Shaken Baby Syndrome: A Public Health Issue Looking For Evidence
Have you ever noticed that parents get an awful lot of education about Shaken Baby Syndrome? We’re told all the time never to shake our babies- though any other form of abuse is rarely talked about. Have you ever stopped to ask why shaking is such an issue rather than just child abuse in general? It’s actually a rather strange story.
Shaken Baby Syndrome as an accepted pathology and its accompanying prevention campaigns were not the result of several repeatable studies on a large number of human infants displaying the “triad” of SBS symptoms (subdural and retinal hemorrhage with brain swelling) after confirmed child abuse. Instead, it began with monkeys and simulated motor vehicle collisions.
These experiments were conducted in 1968 on rhesus monkeys subjected to simulated motor vehicle collisions at speeds of 40 miles per hour. 15 of the 19 monkeys were found to have a “triad” of symptoms (subdural and retinal hemorrhage and brain swelling) after the experiments. From these observations (and without any further independent investigation), American radiologist John Caffey and British neurosurgeon Norman Guthkelcher theorized that human infants could develop a similar condition if deliberately and violently shaken.
Since infants displaying subdural hematoma with retinal hemorrhage (bleeding in the brain and behind the eyes) frequently did not show any signs of head injury or abuse, Caffey and Guthkelcher proposed that the shaking must have occurred in secret with no other witnesses. This theory was not consistent with a significant and well-established body of literature which showed that subdural hematoma, retinal hemorrhage and brain swelling could occur without impact to the head or shaking, but it was published and subsequently became very popular at many conferences aimed at law enforcement, social services and physicians. Actually, a review of the literature on child abuse from 1966 through 1998 showed significant weaknesses in SBS literature. There are no published controlled prospective trials with replicated studies on the condition (Gabaeff, 2011). In other words, people started believing SBS was real simply because they heard about it so much from sources they thought were trustworthy.
Current research has shown the theories behind SBS to be highly questionable. An experiment with dummies that mimicked the size and weight of human infants with sensors attached throughout showed that shaking would not cause the type of acceleration which would produce a subdural hematoma in a human infant. Other inconsistencies with SBS are that experts admit that bruises on the baby’s arms and torso that would normally be expected in a baby subjected to excessive force are mostly absent from SBS cases. Which begs the question, how can a baby be shaken so hard that it induces brain damage, but not bruising?
Shaken Baby Syndrome was once unchallenged in the medical community. But lately it has been under greater scrutiny- especially with more parents and caretakers being tried for murder and attempted murder with an SBS diagnosis though they maintain their innocence. And with this greater scrutiny a more complicated picture is emerging.
For example, certain vitamin deficiencies and encephalopathy are known to cause the triad of SBS symptoms. Because of this, more physicians are testifying for the defense on behalf of parents and caretakers that shaking is not the only cause of the symptoms seen in the baby. (Many defense experts for SBS will charge on a sliding scale because they know that a public defender won’t have the expertise to provide an adequate and informed defense.)
Another problems comes from a behavioral perspective. Some people accused of shaking a baby have no history of violent behavior. In one case highlighted in the New York Times, the daycare worker convicted of shaking a two month old baby had cared for her own children and several others including an autistic boy and a girl with one arm without any history of violent behavior. The other daycare workers described her as a very patient and gentle person. Many cases of SBS ask us to assume that people without any history of abusive or violent behavior and who have frequently raised their own children without any abuse suddenly shake a baby to death or brain damage out of the blue. And then other cases involve clear cut abuse where shaking wasn’t the only form of abuse involved.
SBS proponents frequently point out that the diagnosis still holds up because they have confessions from parents and caretakers as evidence. However, these confessions are not very clear representations of the situation. Some parents said they had shaken the baby in a non-aggressive way to try to revive it after finding the infant unconscious and not breathing. Others admitted to shaking, but only in a more generalized way as one of many abusive actions against the baby, so it may not have been shaking that actually caused the death.
Others have been told point blank by law enforcement and medical experts that the police and doctors know the accused is guilty and that he or she will no chance at acquittal in a trial since doctors and scientists will testify that there is no other way the baby could have died than at the hands of the accused. Sometimes they’re are offered a plea bargain and told it is the only way they will escape a lifetime in prison, so they confess. The New York Times highlights the case of a daycare worker from Peru for whom English was a second language who was interrogated in English, not Spanish, another thing that could “muddy the waters”.
For me, I believe in the power of public health as a field of study and as a tool for making the world a better place. Many of the things we’re doing to promote public health have solid evidence like eating a healthy diet, exercise, smoking cessation, seat belts and the list can go on and on. But Shaken Baby Syndrome simply doesn’t have the evidence the back it up as a public health problem.
Worse, in my opinion, is the possibility that because we’re focusing so much on Shaken Baby Syndrome as the definitive form of child abuse that we’re missing out on helping families where abuse is a real problem. You can’t stop child abuse simply by telling people not shake a baby. To me, this is a reminder of how we need more than good intentions in the field of public health, we need to be brutally honest with ourselves about how we are allocating our resources and what we are supporting so that we can be more effective.