SBS 101 | Anatomy of an Autopsy | Neuro-Anatomy 101 |
Biomechanics 101 | SBS Facts vs. Fiction | Alternate Explanations | Glossary
"SBS" Myths Fighting Fiction with Facts
It is estimated that there are 1500 cases of Shaken Baby Syndrome charged each year and the numbers appear to be growing annually. Are there really more parents and care takers violently shaking infants or are there other possible explanations for the infant's injuries and/or death?
The standard diagnosis/charge of "Shaken Baby Syndrome" (SBS) occurs when a child is admitted to an emergency room with 1) subdural hematomas, 2) retinal hemorrhages, and 3) a history other than that of a motor vehicle accident or a fall from an appreciable height. Some have referred to this as the "Shaken Baby Triad." The original theory of the American Academy of Pediatrics and most Children's Hospitals across the nation was that these signs and symptoms were exclusively found in nonaccidental trauma cases.
Under current reporting laws, when retinal hemorrhages and subdural hematomas are found in a child, there is an immediate referral to child protective services. 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 or caregiver 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.” The only thing that stands between the accused and a conviction at that point, is a very informed defense attorney and the proper expert.
One of the biggest problems in defending a childhood head trauma case is that the theories upon which the original syndrome was based, are contradicted by evidence based research. Those who study the debate will find that the two sides could not be more polarized. On one side of the controversy sit pediatricians and “child abuse advocates” who were trained that nearly every child who suffers a subdural hematoma and retinal hemorrhage is a shaken or abused child. On the other side of the debate are evidence based medical researchers who say some children can and do suffer these types of injuries from accidental traumas, short falls or systemic disorders. Finding the proper expert is essential to the outcome of an SBS case. It is essential that the expert you retain bases their opinion on facts rather than theories and that your attorney be ready to cross examine with recent medical literature.
There are 5 major areas of contention in the medical literature surrounding childhood head injuries. It is essential to when preparing your case to separate old theory from current fact.
Theory: Only the violent shaking of an otherwise healthy child can cause retinal hemorrhages and subdural hematomas.
Fact: Biomechanical research has shown that shaking alone, of an otherwise healthy baby, cannot produce subdural hematomas and retinal hemorrhages without first producing whiplash or neck damage of some sort. Case studies have shown there are a variety of different accidental or natural causes that can produce the same symptoms.
Theory: Short distance falls do not cause subdural hematomas infants or children.
Fact: Biomechanical research shows some children can and do suffer subdural hematomas from short falls. Research has shown that an impact from a short fall can cause 50-100 times greater forces than can be created by humans from shaking alone.
Theory: Chronic subdural hematomas do not rebleed spontaneously or with lesser trauma.
Fact: It is now undisputed subdurals can rebleed spontaneously within the healing process or with lesser degrees of force. Rebleeds can be instigated by minor trauma, illness, dehydration, infection, seizures, or by any fluctuation in intracranial pressure.
Theory: A child suffering from an ultimately fatal head injury becomes immediately symptomatic and thus, the last person standing with the baby, when the baby arrests, must have abused the child.
Fact: Recent research has shown that children can and do experience asymptomatic subdural hematomas that can later become problematic. Medical literature has documented numerous instances of lucid intervals in fatal childhood head injury cases. Radiological research done in the last two years, has shown that between 26% and 46% of all babies born, have asymptomatic subdural hematomas.
Theory: Retinal hemorrhages only occur in cases of "Shaken Baby Syndrome" or non-accidental trauma.
Fact: It is now known that the number, type, and location of retinal hemorrhages cannot be pathologically interpreted or dated with any accuracy. Retinal hemorrhages can be found in a myriad of different scenarios including child birth, CPR, coagulation disorders, anemias, metabolic disorders and from increased intracranial pressure (as one would expect to see with a symptomatic subdural hematoma).