http://sunday.ninemsn.com.au/sunday/cover_stories/article_1316.asp

A parent's nightmare: shaken baby syndrome
June 29, 2003
Reporter : Helen Dalley
Producer : Paul Steindl

It's a parent's worst nightmare. Your young baby appears to suffer a fit, has breathing difficulties -- is suddenly seriously unwell. An ambulance rushes the baby to hospital where it undergoes tests and assessment by paediatric specialists.

But the nightmare is only just beginning. Within 24 hours, the diagnosis is that the baby has probably been severely shaken. And you, the parent, are directly in the firing line as the culprit.

This week Sunday examines the dilemma facing parents, doctors and child protection officers when they come across cases where they suspect a baby has been shaken.

The parents Sunday has spoken to all say their babies were misdiagnosed as having been violently shaken and yet they were treated as if they were guilty. They have either faced court, or have had their baby removed from them by social workers while the investigation takes place.

"There was no innocent until proven guilty, at all. It was guilty until proven innocent," says Donna Meads-Barlow. Her baby, Codey, was taken away from her for nine months by welfare officers after he suffered a fit and was found to have bleeding in the head and eyes.

Around the world thousands of people are accused of shaking babies every year. But even within the medical establishment there is some emerging disagreement about the diagnosis of shaken baby syndrome, or SBS, as it's known. The view, accepted by most paediatricians working in major hospitals, is that when a baby is found to have bleeding around the brain, extensive bleeding behind the eyes and brain swelling, this collection of symptoms means the baby has been shaken.

Dr Paul Tait, from the Child Protection Unit at Westmead Children's Hospital in Sydney, says he has little doubt nearly all the cases he sees with these symptoms are shaken babies.

Helen Dalley asked Dr Tait: "What percentage of cases where there is a subdural bleed and a retinal bleed, would they be shaken?"

Dr Tait replied: "I guess it's hard to put a number on that because we haven't got a way of screening all those cases, but I'd say you are sort of looking at 99% of cases. I guess in my position it would be shaken baby until proven otherwise."

There's no argument the majority of these cases where those symptoms are discovered are genuinely a result of SBS. Some parents and carers do harm their babies. But there's a view growing among some specialists that a small percentage, perhaps more than 5% of cases, may be wrongly diagnosed as "shaken baby".

In Britain, a neuro-pathologist Dr Waney Squier has questioned the accepted diagnosis of Shaken Baby Syndrome: "I think this is very much open to question. Because we don't have any evidence that babies with this constellation of findings, that is, retinal haemorrhage, subdural haemorrhage, and brain swelling, have been shaken."

It is these cases, where doubt is involved, that Sunday has focused on, in particular, the difficulty of authorities to prove the cases.

Sharon and Chris Taylor were devastated when authorities placed a restricting order on them when their child was diagnosed with a subdural haemorrhage (or brain bleed).

"Like a living nightmare. Absolutely. Totally helpless. Nothing we could do or say would make them believe that what we were saying was right," says Chris Taylor. "It was just all pointed towards us proving we were innocent," says his wife Sharon. "We were branded guilty right from the word ‘go'."

Professor Helen Whitwell from the Department of Forensic Pathology at the University of Sheffield in the UK is involved in the current research: "What we shouldn’t do is assume that in all cases the subdural, the retinal and the brain swelling has been due to violent shaking."

All of which raises doubts about accusations of "baby shaking" against parents and carers. There's no argument the majority of cases with these symptoms in hospital casualty wards are genuinely shaken babies. Undoubtedly some parents and carers do harm their babies. But with a small percentage there is an element of uncertainty.

Professor Waney Squier says: "I think there are people being wrongly accused, because the history they've given has not been taken into account. It's been a knee-jerk response of saying, ‘this is shaken baby syndrome, so ignore everything the family is saying'."

Dr Mark Donohoe is a GP who has looked carefully at all the available literature on SBS.

"Here's the problem: we call it shaken baby syndrome. You've already predetermined the cause by the very naming of it, and that happened 25 years ago, so that changes the mindset of doctors who hear the term," Dr Donohoe says.

"We think: retinal haemorrhages, bleeding into the brain, shaken baby syndrome. It's become such a common part of our training that we don't doubt it."

Professor Helen Whitwell agrees: "Essentially a syndrome is simply a collection of signs and symptoms which are put together and may in some instances equal that diagnosis. However, I think that the problem that we have here is that if those are seen, it is now assumed that it's shaken baby and that may not necessarily be so."

When Craig and Caroline Court rushed their sick child to hospital in Perth in May 2001, they had no idea of the events that would unfold over the next two years. Earlier this month, Craig came before the Supreme Court charged with shaking his baby boy, Cameron, to death. Because he was charged with murder he was refused bail and ended up spending 20 months behind bars. In jail he faced an attempted stabbing and assault and was pelted with rocks.

Craig, supported throughout by wife Caroline, strongly denies the allegation, saying the boy had gone into a fit and he had been trying to resuscitate him.

Robin Napper, lecturer at Perth's Centre for Forensic Science, observed the trial.

Robin Napper: "The prosecution case was, of course, that this was a deliberate shaking act which killed the child."
Helen Dalley: "A malicious, kind of violent shaking, picking it up and shaking it…?"
Robin Napper: "A malicious, malicious, violent shaking."
Helen Dalley:"What, having lost the plot, or angry?"
Robin Napper: "That was the allegation and the defence quite clearly showed that this could just purely have been a father trying to resuscitate his dying child."
Robin Napper: "And that these same injuries could have been caused by more minor kind of shaking or movement of the baby's head?"
Robin Napper: "Precisely. Yes, exactly. The head being floppy over the back of the shoulder, this would have, this could have, caused the brain and the retinal injury that was seen on the child."
Helen Dalley: "In a bid to resuscitate it?"
Robin Napper: "In a bid to resuscitate his child."

Craig Court's barrister, Judith Fordham, can't comment specifically on his case, but offers insights into the latest research on SBS, being introduced as evidence.

"The Geddes-Whitwell research is probably the world leading research at the moment," Ms Fordham says.

"What they are suggesting is that really in some instances, that a relatively minor degree of shaking, and when I say shaking, I mean movement, I don't necessarily mean deliberate shaking. They're talking about movement of the head, however caused, that can produce these injuries, and the frightening thing for investigators is: how do you tell which from which?"

Professor Helen Whitwell was a co-author of a research study that challenged assumptions that violent force was needed to produce the brain injuries.

"The work that I did with Dr Geddes in 2001 which involved the largest series of brains from these injured children that has so far been described. What we particularly identified in the young age group was that a significant proportion showed damage due to lack of oxygen getting to the brain, not damage to the nerve fibre caused by severe trauma, so that led us to then re-question, well, if the brain damage is not due to trauma but due to lack of oxygen then the brain swells. How do we know how much force is required to produce to give rise to the lack of oxygen?"

Professor Waney Squier comments on the Whitwell research.

"She has hypothesised it could be less than an intentional, malicious aim to injure that child," Professor Squier says.

"But just simply a quick hypertension or inflection of the neck, maybe one two shakes, might be sufficient to produce this injury. Although she was at pains to point out that it would be more than happens in the normal caring of a child."

The message is still clear – shaking is bad for babies. But the UK research suggested that rather than a deliberate shake to harm a baby, the terrible injuries could possibly be more accidentally explained. This research was raised as evidence in Craig Court's case.

While the Crown presented several eminent specialists who testified they believed the baby was violently shaken, by the end of the trial, two key prosecution witnesses expressed doubt that deliberate shaking was the cause of Cameron's injury. Because of this doubt Craig Court was acquitted, but the Crown has since appealed.

The difficulty for both sides involved in these cases is that they have to rely on medical evidence as there are rarely any witnesses to these events. What was sure and accepted by experts in the past may be open to questions in the future.

Click here to read a transcript of this story.

For further information, here are a few sites, among many, dealing with Shaken Baby Syndrome.

The Shaken Baby Syndrome Defense site is put together by a group of consultants, doctors and legal experts who represent those falsely accused of abuse by SBS. The link is: http://www.sbsdefense.com

Shaken Baby Syndrome Resources belongs to Susan C. Anthony, who started researching SBS when a friend was babysitting for a sick child. The child had a seizure and died two days later. The babysitter was charged with manslaughter. The link is: http://www.susancanthony.com/Resources/SBS/sbsres.html

The Shaken Baby Alliance's mission is to provide support of SBS victim families (including adoptive and foster parents), to advocate justice for SBS victims, and increase SBS awareness. The link is: http://www.shakenbaby.com

The Shaken Baby Syndrome Resource Centre has its aim to educate the public to this serious form of child abuse, and to campaign for SBS awareness. The link is: http://www.geocities.com/HotSprings/Spa/4069

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