SBS 101
Subdurals
Retinal Hemorrhages
Fractures
Anatomy of an Autopsy
Neuro-Anatomy 101
Biomechanics 101
SBS Myths
Alternate Explanations
Annotated Bibliography
Glossary
Shaken Baby Syndrome Defense
Under current reporting laws, when retinal hemorrhages and subdural hematomas are found in a child, there is an immediate referral to child protective services, unless the caretaker has story that comports with a 2-3 story fall, or a 35 mile per hour unrestrained car accident. A determining factor of whether a child receives a diagnosis of "SBS" or not (and whether a caregiver is charged), is the believability of the story.
If there are multiple witnesses, or one disinterested witness , the caregiver is not likely to be charged. If the history given at the hospital is that of a motor vehicle accident or a high fall, the case is unlikely to be charged. However, if the parent reports a short fall or some other event less likely to result in death, the case is quick to be charged as a "shaken baby case" and the child is not screened further for precipitating or contributing factors.
When looked at through the SBS lens, doctors see what may be precipitating or contributing factors (such as an old subdural, thrombotic disorder, or a tendency to bruise easy) as evidence of prior abuse. In actuality, these may be indicators of systemic problems or red flags for high-risk babies. The problem is, diagnosing in this manner allows these cases to be charged based on statistical probabilities: cases that are improbable are deemed child abuse.
Though it is less likely than other scenarios, and agreeably not the norm, children do sometimes die from falls of less than six feet. Therefore, to charge someone for child abuse, simply because it is a statistically improbable scenario or lacks corroboration, is a great misuse of probabilities to allocate justice. Charging these cases in this way, obscures the constitutional requirement of proof beyond a reasonable doubt and relies on the "reasonable suspicion" standards set for doctors by mandatory reporting laws.
One of
the biggest problems in defending a childhood head trauma case is that the
theories on nonaccidental head trauma have been developed in the void of
any reliable scientific data. On one side of the controversy sit pediatricians
and child abuse experts who were trained that babies do not suffer the degree
of neurological damage seen in these cases, without force commensurate with
that of a 2-3 story fall or a 35 mph unrestrained auto accident. On the
other side of the debate are biomechanics experts, ophthalmologists, neuropathologists,
neurosurgeons, neurologists and forensic pathologists who say some children
can and do suffer these types of injuries from accidental traumas, short
falls or systemic disorders. There are also documented cases in the literature
of short fall injuries and deaths in both adults (i.e. Chick Herns, Reagan)
and in children (Plunkett (2001), Rieber(1993), Root (1992).
It is estimated that there were nearly 1500 reported cases of Shaken Baby
Syndrome last year alone and the numbers appear to be growing annually.
Are there really more children who suffer abuse by violent shaking, or are there underlying illnesses or other possible explanations for the infant's injuries and/or death?
The theory of Shaken Baby Syndrome and current diagnosis of nonaccidental trauma rests on 5 erroneous assumptions :
- Subdural hematomas and retinal hemorrhages can only be caused by shaking, even in the absence of other injuries.
- Short distance falls can not kill infants or toddlers.
- Chronic subdural hematomas cannot rebleed with lesser degrees of trauma.
- All subdural hematomas will be immediately symptomatic.
- Retinal
hemorrhages can only occur in cases of nonaccidental trauma.
Our goal is to provide the defense attorney, medical expert, concerned family member or the falsely accused with a user-friendly look at the diagnosis and prosecution of cases involving allegations of Shaken Baby Syndrome. We have provided a tutorial on childhood head trauma, with glossaries and references to some of the best articles for fighting fiction with fact. We have now consulted on over 400 cases charged as "Shaken Baby Syndrome." It is our wish to disseminate information that will dispel some of the myths about childhood head trauma and to help to further accurate medical diagnosis and testimony in these cases.