In ‘shaken-baby’ debate, studies disagree

An estimated 1,500 shaken-baby cases were reported in the United States last year, says Toni Blake, a San Diego defense attorney who specializes in the cases.

But 3½ decades after the term was first used, there seems to be no middle ground in the debate.

“It doesn’t exist,” contends Dr. John Plunkett, a Minnesota pathologist who began openly questioning shaken-baby following the 1997 involuntary manslaughter conviction of British nanny Louise Woodward, the case that put SBS on the map. “You can’t cause the injuries said to be caused by shaking, by shaking.”

Many pediatricians disagree.

“People confess to it. So it has to be possible,” counters Dr. Suzanne Starling, director of forensic pediatrics at Children’s Hospital of The King’s Daughters in Norfolk, Va.

She and her colleagues analyzed 81 cases in which an adult confessed to shaking and/or battering a child. In cases where only shaking was admitted, the children were 2.39 times more likely to have retinal hemorrhages than victims of impact alone, they found, “suggesting that shaking is more likely to cause retinal hemorrhages than impact.”

Plunkett scoffs: “What is the No. 2 cause of wrongful convictions? False confessions. ... You don’t base scientific conclusions on what people confess to.”

Conflicting studies
Boston pediatrician Robert Reece is on the international advisory board of the National Center on Shaken Baby Syndrome, and yet he avoids using the term in a courtroom. “What goes on in the courtroom is up or down, and medicine doesn’t work that way usually,” he says.

Chitose Suzuki / AP Boston pediatrician Dr. Robert Reece poses behind images from CT scans at Tufts-New England Medical Center in Boston. The scans are from brains of shaken-baby syndrome victims.

In testimony, he refers to “abusive head trauma” or “inflicted traumatic brain injury” instead, though he still believes shaking alone can cause it.

Research is split:

• Plunkett, in a 2001 article, concluded an infant could suffer a fatal head injury from even a short fall, and that the injury “may be associated with a lucid interval and bilateral retinal hemorrhage.” In other words, symptoms might not immediately follow the injury — which can be an important issue in fixing blame. In addition, there were other, accidental sources for one of the “classic” signs of SBS, he wrote in the American Journal of Forensic Medicine & Pathology.
• In a 2003 study, University of Pennsylvania researchers used special dummies to simulate a 1½-month-old baby being shaken or dropped from various heights. The response to a vigorous shaking was “statistically similar” to that from a 1-foot fall onto concrete or concrete with carpet pad, they found; a fall from 3 feet produced forces nearly 40 times greater.
• But still-to-be published research using a more advanced infant dummy simulated far greater brain damage than with previous dummies, says Dr. Carole Jenny, a Brown University Medical School professor and chair of the AAP’s committee on child abuse and neglect.

“They come into court and they say, ‘Oh, you can’t kill a baby just by shaking it,’ and yet they have a dead baby before them,” she says. “Did a flying saucer come in from Mars and strike the baby in the head?”

• Other studies cited by SBS opponents have suggested that the hemorrhaging and swelling thought to prove shaking can have myriad causes, from dehydration and infection to oxygen deficiency.

Much of the debate has centered on how quickly symptoms begin after a brain trauma. That question was central to the Wisconsin case.

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