Jocelyn Kearl
Acceptance of Shaken Baby Syndrome and Abusive Head Trauma as Medical Diagnoses
Overturned abusive head trauma and shaken baby syndrome convictions in the United States: Prevalence, legal basis, and medical evidence
Elena Burnett
Erika Petersen
Natural history of retinal hemorrhage in pediatric head trauma
The Supreme Court Screws up the Science: There is No Abusive Head Trauma/Shaken Baby Syndrome 'Scientific' Controversy
Handouts - Monday
Monday, September 26, 2016
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In the Midst of Child Abuse, the Face of an Angel
Lawrence R. Ricci, MD
Angel was then, and is even now, one of the most beautiful babies I have ever seen and I have seen many in my thirty years as a child abuse pediatrician. Yet, to look at her today, asleep against her foster mother’s shoulder, one could never guess at the devastation wrought upon her.
I first met Angel, then only a few months old, in the pediatric intensive care unit just before Christmas. She had been admitted unresponsive the night before. Her father had told the hospital staff that he had picked her up from her crib tochange her soaked diaper and as he did so she slipped from his grasp and fell back into her crib. He said she went limp and stopped breathing. He rushed her into his car and drove wildly to the local hospital. Eventually, Angel ended up in my hospital.
I was called in to see her after a CT scan showed subdural hematomas. Later, an MRI found evidence of parenchymal injury. An ophthalmology exam found such severe hemorrhages retinal hemorrhages that they were visible on the MRI.
Angel’s mother was at work when the injury occurred and only found out about it after Angel was rushed to the hospital. She told me what her boyfriend had told her, that Angel had fallen from his grasp into the crib. She said she had no reason to believe otherwise.
I finished the interview with Angel’s mother then spoke with her father. He was anxious and somewhat furtive. He told me that Angel had “peed everywhere,” on her clothes, in her bed. When he went to pick her up, she slipped from his grasp and fell onto the mattress. She immediately lost consciousness.
I ended the interview after a few more questions about the fall, and we both went back into the ICU, he to his baby’s side, me to the computer workstation to type my note. As I typed, Angel’s mother came up to me and said that she now knew what had happened. Her boyfriend had just then confessed to her that he had shaken Angel and that he wanted to talk to me.
I went into Angel’s hospital room. Her father was sitting on the cot with his head in his hands, Angel’s mother by his side consoling him. He didn’t look like a bad person; perpetrators rarely do.
Before I could speak he offered, “I’m sorry Doc. I lied. I shook her.”
I asked him why he had shaken her. “I picked her up from the crib. She was screaming and kicking and scratching at me, and I just lost it. I shook her.”
“Did the fall happen?”
“No, Doc. She didn’t fall. I shook her.”
And finally “What happened after you shook her?
“She went limp and stopped breathing. She looked dead. I know what I did was wrong. I’m sorry Doc.”
So there it was. I thanked him for telling me the truth. I told him it was the right thing to do and left to notify the police.
Months later, Angel’s father pled guilty to assault. He said at his sentencing that he had shaken Angel and that he was sorry. He is serving several years in prison.
All of that was yet to pass. Here was Angel in the ICU, profoundly brain damaged, never to awake, a victim of devastating violence, and for all the world she looked like a healthy, beautiful, three-month-old girl about to experience her first Christmas. Having seen too many shaken babies, it always astounds me how normal many of these babies look, few if any bruises, no obvious fractures, nothing to suggest the violence that had been perpetrated on them. To look at her in her hospital bed, surrounded by beeping instruments and tubes, intubated, not breathing, to look at her face and body, she looked fine, not a scratch, cherubic.
I saw her one last time several months later accompanied by her foster parents. Her functioning at a year was that of a one month old. Her existence, like that of a light switch without nuance, flipped between screaming/arching and deep sedation. She was quadriplegic, blind, and deaf. Her foster parents attend to her every day and every night, ceaselessly, religiously. I am myself not religious and have never said to anyone “God bless you.” I did to them. My eyes filling, I told them they were saints who deserved a special place in heaven.
There is something of a “debate” within the legal community and on the fringes of the scientific community about the existence of shaken baby syndrome. One argument offered is that confessions are always coerced. Another is that shaking cannot cause these injuries. Those who would say such things should talk to Angel’s father.
Yet, for Angel, none of this matters. Words and events orbit around her like so many errant planets: shaken baby prevention, child protective custody, termination of parental rights, grand jury, criminal prosecution, plea bargain, prison. Unknown and unknowing, immutably beautiful, she spins silently within her own dying sun.
God bless you Angel and may flights of angels sing thee to thy rest.
Re-posted with permission from Dr. Lawrence Ricci.
1996 Salt Lake City
First International Conference
The First International Conference on Shaken Baby Syndrome was held at the Little America Hotel & Towers in Salt Lake City, Utah. The leadership committee included co-directors Marilyn Sandberg, SSW, Executive Director, Child Abuse Prevention Center, Jacy Showers, EdD, Director, SBS Prevention Plus and sixteen other national experts in the field of child abuse.
Conference Highlights
The First International Conference on Shaken Baby Syndrome/Abusive Head Trauma drew over 750 attendees from a variety of disciplines, including medical, legal, investigative, prevention and parents. This conference included 89 of the leading experts on shaken baby syndrome.
Many agencies, both local and national, supported this landmark event including: National Center on Child Abuse and Neglect, Independent Order of Foresters, Intermountain Health Care, National Network on Shaken Baby Syndrome Prevention, Child Abuse Prevention Center, Utah.
Arkansas
The Period of PURPLE Crying was implemented in the University of Arkansas for Medical Sciences Nurseries (UAMS) and in the Arkansas Children’s Hospital (ACH) Nursery in Little Rock Arkansas in early 2013. Since then the program has been made accessible in the Emergency Department, and in the Infant/Toddler Unit of the Arkansas Children’s Hospital. It also has been made available to all the Pediatric Residents and Resident Physicians from other services via the ACH Intranet. The program has been evaluated by surveys completed by the parents of newborns admitted to the nurseries and by the nursing staff.
The Period of PURPLE Crying program is introduced in the pre-partum and post-partum units of the Obstetrics Units at UAMS, and as part of follow-up, the information is reviewed with the parents again as part of the discharge education. The UAMS nursery Education Team is working on creating an information packet about safety (Period of PURPLE Crying will definitely be included).
In the prenatal classes that are taught by 4 educators on the UAMS campus, the Period of PURPLE Crying is being mentioned in each one of the classes. The topics that are being taught include: preparing for birth, infant CPR and safety, breastfeeding, and newborn care. In the newborn care class, parents watch the Period of PURPLE Crying video! Prenatal classes are taught as well at the 12th Street Community Clinic. The Period of PURPLE Crying program is mentioned in those classes as well.
The Injury Prevention Center at Arkansas Children’s Hospital has been promoting the Period of PURPLE Crying as part of their Out-Reach Programs throughout the State of Arkansas.
In 2013, the Arkansas State Legislature assigned the Arkansas Department of Health with the task of creating brochures and other literature about Shaken Baby Syndrome that will be distributed in more than 100 hospital maternity wards, birthing centers and child-care centers across Arkansas. The Arkansas Department of Health makes information on the Shaken Baby Syndrome available on its website.
Our goal is to eventually have the Period of PURPLE Crying program in all the hospital maternity wards, birthing centers, and child care center across the state of Arkansas.
Contacts
- Maria Teresa Esquivel, M.D.:
- Pamela Tabor:
- Rebecca P. Sartini, MSN, RNC-NIC, Clinical Services Manager, NICU:
Implementation Locations
Medical Consensus
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General Consensus
In May 2018, The Society for Pediatric Radiology (SPR), European Society of Paediatric Radiology (ESPR), American Society of Pediatric Neuroradiology (ASPNR), American Academy of Pediatrics (AAP), European Society of Neuroradiology (ESNR), American Professional Society on the Abuse of Children (APSAC), Swedish Paediatric Society, Norwegian Pediatric Association and Japanese Pediatric Society published a joint consensus statement on abusive head trauma/shaken baby syndrome. This is the most comprehensive and complete consensus statement published to date. The statement is published in Pediatric Radiology.
American Academy of Pediatrics
The AAP continues to affirm the dangers and harms of shaking infants, continues to embrace the “shaken baby syndrome” diagnosis as a valid subset of the AHT diagnosis, and encourages pediatric practitioners to educate community stakeholders when necessary.The American Association of Neurological Surgeons
Shaken Baby Syndrome (also known as Shaken Impact Syndrome) is a serious form of abuse inflicted upon a child. It usually occurs when a parent or other caregiver shakes a baby out of anger or frustration, often because the baby will not stop crying.Canadian Joint Statement on Shaken Baby Syndrome/Abusive Head Trauma
Shaken Baby Syndrome is a collection of findings, all of which may not be present in any individual child with the condition. Injuries that characterize Shaken Baby Syndrome are intracranial hemorrhage (bleeding in and around the brain); retinal hemorrhage (bleeding in the retina of the eye); and fractures of the ribs and at the ends of the long bones.The American Academy of Ophthalmology
Shaken Baby Syndrome is a subset of Abusive Head Trauma characterized by repetitive acceleration-deceleration forces with or without blunt head impact resulting in a unique complex of ocular, intracranial, and sometimes other injuries, usually in infants…it has become widely recognized as one of the most serious manifestations of physical child abuse.Centers for Disease Control and Prevention
Abusive head trauma (AHT), which includes shaken baby syndrome, is a preventable and severe form of physical child abuse that results in an injury to the brain of an infant or child. AHT is most common in children under age five, with children under one year of age at most risk. It is caused by violent shaking or blunt impact.The Royal College of Ophthalmologists and The Royal College of Paediatrics and Child Health
A child suspected of abusive head injury is referred by paediatricians to an ophthalmologist for evaluation. The incidence of abusive head injury in children is highest in infancy and less frequently seen in children over 3 years of age. Retinal haemorrhages have a high positive predictive rate for abusive head injury.French Society of Physical Medicine and Rehabilitation
SBS is a type of inflicted, non-accidental or abusive head injury caused by shaking (either alone or combined with an impact). It mainly occurs in babies under the age of one. It is thought that 180 to 200 children per year are victims of this type of abuse in France, although this value is certainly an underestimate. Failure to diagnose SBS increases the likelihood of recurrence.American Association for Pediatric Ophthalmology and Strabismus
SBS, a form of non-accidental trauma, occurs when babies are shaken. This shaking damages the brain and eyes and can lead to lifelong consequences including death. When there is suspected abuse an eye examination is performed to look for injury. The eye examination is only one aspect of an SBS diagnosis. An evaluation includes multiple experts who examine the child’s brain, bones, and environment. Alternate explanations for injuries are looked into and tested prior to diagnosing SBS.
Research
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Articles Everyone Should Know
These are some of the most relevant research articles about Shaken Baby Syndrome/Abusive Head Trauma that will aid a lay person wanting to learn more about this form of child abuse.
Recent Research
The list below contains the most recent research relevant to SBS/AHT published during the past few years. The list cites the article’s title, author(s), title of the periodical or book, publication date and a link to the abstract or full article (if available).
State Specific Legislation
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Please click on a state to see the legislation related to shaken baby syndrome specific to that state.
FAQ
Attention on Prevention Podcast
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Attention on Prevention podcast brings in guests to talk about the prevention of child and infant maltreatment as well as delve into other parenting issues. We'll bring in families of victims of abuse and victims themselves to discuss their stories, world experts in various medical fields to discuss current research and past experiences as well as other guests with legal and prevention backgrounds. Brought to you by the National Center on Shaken Baby Syndrome. You can find each month's episode here on our website or wherever you get your podcasts.
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