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Shaken Baby Syndrome: My Front-Row Seat at a Bitter Professional Debate

Shaken Baby Syndrome: My Front-Row Seat at a Bitter Professional Debate

Picture of Sue Luttner
A shocking truth about a common misdiagnosis
Shaken Baby Syndrome: A Misguided but Potent Diagnosis

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On an early spring afternoon in 1996, the adult niece of a friend was watching a baby girl who seemed to choke on a bottle and quit breathing in her arms. At least that was her story: At the hospital, doctors said the infant had been violently shaken, within minutes of the breathing problems. My friend's niece was convicted of child abuse, to the shock of her family, friends and neighbors.

Then the "Boston nanny" case hit the headlines and stayed there for a year: In a televised trial, 19-year-old British au pair Louise Woodward was convicted of second-degree murder (later reduced to manslaughter) for the death of an 8-month-old boy who she claimed had quit breathing in her care. The doctors were sure the child had been shaken to death.

As a technical writer and occasional journalist, I saw little choice but to start researching the medical thinking behind both convictions. What I found was so startling I've spent 15 years now educating myself and writing a book.

During that time I've watched a very real professional debate about shaken baby syndrome polarize and escalate. A growing chorus of critics is now arguing that the classic model suffers from two flaws:

Specificity of the symptoms. While it's well known that abuse can cause the intracranial bleeding and swelling that defines shaken baby syndrome, the pattern can also result from any of a long and growing list of legitimate medical conditions. This development calls into question decades of convictions based on the presence of the brain injury alone, with no bruising, red marks or other signs of abuse.

Timing of the symptoms. The classic model says that symptoms of a serious shaking are immediately apparent, often leaving law enforcement with a single suspect: the caretaker who dialed 911. Experience has now provided a handful of documented cases, however, where serious symptoms emerged only hours after injury (see, for example, the letter from a pathologist on the home page of my web site).

The critics are still in the minority, but they are publishing in medical journals and testifying in court. In 2007 the Innocence Project of Wisconsin won the reversal of a shaking conviction, with the argument that the burgeoning medical debate constitutes new evidence (Madison Magazine coverage). In the wake of that decision, law professor Deborah Tuerkheimer at De Paul University did her own research and concluded that the Innocence Project was correct. The New York Times ran her opinion piece in 2010, and then a magazine cover story on infant shaking in 2011.

This past fall, Supreme Court Justice Ruth Bader Ginsburg inserted the criticism of shaken baby theory into the court record, in her unconventional minority opinion on the Shirley Ree Smith decision, the first shaken-baby case I know of to have reached the high court. Her comments appear at the end of the full opinion.

Last week I interviewed Dr. A. Norman Guthkelch, the British neurosurgeon who first proposed shaking as a mechanism of infant brain injury, in a 1971 article in the British Medical Journal. He told me he is "horrified" that intracranial bleeding and swelling is used to diagnose abuse with no other signs of violence. "I am very distressed about what's going on in the courtroom," he said, "the rigid thinking that seems to have set in."

Still, most child-abuse professionals reject the legal criticisms. The National Center on Shaken Baby Syndrome has posted a collection of letters written in rebuttal to the New York Times coverage, for example, and Professor Tuerkheimer has been criticized harshly in print and at conferences. I don't see an end to the debate soon.

This project has been an extraordinarily tough sell, but I'm reinvigorated by my talk with Dr. Guthkelch, and I'm optimistic that the story, and the debate, will reach a wider audience. I especially hope our medical and legal systems can find a way to acknowledge and address 30 years of convictions based on sincere but flawed medical opinion.

For a quick story about an accused family eventually exonerated, please see the prologue to my book.

For an article-length treatment with more details about the medical issues, see this posting about a probable choking misdiagnosed as shaking—paramedics removed a rubber band from the child's throat, but the babysitter still went to prison.

Comments

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The author has an excellent handle on the law, the medicine, the evidence and the investigative techniques. Great post!

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Go Sue....you are getting closer and closer to debunking yet another "medical fact"!

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Thank you for your excellent research and writing skills to educate the public of this problem.

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Fascinating article. Read the prologue to your book - chilling. Good Luck changing a piece of the world. Good Luck with your book.

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At the very least, the new evidence seems to raise a reasonable doubt in cases where there is no evidence of mistreatment other than the closed-head injury, itself.

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Ms Luttner, May your years of research finally change some minds. My fingers are crossed.

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Dear Ms. Luttner,

Thanks be to you for helping to enlighten this world about so-called "sewn-up" cases of abuse. We need more investigators like you. I attempted the same thing, on a much smaller scale, in San Benito County, CA with CPS. At the time, 7 years ago, it did win custody back to parents from a father-in-law preacher child molester! Again, thank you.

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You bring up an excellent point, Susan.  You're right:  foreign national nannies are paying an especially high price for this tragic misunderstanding.  Basically, anyone who takes care of young children for a living is vulnerable, and most of them do not have vast resources.

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Thank you, and commendations on your own work in the arena, Ms. Woods.  One step at a time.

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An excellent and persuasive summary of years of work. May it bear even more fruition.

Fenton Johnson

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It is a fascinating cause, horrific that such a misdiagnosis can occur. Thanks for exploring this so thoroughly, Ms. Luttner!

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So immediately and emotionally involving -- SO important! Absolutist thinking, assuming there is no viable alternative explanation, is surprisingly common and so often incorrect -- with consequences that compound rather than resolve tragedy. Thank you for working long and hard on a very difficult issue. The approach you've taken seems, to me, the essence of good journalism.

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May your years of dedication result in something more than this very good prose.

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The sad end result (the death of a baby), can look like it came from one cause (SBS), although it very well could have come from a number of other ones. Maybe your book will enlighten people to look at the total picture & not make assumptions.

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I've been interested in your research on this topic for many years. Glad to see that it is finally beginning to get the attention it deserves!

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Thanks for this article. I hadn't been aware that there was controversy about this, but now I will look at reports of SBS with a much more skeptical eye. I can see that it's difficult to challenge the conventional wisdom and applaud the author's efforts to bring in new evidence and ask probing questions.

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Thank you for documenting how one tragedy (a baby's death) is often compounded with another (our "justice" system harshly punishing an innocent caregiver).

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Both Drs Piatt and Vinchon have shown the eye findings of presumed abuse can occur with minimal or no trauma and Lantz and others have shown the eye findings can occur in situations other than abuse. Keep up the good work and we may someday solve this distressing problem.

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Sue - Thanks for continuing to shine your light on this much misunderstood issue. Good job.

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This is an important investigation into a complicated and emotion-laden topic. Thank you, Sue Luttner!

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A very important topic. I see a potential for one controversy--SBS--to interest with another controversy--how to handle immigration in a way that works for everyone, with disastrously unjust consequences for some individuals. Many families in this country obtain desperately needed, quality day care help from skilled, caring women whose only shortcoming is that they entered the country illegally. If one of these women were unjustly accused of hurting a child, she would have almost no hope of defending herself. The United States already has the worst record in providing support for working parents in the industrialized world. We really don't need anything that might prompt potential child-care providers to regard picking strawberries as a safer profession!

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Please read this http://nojusticeinthejudicialsystem.blogspot.com/2012/02/our-story.html and help my family get this story out.

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I'm heartened to know that someone with your investigative skills is digging for truth in this field.

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