, Freeman asked Dias if he was a radiologist.
"No, I'm a neurosurgeon," Dias replied.
Dr. Arabinda Choudhary, director of pediatric neuroradiology at Hershey, also testified Tuesday that the baby had blood on her brain and retinal hemorrhages, as well as apparent brain swelling and bruising.
He showed the jury MRI images that he said showed Leiana's damaged brain. The blue and white cross-sectional views of the baby's head showed noticeable differences between the left and right sides.
He said that "based on (his) training and experience," the was "no evidence of thrombosis" in the baby's scans. He showed the jury images of a normal adult brain alongside images of the same brain with thrombosis, and explained the differences.
Assistant District Attorney Lauren Sulcove said she will formally rest her case against Billups first thing today. The defense is expected to call its first expert witness, a doctor, about 9 a.m
http://www.publicopiniononline.com/localnews/ci_16861375

SBS: Texas: Jose Trevino

 December 16, 2010:  Robin Pyle
Lubbock authorities on Wednesday filed felony charges against a baby sitter’s boyfriend in connection with a severe shaken baby case last month.
A 6-month-old boy on Nov. 5 suffered bleeding between his brain and skull after police say 19-year-old Jose Trevino violently shook the infant while frustrated, according to court documents.
On Wednesday, Lubbock police obtained an arrest warrant for Trevino, charging him with two counts of intentionally and knowingly causing serious bodily injury to a child. One count was causing injury by shaking the infant, the other involved striking the child with a hard object.
Police say Trevino’s girlfriend was watching the infant at their residence when she went to take a shower, leaving her boyfriend and the infant alone together in the living room. The child was sleeping, but woke up fussy while the girlfriend was still in the shower.
Authorities were called just after 9 a.m. to the 5700 block of Second Place after a report of a child not breathing. The infant was rushed to the hospital, and emergency crews were able to revive him en route, according to police reports.
According to the National Institute of Neurological Disorders and Stroke, the majority of infants who survive severe shaking will have some form of neurological or mental disability, such as cerebral palsy or mental retardation, which may not be fully apparent before the age of 6.
Shaking infants can cause such severe damage because their fragile brains bounce back and forth inside the skull, which causes bruising, swelling and bleeding.
Lubbock police say Trevino admitted he shook the child because “he was getting frustrated.” The infant was fussy — possibly from teething — and he couldn’t get him to calm down, even after giving him a bottle of milk and giving him medicine.
“Jose stated he repeatedly shook (the infant) with a back and forth motion,” the officer said in his report. “Jose stated he knew he shook him too hard and immediately knew he had hurt him. Jose stated (the infant’s) eyelids started to close and he stopped breathing.”
Medical staff told police the injuries were consistent with child abuse.
A CAT Scan revealed the child suffered “diffused subdural hemorrhaging,” which is bleeding between the brain and skull and often the result of abusive head trauma, the officer said in his report.
When police first interviewed Trevino, he told them the child just stopped breathing and said: “I wasn’t shaking him vigorously, I was just kind of rocking him,” according to court documents.
But Trevino later reportedly told police he “originally lied because he did not want people to think bad about him,” according to court documents.
He also told police he accidentally hit the child’s head with the car seat handle when taking him out of his car seat.
The Avalanche-Journal reached Trevino by phone on Wednesday afternoon, and he said: “I’d rather not comment.”
He also refused to give the name of his attorney, and attorney information wasn’t available in public record for him.
The bail attached to Trevino’s warrant was $100,000.
http://lubbockonline.com/crime-and-courts/2010-12-16/baby-sitters-boyfriend-charged-connection-shaken-baby-case

AHT: Georgia: Daryl Keon Jones

December 14, 2010 - 12:00am
     
Brianna Kichelle Hester was 17 months old when she died May 1, 2009, of blunt force trauma consistent with shaken baby syndrome, according to the autopsy. She was being watched by her mother's boyfriend.
    BRUNSWICK - A 10-year-old boy told and showed Glynn County police how his father repeatedly slammed a crying 17-month-old Brunswick girl face-first onto the floor of their home last year.
    Alijah Jones is expected to be a crucial prosecution witness against his 33-year-old father, Daryl Keon Jones, who went on trial Monday in the beating death of Brianna Kichelle Hester, who died the day after being injured at Jones' Lantana Court apartment.
    The elder Jones has pleaded not guilty to murder, felony murder and first-degree cruelty to children in Brianna's death.
    Jones listened impassively as Glynn County police Sgt. Bill Daras testified that on May 2, 2009, Alijah described and demonstrated how his father hurt Brianna. Police videotaped that interview, but it wasn't shown to jurors Monday morning.
    "Alijah told me he witnessed his father pick Brianna up by the throat and he slammed her forehead into the ground nine or 10 times. He showed me how his father did it, with his hand on the back of Brianna's neck," Daras testified.
    The boy is Jones' only son, and the sole witness to Brianna's injuries on April 30, 2009, Assistant District Attorney Greg Perry told the five-man, nine-woman jury in his opening statement Monday morning.
    Alijah will testify his father slammed the crying baby onto the floor of the family's apartment until she cried no more, Perry said.
    "The defendant is the only one other than Alijah Jones, his son, who saw what happened and he [Alijah] will testify ... " Perry told the jury.
    James Yancey Jr., who is defending Jones, said in his opening statement that his client loved Brianna like his own child and that he never hurt her. Alijah is a troubled boy whose mother, Cynthia Jones, is coaching and manipulating him to implicate his father because the estranged couple are in an acrimonious divorce, Yancey said.
    "The evidence will show Daryl Keon Jones is not the one responsible for this child's tragic death," Yancey said.
    The Glynn County paramedic who was first on the scene testified to Jones' demeanor, and Brianna's maternal grandfather, Glynn Hester, a county police officer, testified that he noticed a bruise on Brianna's forehead while visiting her just hours before she was mortally injured.
    Brianna was the daughter of Kim Hester, who at that time was Jones' live-in girlfriend; Jones was not the father. Hester was in nursing school in Jacksonville when her daughter sustained the injuries. At the time, Jones was baby-sitting Brianna and his three children - daughters, 3 and 5, and Alijah - the police investigation showed.
    The toddler died May 1, 2009, in a hospital when her mother allowed doctors to take her daughter off life support.
    Daras testified he interviewed Alijah after Cynthia Jones called him the day after Brianna died. When another detective and a state social worker interviewed Alijah at the scene after Brianna was rushed to the hospital, he didn't tell them about seeing his father hurt her, Daras testified.
    When Daras asked Alijah why he didn't say anything then, the boy said "he felt intimidated. His father was in the residence and he felt he couldn't say anything then," Daras testified.
    County firefighter/paramedic Jonathan Currier testified he was first at the scene for a 911 call that a baby had fallen and was not breathing. Jones' three children were outside the second-floor apartment, he said.
    He found Daryl Jones inside kneeling with his hands on his knees beside Brianna, who was lying on her back with her head about a foot from a window seat. She was not breathing but had a pulse.
    "He said 'She has to go to the doctor because of her legs. She fell and hit her head and was shaking like this.' ... He was a little detached," testified Currier, who also was a neighbor of the Jones family. "I noticed bruises of varying age on the child's jaw. They were small, round like the tips of fingers."
    Glynn Hester wiped tears from his eyes as he identified a photo taken of Brianna that day. He testified he saw a reddish mark, like a bruise, on one side of her forehead during a visit but had not seen other bruises between her eyes, on her neck, chin and jaw line that were documented in the emergency room and an autopsy.
    The autopsy showed Brianna died of blunt force trauma consistent with shaken-baby syndrome, Perry told the jury. The medical examiner will testify he found 36 separate injuries of varying degrees of severity and that Brianna suffered fatal brain damage, he said.
    An emergency room doctor who treated Brianna, however, will not be allowed to testify as a pediatric critical-care expert. Harrison sustained Yancey's objection that he did not have enough advance notice to properly research the doctor's opinion and get his own expert.
    If convicted, Jones faces an automatic life sentence with eligibility for parole under Georgia law. The trial is expected to continue through the end of the week with recesses for Jones to undergo kidney dialysis treatments.
    teresa.stepzinski@jacksonville.com, (912) 264-0405
    http://jacksonville.com/news/crime/2010-12-14/story/police-brunswick-boy-saw-his-father-kill-17-month-old-girl

    SBS: Idaho: Brandon Julian

    Dec 15, 2010
    Ada County Sheriff’s detectives have arrested a Kuna father on a charge of felony injury to a child. Brandon Julian, 32, of Kuna, was booked into the Ada County Jail on the charge early Wednesday morning.
    The charge stems from an investigation that began last Friday, Dec. 10. An 11-week-old infant had been admitted to St. Luke’s after several days of fever, vomiting and lethargy. Tests showed the infant had bleeding and bruising within his skull. Doctors say the tests confirm the infant suffered “non-accidental trauma”, commonly referred to as shaken baby syndrome.
    Doctors immediately reported the findings to Health and Welfare and to law enforcement on Friday.
    Based on the evidence gathered through the course of the investigation, Ada County Sheriff’s detectives determined Brandon Julian is responsible for the injuries to his 11-week-old son. Investigators say the incident that caused the injuries happened in the early morning hours of Friday, Dec. 3, in Julian’s home in the 1900 block of Maroon in Kuna.
    The 11-week-old remains hospitalized. He is expected to survive but his prognosis is not yet known. When he is released from the hospital, the infant will remain in the custody of his mother.
    Julian is being held in the Ada County Jail and is expected to be arraigned on the felony injury to a child charge

    SBS: Arizona: Hernandez

    10 Dec 2010 
    MIRIAM GARCIA
    PHOENIX - It's a tragic case of child abuse: a 3-month-old boy was beaten to death and police say his father is to blame. Now the boy's mother speaks exclusively to FOX 10.
    The mother, who should have been enjoying motherhood, is now preparing to bury her young son.
    Police say the child's father admitted to shaking his own son. The boy clung to life at an area hospital for three days before he passed away.
    "He was breathing and he died, but he died in my arms," said Imari McClure, the boy's mother.
    McClure never though she would be planning a funeral for her 3-month-old baby boy. Francisco Hernandez, Jr. died of shaken baby syndrome on Wednesday.
    "I begged him to wake up..I said if he loves me, he would wake up," said McClure.
    On Monday morning, police say the baby's father who is also named Francisco Hernandez, shook the child so hard it caused brain swelling. Imari and the child's father aren't together, so she got the call at home.
    "I don't think is really the word for it..I'm really angry..I just want to know why," she said.
    Phoenix Police arrested Hernandez on an outstanding warrant. They say he has a violent criminal past. While being questioned, police say Hernandez admitted to shaking the baby out of frustration.
    Imari says she never though Hernandez would hurt his own son.
    "I just don't understand..I hate him," she said. "It's not fair because he could have called..and please pick him up."
    Hernandez is facing a child abuse and murder charge.
    http://www.myfoxphoenix.com/dpp/news/crime/shaken-baby-death-case-12102010

    SBS: Texas: Jose Herrera


    Chris Paschenko : December 15, 2010
    LEAGUE CITY — Although two medical examiners disagree on whether a 6-week-old boy was shaken to death, they agree he was alive when his injuries were inflicted.
    Jose Herrera Jr. likely was alive when he suffered 14 rib and spinal fractures; head, stomach and lung bruising; eye trauma; and two abrasions to his back, according to testimony Tuesday from two Galveston County medical examiners.
    Jose Isaias Herrera, who turned 20 today, was charged with injury to a child in the Oct. 27, 2008, death of his only son, Jose Herrera Jr. The boy, called Baby Jose at trial, was found cold and face down in his crib at his parents’ League City town home.
    During day six of testimony in Judge Lonnie Cox’s 56th District Court in Galveston, Dr. Stephen Pustilnik, chief medical examiner, and Dr. Nobby Mambo, deputy medical examiner, testified Baby Jose died of blunt-force trauma.
    Mambo testified someone vigorously shook Baby Jose, leading to his death.
    Pustilnik, however, testified he didn’t believe the boy was shaken but rather dropped or thrown against something.
    “Holding the child and slamming (him) onto something doesn’t fit the definition of shaken baby syndrome,” Pustilnik said.
    The “vigorous shaking” broke the boy’s back, Mambo testified.
    Baby Jose didn’t have an injury to his brain, which can be a result of shaken baby syndrome, but it is possible the child died before the body had time to produce a brain injury, Mambo said.
    Mambo also testified none of the injuries occurred after the boy’s death.
    Mambo ruled the death was caused by blunt-force trauma.
    “A child cannot inflict these injuries on itself,” Mambo said. “Somebody must have, and that’s why I ruled it a homicide.”
    In the previous testimony, jurors heard Herrera gently shook the lifeless body of Baby Jose before performing cardiopulmonary resuscitation on a mattress.
    Defense attorneys Jeth Jones and Kyle Verret contend that lifesaving attempt caused the child’s injuries. Prosecutors Donna Goode and Kayla Allen disagree.
    Evidence suggested one of the child’s 13 ribs fractures was inflicted possibly two weeks before his death.
    The boy’s injuries were uncharacteristic in cardiopulmonary resuscitation, Pustilnik said.
    Pustilnik took the jury on a nearly three-hour lecture, showing medical studies on bones, how they are formed and how they heal after breaking to bolster his claim the injuries occurred before or at the time of the child’s death.
    After the state rests its case, possibly today, the defense is expected to call a former medical examiner from Kansas City, Mo., to contest the state’s findings.
    Herrera also is expected to testify.
    http://galvestondailynews.com/story/198054

    SBS: Ireland: Man jailed for shaking baby son

    A Mauritian national who shook his eight-week-old son causing him serious lifelong injuries has been given a five-year sentence with the final two suspended on condition he return to his home country.
    The boy, now one-year-old, has been diagnosed with “shaken baby syndrome” resulting in difficulties with movement, feeding, and speech.
    He has developed cerebral palsy as well as epilepsy and is on anti-convulsive medication. His condition is permanent and he is now cared for by foster parents.
    The man told gardaí he had grabbed the crying baby by his clothing when he would not go asleep and shook him for “five seconds at the most”. He said he did not intend to hurt his son.
    The man, who can not be named to protect the identity of the child, pleaded guilty to assaulting his son causing him harm at the family home on a date between March 24 and April 8, 2009. He has no previous convictions.
    Judge Patrick McCartan said that taking into account the “appalling injuries” of the child it was a “remarkable gesture of leniency” that the Director of Public Prosecutions had accepted a guilty plea in this case to assault causing harm rather then the original charge of assault causing serious harm.
    “It is difficult to understand the reasons of the director but no doubt there are good reasons,” he said.
    He said the five-year maximum sentence applicable to assault causing harm was wholly inadequate in this case having regard to the consequences for the child.
    Judge McCartan imposed a five-year sentence but suspended the final two years for a period of 10 years on condition the man return to Mauritius on his release.
    Detective Garda Chris Cahill told Mr Shane Costelloe BL, prosecuting, that gardaí were alerted on April 9, 2009 that a child had been admitted to Temple Street Hospital with injuries that appeared to be non-accidental.
    Gardaí attended at the hospital, observed bruising on the child’s face and spoke to the mother, who at that time was in a relationship with the accused. She said she had left the child in the care of his father on the night of April 7 and the next morning noticed a bruise on his face.
    The following night she again left the child in the care of the accused and when she came back noticed that the bruise was larger. She said she confronted her partner and he denied knowing anything about it.
    She brought the child to her GP on April 9 and after examination the doctor told her to go immediately to the hospital.
    Det Gda Cahill said when he went to the couple’s home he felt the accused man was evasive and behaving suspiciously. He was arrested and brought to a garda station for interview.
    The man was interviewed eight times about the child’s injuries and he initially did not offer an explanation except to say the child may have rolled over on his pacifier.
    During the seventh and eighth interviews he began to accept he was responsible for the injuries and that the only likely explanation was that the child had been shaken vigorously.
    He told gardai that the previous Saturday he had just finished changing the baby and was trying to get him to go asleep. He left the child in his room but he began crying again and he returned to the room.
    He said he grabbed the child by his clothes at his chest and shook him “at most for five seconds”. He said he shook the child from side to side but he cried more so he held him and brought him out to the living room.
    “I just wanted him to go back to sleep, he had not slept all day,” he told gardaí.
    Gardaí asked him if he shook the baby “too hard” and he replied: “For a baby, yeah.”
    He told gardai he did not mean to hurt his son.
    Det Gda Cahill said the accused had come to Ireland some years previously on a one-year student visa which had expired prior to this incident. He had met and begun a relationship with the child’s mother.
    Medical reports indicated the child has been diagnosed with “shaken baby syndrome” a blanket description given to range of symptoms arising in the case of infants who have been shaken to the extent that they receive contusions to the brain.
    Given the child’s age it is not yet possible to determine any psychological effects.
    The baby boy is now in the care of foster parents and his condition is permanent and will not resolve.
    Det Gda Cahill agreed with Ms Caroline Biggs SC, defending, that at the time of the offence both parents were in chronic financial difficulties. He further agreed that the man said in interview he was ashamed of what he had done and exhibited genuine remorse.
    Ms Biggs asked the court to take into account her clients guilty plea, his previous good character, good work history as well as his genuine remorse and care for the child.
    “I would ask you to accept that whatever this court does, he will have a lifetime of punishment and guilt,” she said.
     http://www.irishexaminer.com/breakingnews/ireland/man-jailed-for-shaking-baby-son-485835.html#ixzz18HSWQPjB

    SBS: California: Shirley Ree Smith

    Shirley Ree Smith spent 10 years behind bars for the death of her grandson before her conviction was overturned.  Now she waits on skid row as the courts sort out whether a jury's verdict — even if wrong — must prevail.

    From a second-floor room in skid row's Russ Hotel, Shirley Ree Smith spends sleepless nights listening to the knife fights and profanity-laced taunts of the drug dealers, pimps and brawlers who populate South San Julian Street. She ventures out after dark only as far as she needs to get cellphone reception for the nightly call from her daughter, Tomeka, in Kankakee, Ill. It is the emotional high point of each day spent looking for work no one will give her. Smith has been separated from her daughter and grandchildren for 14 years, since her arrest in the 1996 death of her 7-week-old grandson. After a Van Nuys jury accepted a prosecution theory that Smith must have shaken the baby violently to stop him from crying, she spent 10 years behind bars. Then in 2006, an appeals court ruled the evidence against her was so flimsy it violated her constitutional right to a fair trial. She was ordered freed.
    But a long-running legal dispute among the nation's most influential judges has continued to put restraints on Smith. She has been confined to Southern California while the U.S. Supreme Court and the 9th Circuit Court of Appeals exchange contradictory musings, not about her guilt or innocence, but on whether a jury verdict should be respected — right or wrong. Smith still could be locked up in prison for the rest of her life, if the high court justices take another look at the 9th Circuit's release order and conclude it failed to respect the jury's guilty finding.
    **
    Smith says she was dozing on her sister's living room carpet, the TV tuned to the western she'd been watching. She recalls being awakened by "a little cry," and found her two baby grandsons had slipped off the sofa cushions onto the floor. She put 14-month-old Yondale and 7-week-old Etzel back on the sofa. Their 3-year-old sister, Yolanda, was asleep on the nearby love seat, Smith said. "They were fine," she insists, despite the short tumble. She woke again a couple of hours later to use the bathroom. On her way back to the living room, she checked on Etzel, thinking he needed a diaper change. In the flickering light from the TV screen, she saw blood trickling from the infant's nostril and something white and foamy at his mouth.
    "His head just flopped back," Smith said, her eyes widening in terror at the recollection.
    She raced the infant to Tomeka, who had fallen asleep in a bedroom. Mother and daughter called 911 and took turns giving the baby CPR, guided over the telephone by paramedics as an ambulance rushed to the Van Nuys home and emergency dispatchers recorded the women's anguished pleas for help. Etzel was pronounced dead on arrival at Mission Community Hospital about 4 a.m., Nov. 30, 1996. The attending physician listed the cause of death as suspected sudden infant death syndrome.
    Within a few days, though, a preliminary autopsy finding would quash that diagnosis and compound the family's grief. The death was ruled a homicide and Smith was the suspect.
    A tiny patch of blood found under the skull and a scrape the size of a match head prompted the autopsy doctor to call Los Angeles County's child abuse hotline. A social worker with the Department of Children and Family Services showed up at Smith's sister's apartment two days later to take Yondale and Yolanda into protective custody, commenting disparagingly on Tomeka's having borne three children by the age of 18.
    Two months later, before the cause of death was made final or all postmortem test results had been received, Smith was arrested and accused of causing her grandson's death by shaken baby syndrome.
    None of the usual signs of violent shaking were present, experts for the prosecution and defense testified at her 1997 trial. The blood on the brain wasn't enough to have caused the death, nor could the small abrasion have been fatal, jurors were told. There was no telltale blood in the baby's retinas, nor was there hemorrhaging around the brain stem or the bruising and fractures that usually speak to abuse.
    Associate Deputy Medical Examiner Stephanie Erlich was four months into a two-year forensic training program when she discovered the small brain bleed — the first autopsy she performed that raised suspicion of child abuse. She testified that other indicators of shaken baby syndrome may have been missing because the shaking was so violent that tiny blood vessels in the brain stem suffered "shearing," causing instantaneous death without bleeding because the heart had stopped.
    Deputy Dist. Atty. Falomi Pierson objected every time a witness referred to Smith's loving and patient nature, as well as all accounts by paramedics, police and emergency room doctors of her shock and grief. The trial transcript records Superior Court Judge Darlene Schempp, clearly irritated by the rambling, inarticulate questioning of witnesses by defense lawyer Ubiwe K. Eriye, sustaining most of Pierson's objections and offering many of her own.
    Just weeks after the headline-grabbing trial of British nanny Louise Woodward brought shaken baby syndrome to the nation's attention, the jury convicted Smith of causing her grandson's death. She was sentenced to 15 years to life in prison. Jurors apparently gave more credence to Erlich and her supervisor, Eugene Carpenter, than to the two pathologists called by the defense who disputed the abuse conclusions and said the baby, born with jaundice, a heart murmur and low birth weight, was probably a victim of sudden infant death syndrome.
    "I never thought I could be convicted because I knew there couldn't be evidence of something I didn't do," says Smith, still baffled by the verdict. "You can't send a person to prison on a theory."
    The 9th Circuit panel agreed when it ordered her release in 2006. But since then, the appeals court has been engaged in a legal chess match with the U.S. Supreme Court in which Smith isn't a player but a pawn. The high court has twice sent her case back for the 9th Circuit to reconsider in light of Supreme Court rulings that recognize a jury verdict as beyond question.
    "My attorney says it's not about me. But who is it about, if not me? It's my life that is being ruined day after day. I'm the one living through all this," she says with a gesture sweeping in the skid row squalor.
    The 1996 Anti-Terrorism and Effective Death Penalty Act prohibits an appeals court from second-guessing a jury's evaluation of the evidence except when it constitutes a clear violation or unreasonable application of the law. Smith's conviction was one of those rare but patently wrong judgments, insisted the 9th Circuit panel comprising three appointees of President Carter — Circuit Judges Harry Pregerson and William C. Canby Jr., and U.S. District Judge Edward C. Reed of Nevada.
    Another round of legal jousting is already under way. Attorneys for the state have petitioned the 9th Circuit for a full 11-judge hearing and are expected to appeal again to the Supreme Court if they don't get it. In a Nov. 10 filing, the office of Atty. Gen. Jerry Brown scolded the three-judge panel for a decision that "once again failed to follow an implied directive from the United States Supreme Court to change the outcome in this case" by restoring the jury's conviction.
    "The sad part is that the science used in her defense has been validated in the intervening years," said Jeff Chinn, associate director of the California Innocence Project, a law student project dedicated to winning release of the wrongly convicted. "With the current research, I don't think she would have been convicted."
    **
    After her release from the Central California Women's Facility at Chowchilla, Smith bounced between the homes of her brother and sister. But her brother has a new girlfriend, and her sister wanted some space. A few weeks ago she moved to "emergency housing" arranged by agents of the court to whom she must report.
    In the four years since being freed from prison, Smith had been forbidden to leave the state because appeals of her release are pending. But earlier this month, a state court relented and told Smith she could go to Illinois to live with Tomeka and her grandchildren while the judges ponder the validity of her conviction. She has been asking relatives for bus or airfare in hopes of being home by Christmas.
    Tomeka Smith works nights packing candy at a warehouse south of Chicago, eagerly awaiting her mother's help raising her two teenagers and 12-year-old Marquis, whom Shirley met just once, a year ago, when she was allowed to leave Los Angeles to attend her mother's funeral.
    "It's just been terrible, terrible, terrible," Tomeka says of the criminal case that has branded her mother a baby-killer. "She isn't capable of doing this. She never even hollered at me when I was growing up....I miss my mother dearly. All we ever wanted was to be together and make a life."
    Citing her faith and her confidence that "there are people with consciences on the Supreme Court," Smith says she firmly believes her ordeal is nearing an end and the high court won't step in again to question the 9th Circuit judgment.
    On other days, she is haunted by the darker scenario.
    "I won't go back to prison," she vows, shaking her head with conviction. "I'll take my own life first, but I won't go back there."
    http://www.latimes.com/news/local/la-me-1216-shaken-baby-verdict-20101216,0,6598490,full.story

    Friday, 10 December 2010

    SIDS: Erythrocyte transketolase activity and sudden infant death

    DR Peterson, RF Labbe, G van Belle and NM Chinn
    Postmortem heart blood aspirates from 24 consecutive sudden infant deaths and 23 consecutive infant deaths from other causes yielded evidence of erythrocyte transketolase activity (ETKA) in every instance. ETKA measurements from cadaver specimens have not been previously reported. ETKA values did not correlate with the interval from death to sampling or with age at death. Activity coefficients from postmortem material corresponded closely to those from previous studies on living subjects which suggests that the method of Bayoumi and Rosalki yields valid measurements at least for 77 h postmortem. Statistical comparisons of the sudden infant deaths with non-sudden infant deaths revealed no significant differences. This investigation failed to disclose evidence in favor of the hypothesis, advanced by Read, that unsuspected thiamin deficiency may explain some cases of the sudden infant death syndrome.
    http://www.ajcn.org/content/34/1/65.short

    SIDS: Arkansas: Hardwick

    The death of a 10-week-old Foreman, Ark., baby was a result of sudden infant death syndrome, said Special Agent Hays McWhirter of the Arkansas State Police.
    The autopsy was performed by the Arkansas Crime Lab in Little Rock.
    Janae Joelle Hardwick, the daughter of Leroy Hardwick Jr. and Arnetha Hardwick, was found not breathing in her crib by her mother Sept. 22. Arnetha Hardwick performed CPR on the baby until Foreman first responders arrived within four to five minutes of the call to 911, said Little River County Sheriff.

    SIDS: North Carolina: Richards

    At birth and even in death, tiny Autumn Naimi's health left many questions. The 3-month-old Jacksonville girl died at an Apex home in October 2009.
    “She was 2 pounds, 10 ounces, and she was about 15 inches long. So, you could hold out your hand and her head would fit in the palm when she was born,” Autumn’s mother, Nicole Richards, said.
    Autumn had a heart defect, a thyroid problem, and Richards says she was to be tested for a genetic growth disorder. Richards says life was touch-and-go for the little girl from day one.
    “I had to be First Aid certified before she could leave the hospital. The doctor told me she could stop breathing at any time,” she said.
    At 3 months old and weighing just 9 pounds, that's exactly what happened.
    “She was asleep. I laid her down on her back,” Richards said.
    But Apex police said they don't believe that. They arrested her at the funeral and charged her with involuntary manslaughter.
    The woman Richards was staying with gave a conflicting statement saying Richards put the child on her stomach, which Richards would know was dangerous given the child’s weight and inability to hold up her head.
    “We’re absolutely sure we did the right thing,” said Apex police Capt. Ann Stephens. “The D.A.’s office is sure they did the right thing. We would not charge a mother with the death of her child if we didn’t have compelling evidence to believe she was involved.”
    Police say Richards also exchanged odd text messages with the woman on the way to the hospital. They would not make those records available.


    Apex police say Richards later admitted to putting the child on her stomach, which Richards denies.
    “The only time Autumn ever laid on her stomach was when I was right there with her,” Richards said.
    An autopsy came back inconclusive with a possible cause of Sudden Infant Death Syndrome. Richards remained in jail for one year without ever being formally indicted by a grand jury. Then, prosecutors offered her a chance to walk free if she pleaded guilty, which she took.
    “Being in jail is torture,” Richards said, explaining her decision to take the deal.
    Richards also has cervical cancer and three other children whom she can't have custody of now. Still, it was a way out of jail, she said. Richards is now talking with an attorney to have the plea overturned.
    “The child pretty much fought for her life every day. It was a constant battle that never ended until the day she died,” Richards said.
    She knows her word against someone else's may end in the same result, but Richards said she wants someone to take another look at the autopsy, the health history and the text messages.
    http://www.wral.com/news/local/wral_investigates/story/8732645/

    SIDS: North Carolina: Lincoln sheriff reviewing case in baby's death

     Fred Clasen-Kelly: Dec. 07, 2010
    On his first day in office Monday, Lincoln County Sheriff David Carpenter said he may reopen a 2008 child death case that involved a deputy who went to sleep instead of investigating the death of a 3-month-old baby.
    Carpenter told the Observer he would soon meet with detectives to discuss how the office handled the investigation of Aidan Christopher Stewart, whose death was classified as a case of sudden infant death syndrome.
    An Observer story published in September examined the boy's death and the department's investigation, raising questions about whether the death had been properly classified.
    Lincoln County Deputy Don Mauldin told the Observer this summer that after Aidan died, he received an early-morning call from a medical examiner, informing him about the boy's death. Instead of heading to the baby sitter's house in Lincolnton where Aidan was found unresponsive, Mauldin acknowledged that he went back to bed.
    It's unclear exactly when a deputy actually went to the house to investigate. The sheriff's department has said a deputy responded within 24 hours of receiving word from the medical examiner. But Aidan's family members say no one investigated for several days.
    "It's something we will discuss because we want to make sure we do all the things we should," Carpenter said Monday. "We will get our heads together."
    Carpenter has a personal connection to Aidan's death: The boy's grandmother is Carpenter's cousin.
    Mauldin has insisted he did nothing wrong in his response to the death report because the medical examiner indicated that, although the child had a enlarged rectum, he did not believe any crime had been committed.
    A forensic pathologist reported that he found no signs of abuse and ruled that Aidan had died from SIDS, a mysterious natural cause of death that kills babies under age 1.
    Still, Aidan's family has raised questions about the findings.
    Medical examiners, they note, are supposed to classify deaths as SIDS cases only after a thorough investigation of the death scene helps rule out other causes. Sheriff's officials have acknowledged that possible evidence in the room where Aidan was found may have been lost or disturbed by the time an investigator arrived at the house.
    Family members suspect Aidan might have suffocated. He was discovered face down in an adult bed where he had been sleeping, raising the possibility that he could have suffocated from sleeping in an unsafe position or from his bedding.
    Former Lincoln County Sheriff Tim Daugherty, who lost his bid for re-election in a May primary, has refused to answer questions about the investigation of Aidan's death.
    The case briefly surfaced as an issue this fall during Carpenter's campaign for sheriff against Democrat Terry Burgin, who defeated the incumbent sheriff.
    Carpenter, a Republican, and Burgin both said the sheriff's office mishandled the investigation. Both promised that, if elected, they would instruct their deputies to immediately go to all baby death scenes - which sometimes aren't properly investigated in part because police want to spare grieving parents additional pain.
     http://www.charlotteobserver.com/2010/12/07/1892945/lincoln-sheriff-reviewing-case.html#ixzz17jFlVeDO