Shaken Baby Syndrome: A Diagnosis That Divides the Medical World - The New York Times
SEPT. 13, 2015
By CLYDE HABERMAN, New York Times
Perhaps no crime staggers the mind, or turns the stomach, more than the
murder of a baby, and so it is not a surprise when law enforcement comes
down hard on the presumed killers. Often enough, these are men and women
accused of having succumbed to sudden rage or simmering frustration and
literally shaken the life out of a helpless infant who would not stop crying or
would not fall asleep.
Shaken baby syndrome has been a recognized diagnosis for several
decades, though many medical professionals now prefer the term abusive head
trauma.
It is defined by a constellation of symptoms known as the triad: brain
swelling, bleeding on the surface of the brain and bleeding behind the eyes.
For years, those three symptoms by themselves were uniformly accepted as
evidence that a crime had been committed, even in the absence of bruises,
broken bones or other signs of abuse. While many doctors, maybe most, still
swear by the diagnosis, a growing number have lost faith. Not that they doubt
that some babies have been abused. But these skeptics assert that factors other
than shaking, and having nothing to do with criminal behavior, may sometimes explain the triad.
Has the syndrome been diagnosed too liberally? Are some innocent
parents and other caretakers being wrongly sent to prison? Those questions, at
the complex intersection of medicine and the law, can stir strong emotions
among doctors, parents and prosecutors. They shape this first installment in a
new series of Retro Report, video documentaries that explore major news
stories of the past and their enduring consequences.
The video’s starting point is a Massachusetts criminal case that
introduced the concept of shaken baby syndrome to many Americans: the 1997
murder trial of Louise Woodward, an 18-year-old British au pair accused of
having shaken an 8-month-old boy, Matthew Eappen, so aggressively that he
died. Matthew also had injuries that may have predated Ms. Woodward’s
joining the Eappen family in Newton, outside Boston. The focus, however, was
on the triad of symptoms. To prosecution witnesses, they proved that the baby
had been shaken violently, his head hitting some hard surface.
Throughout, Ms. Woodward insisted on her innocence. But a jury in state
court found her guilty of second-degree murder, and she was sentenced to a
prison term of 15 years to life. Within days, though, the trial judge called the
murder conviction an injustice. He knocked down the charge to involuntary
manslaughter, reducing the young woman’s sentence to time already served,
279 days. Many in Massachusetts and beyond were outraged. Nonetheless, Ms.
Woodward was free to return to England.
The “nanny murder trial,” as headline writers called it, had an unfortunate
subplot. In some quarters of public opinion, Matthew’s mother, Deborah
Eappen, stood figuratively in the dock as well. A doctor — like her husband,
Sunil Eappen — she found herself under the sort of attack many working
women face to this day. The case, a New York Times article said in 1997, “put a
spotlight on the backlash against working mothers who consign their children
to the care of others.”
But the dominant issue was child abuse. Shaken baby syndrome is but one
aspect of this phenomenon. It is a topic in which statistics can be elusive
because reported episodes may not reflect the full extent of the problem. That
said, a report issued in April by a division of the Department of Health and
Human Services estimated that in 2013, more than 1,500 children in the
United States, or four a day, died from various forms of abuse or neglect.
Nearly three-fourths of the victims were under the age of 3. (Various studies
over the years have suggested that a serious threat to a small child’s well-being
is the presence of the mother’s live-in boyfriend.)
In the Woodward trial, a key prosecution witness was Dr. Patrick Barnes,
a neuroradiologist then at Children’s Hospital in Boston, now at Stanford
University. “I was adamant that it had to be child abuse, shaken baby
syndrome,” Dr. Barnes told Retro Report.
But after the trial, he rethought his testimony and in effect became a
penitent. He is now convinced that the diagnosis has been invoked too readily
in criminal cases and that other causes might explain any bleeding and brain
swelling. They include infections, earlier injuries from accidental falls and
even strokes that occurred in utero. Other doctors who share his outlook
question whether just shaking an infant, without resorting to other forms of
violence, could in fact produce the triad’s telltale signs. Testing that thesis,
though, may verge on the impossible: Who in the name of responsible science
is about to shake a roomful of babies to see what happens?
Without question, Dr. Barnes said, abuse exists, “and we have to do our
duty to protect children.” But families need protection, too, he said, and in
some criminal cases, “there is no doubt that errors have been made and
injustices have resulted.” Were he able to testify again in the Woodward trial,
he said, he would say that the medical findings do not confirm abuse and that
the baby’s injuries “could have been accidental.”
One of the more exhaustive studies of shaken baby syndrome’s legal
ramifications was conducted by The Washington Post and journalists from the
Medill Justice Project at Northwestern University. In March, they published
their analysis of about 1,800 abuse cases across the country that had reached
resolution since 2001. Far more often than not — 1,600 cases — the result was
a conviction. But the researchers found that in 200 cases, a substantial
number, charges were dropped or dismissed, defendants were acquitted or
convictions were overturned. The Retro Report video examines one such
instance, involving Quentin Stone, a California man whom a jury last year
cleared of charges that he had violently shaken his 3-month-old son to death.
Not that the medical establishment is starting to line up on Dr. Barnes’s
side. Far from it. Dr. Robert W. Block, a former president of the American
Academy of Pediatrics, stands firmly by the diagnosis, telling Retro Report
that abusive head trauma is supported by decades of observation.
The divisions within the medical world run so deep that they pain a
towering figure on this issue: Dr. A. Norman Guthkelch, a British doctor who
in 1971 found a connection between baby-shaking and brain injury. “There are
cases where people on both sides, both of whom I admire equally, are barely
able to speak to one another, and that’s a shame,” Dr. Guthkelch, who turned
100 this month, told NPR in 2011. Yet he, too, has come to believe that the
syndrome is applied too loosely in some criminal cases.
As the debate continues, Louise Woodward has carved out a new life in
Shropshire, in central England, where she teaches dance. Married, she has a
baby of her own now, a girl born 20 months ago. Even before her pregnancy,
she was quoted as telling The Daily Mail: “I know there are some people
waiting for me to have a baby so they can say nasty things. It upsets me, but
that is not going to stop me leading my life. I am innocent. I have done nothing
wrong.”
The videos with this article are part of a documentary series presented by The
New York Times. The video project was started with a grant from Christopher
Buck. Retro Report has a staff of 13 journalists and 10 contributors led by Kyra
Darnton. It is a nonprofit video news organization that aims to provide a
thoughtful counterweight to today’s 24/7 news cycle. Previous episodes are at
nytimes.com/retroreport. To suggest ideas for future reports, email
retroreport@nytimes.com.
© 2015 The New York Times Company
The Bottom Line: NEVER, EVER shake a baby. If you feel frustrated or overwhelmed by your baby's crying, call someone -- a friend, a family member or other helpful connection. Learn more about the Purple Period Program athttp://dontshake.org/sbs.php?topNavID=4&subNavID=32&navID=170