20 May 2011,
A single firm shake has long been thought to be able to cause serious damage to a baby's brain. But an article published in the Journal of Primary Health Care (JPHC) suggests it might not be so clear cut, and that babies thought to have died because of being shaken may have actually died from other causes.
Both sides of the debate are presented. Dr Lucy B Rorke-Adams, who holds numerous neuropathology posts and is the Clinical Professor of Pathology, Neurology and Pediatrics at the University of Pennsylvania School of Medicine, suggests that shaking is indeed why the babies have died.
She points out that there is a "high frequency of association between the [three features that indicate central nervous system trauma] and shaken impact syndrome" before moving on to demonstrate the flaws in possible alternate explanations.
She backs up her argument with reference to the body of knowledge about shaken baby syndrome that has built up over the years.
"The scientific base for shaken impact syndrome has accumulated over a period of at least 150 years, although sporadic writings of physicians, anatomists and writers commenting about effects of CNS trauma, in particular concussion, appeared long before that time."
Dr Rorke-Adams finishes her discussion with a warning that "Those who offer untested hypotheses to defend individuals who have harmed infants do considerable disservice to science and to the victims."
On the other side of the debate is Consultant Paediatric Neuropathologist Dr Waney Squier, from the John Radcliffe Hospital in Oxford, UK.
While stating that "We can all agree that it is never safe to shake a baby", she also points out three major arguments against the shaken baby hypothesis.
In the first, Dr Squier states that, "In nearly 40 years [since the syndrome was recognised], no one has ever witnessed shaking to cause the collapse of a well baby."
Dr Squier describes the second argument as appealing to common sense. Violent shaking would cause neck injuries, which are seldom seen.
A third argument is more complex. To paraphrase Dr Squier, shaking a baby would not cause one of the symptoms seen in shaken baby syndrome. The symptom is "thin-film subdural bleeding"; shaking a baby may well cause bleeding, but because of the anatomy of the central nervous system, it would have a very different pattern.
Like Dr Rorke-Adams, Dr Squier also finishes with a warning.
"Failure to look beyond the simplistic and increasingly untenable shaking hypothesis risks incalculable damage by wrongfully removing children from loving parents or incarcerating innocent people.
"Further, by focusing on shaking or inflicted trauma to the exclusion of accidental and natural causes, we are almost certainly missing opportunities to save babies through prevention, early diagnosis and treatment."
Journal Editor Professor Felicity Goodyear-Smith says, "Both failure to act in cases of genuine child abuse, and unnecessarily separating children from their parents do irrevocable harm, so this is an important debate that needs to be had."
Both sides of the debate can be found in the June 2011 issue of the JPHC, which is a scientific journal published by the Royal New Zealand College of General Practitioners
A single firm shake has long been thought to be able to cause serious damage to a baby's brain. But an article published in the Journal of Primary Health Care (JPHC) suggests it might not be so clear cut, and that babies thought to have died because of being shaken may have actually died from other causes.
Both sides of the debate are presented. Dr Lucy B Rorke-Adams, who holds numerous neuropathology posts and is the Clinical Professor of Pathology, Neurology and Pediatrics at the University of Pennsylvania School of Medicine, suggests that shaking is indeed why the babies have died.
She points out that there is a "high frequency of association between the [three features that indicate central nervous system trauma] and shaken impact syndrome" before moving on to demonstrate the flaws in possible alternate explanations.
She backs up her argument with reference to the body of knowledge about shaken baby syndrome that has built up over the years.
"The scientific base for shaken impact syndrome has accumulated over a period of at least 150 years, although sporadic writings of physicians, anatomists and writers commenting about effects of CNS trauma, in particular concussion, appeared long before that time."
Dr Rorke-Adams finishes her discussion with a warning that "Those who offer untested hypotheses to defend individuals who have harmed infants do considerable disservice to science and to the victims."
On the other side of the debate is Consultant Paediatric Neuropathologist Dr Waney Squier, from the John Radcliffe Hospital in Oxford, UK.
While stating that "We can all agree that it is never safe to shake a baby", she also points out three major arguments against the shaken baby hypothesis.
In the first, Dr Squier states that, "In nearly 40 years [since the syndrome was recognised], no one has ever witnessed shaking to cause the collapse of a well baby."
Dr Squier describes the second argument as appealing to common sense. Violent shaking would cause neck injuries, which are seldom seen.
A third argument is more complex. To paraphrase Dr Squier, shaking a baby would not cause one of the symptoms seen in shaken baby syndrome. The symptom is "thin-film subdural bleeding"; shaking a baby may well cause bleeding, but because of the anatomy of the central nervous system, it would have a very different pattern.
Like Dr Rorke-Adams, Dr Squier also finishes with a warning.
"Failure to look beyond the simplistic and increasingly untenable shaking hypothesis risks incalculable damage by wrongfully removing children from loving parents or incarcerating innocent people.
"Further, by focusing on shaking or inflicted trauma to the exclusion of accidental and natural causes, we are almost certainly missing opportunities to save babies through prevention, early diagnosis and treatment."
Journal Editor Professor Felicity Goodyear-Smith says, "Both failure to act in cases of genuine child abuse, and unnecessarily separating children from their parents do irrevocable harm, so this is an important debate that needs to be had."
Both sides of the debate can be found in the June 2011 issue of the JPHC, which is a scientific journal published by the Royal New Zealand College of General Practitioners
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