The Shaking Baby Debate

As I have been focusing on cases of shaken baby syndrome these past weeks, the December issue of Discover magazine publishes an article entitled The Shaken Baby Debate. Author Mark Anderson raises the issue of how the legal system pigeonholes the issue and, at times, wrongfully prosecutes.

“On one side of the courtroom, representing mainstream medical opinion, are those who believe shaken baby syndrome (SBS) is a valid diagnosis…On the other side, a growing number of skeptics are now claiming that the evidence for the syndrome rests on dubious medical ground with questionable biophysical models supporting it…Each side is battling for the high moral ground.”


Just as in other areas of litigation – you can always get what you pay for.
“Money…has brought otherwise good people over to what…colleagues call the ‘dark side,’ doubting SBS.”
 

Eli Newberger, assistant professor of pediatrics at Harvard Medical School, states, “I have never ceased to be amazed about what highly regarded, well published, scientifically informed doctors will do when they’re offered large amounts of money.”


The advocates of diagnosing SBS base their observations of modern scientific diagnostic technology such as Magnetic Resonance Imaging (MRI). The skeptics, conversely, say that innocent families around the world have been left in ruins by prosecutors and child protective agencies who have wrongfully accused parents and child-care workers of child abuse.


My personal thoughts, as always, make room for salient arguments on both extremes. If the system wrongfully prosecutes even one, then the entire system loses credibility for the rest who then fear similar retribution. However, let us never lose sight of what we are potentially doing by ignoring the signs and symptoms of SBS. The condition is serious and must be so regarded.
To read more about the article click here. And always have access to my web site at www.titololawoffice.com.
 

NH mom convicted of manslaughter in toddler death

New Hampshire mom convicted of manslaughter in toddler death Another shaken baby case reveals the prevalence of this type of injury.

I have been focusing on shaken baby syndrome this past week.  This tragic reality appears in parent-child and caregiver-child scenarios. 

Signs and symptoms
SBS is accompanied by a variety of signs, which range from mild to severe and nonspecific to obviously head trauma-related.[2] The characteristic injuries associated with SBS include retinal hemorrhages, multiple fractures of the long bones, and subdural hematomas (bleeding in the brain).[6] These signs have evolved through the years as the accepted and recognized signs of child abuse and the shaken baby syndrome. Medical professionals strongly suspect shaking as the cause of injuries when a baby or small child presents with retinal hemorrhage, fractures, soft tissue injuries or subdural hematoma, that cannot be explained by accidental trauma or other medical conditions. Additional effects of SBS are diffuse axonal injury, oxygen deprivation and swelling of the brain, which can raise intracranial pressure and damage delicate brain tissue.

Victims of SBS may display irritability, failure to thrive, alterations in eating patterns, lethargy, vomiting, seizures, bulging or tense fontanels, increased size of the head, altered respirations, and dilated pupils.[7]

Fractures of the vertebrae and ribs may also be associated with SBS.

 

Council Bluffs man accused of shaking baby

Another shaken baby syndrome case.  Council Bluffs man accused of shaking baby. Here the sad case involves a 4 month old infant.

 Mechanism
SBS results from rotational acceleration of the head. Rotational injury is especially damaging and likely to occur in shaking trauma.] The type of injuries caused by shaking injury are usually not caused by falls and impacts from normal play, which are mostly linear forces. The type of shaking that is necessary to cause SBS is very violent and would be clearly recognizable to an observer as dangerous and potentially deadly. The set of injuries found in SBS is not caused by falls from short heights, seizures, or vaccinations.


Prevention
Prevention is similar to the prevention of child abuse in general. New parents, babysitters, and other caregivers can be warned about the dangers of shaking infants. A child's crying and irritation are common triggers for the frustration that can lead to violence in the caregiver.Some experts have advised that caregivers need strategies to cope with their own frustrations; for example, they may be reminded that they are not always responsible when babies cry.

 

BIAA Legislative Update November 2008

Dear Advocates:

Congress returned this week for a lame duck session after being in recess since October 3, 2008. This lame duck session follows a historic November 4 election, which will result in significant changes in the makeup of both the House and Senate – not to mention the White House - in January.

So far, the lame duck session has produced successful legislation extending unemployment benefits, but it now looks as though Democratic leaders will wait until the beginning of a new legislative session in January to move a broader economic stimulus package. BIAA will continue to advocate for inclusion of increased federal funding for state Medicaid programs in any such stimulus package.

Meanwhile, Congress continues to debate a possible bailout plan for the auto industry, and this debate could continue into December, thus extending the lame duck session.
Over the past few weeks, numerous developments related to brain injury policy have occurred and are described below.

Please note that BIAA is currently in the process of updating the “Policy & Legislation” section of its website, and as a result many documents referred to below are not yet posted online. Rest assured these documents will become available shortly. We sincerely appreciate your patience while we work to improve the comprehensiveness and accessibility of our website.

*Distributed by Laura Schiebelhut, BIAA Director of Government Affairs, on behalf of the Brain Injury Association of America; 703-761-0750 ext. 637; lschiebelhut@biausa.org

BIAA’s Policy Corner and Legislative Action Alerts are made possible by the Centre for Neuro Skills, James F. Humphreys & Associates, and Lakeview Healthcare Systems, Inc. The Brain Injury Association of America gratefully acknowledges their support for legislative action.
 

Baby sitter held in shaking incident

Here is another tragic story of a babysitter abusing a baby and causing brain injury.  Shaken Baby Syndrome is a very real risk for parents and their childrren.  Read about the case here.

Anatomy and pathophysiology
People under the age of three years are especially susceptible to brain damage from shaking. This is due to several anatomical factors. Their heads are bigger and weigh more with respect to their bodies than adults' heads, and their neck muscles are weak and cannot prevent violent motions. Infants' brains are not fully myelinated; myelin sheaths form in childhood and are complete in adolescence. The water content of the brain is reduced as neurons gain myelin during development, so babies have a greater percentage of brain water than adults do.[10] Because of this higher water content, children's brains are softer and are much more susceptible to acceleration-deceleration injuries and diffuse axonal injury.

The underlying injury in SBS is typically diffuse axonal injury.

In 2004, a Scottish database collected data for five years on cases of suspected non-accidental head injury diagnosed after a multiagency assessment and included cases with uncoerced confessions of perpetrators and criminal convictions. Several patterns appeared allowing the categorization of the cases into four predominant types: Hyperacute encephalopathy (6% of all cases); Acute encephalopathy (53% of cases (SBS)); Subacute non-encephalopathic presentation (19% of cases); Chronic extracerebral presentation (22% of cases). Infants can be traumatically injured in many ways, and many instances are unwitnessed. Thus the generic term non-accidental head injury or inflicted traumatic brain injury is occasionally used in preference to shaken baby syndrome, which implies a specific mechanism of injury.[12] An earlier detailed neuropathological study was publish in the UK in 2001, which included immunocytochemistry for microscopic damage.[
.

Trial to begin over 2004 RI toddler death

 A trial involving abuse of a toddler is gearing up.  Lets remember that young children's brains are more suseptible to injury.  What is referred to as Shaken Baby Syndrome.  Click here.

 Wikipedia defines Shaken baby syndrome (SBS) as a form of child abuse that occurs when an abuser violently shakes an infant or small child, creating a whiplash-type motion that causes acceleration-deceleration injuries. The injury is estimated to affect between 1,200 and 1,600 children every year in the USA.[1] It is common for there to be no external evidence of trauma.[2] Injuries from impacts with hard objects may accompany SBS; this combination of shaking with striking against a hard object is sometimes termed the shaken impact syndrome or shaken/slam syndrome.

The concept of SBS was initially described in the early 1970s, based on a theory and a wide variety of circumstances by Dr. John Caffey, a radiologist, as well as Dr. Norman Guthkelch, a neurosurgeon.[3][4]

SBS, a major cause of death in infants, is often fatal and can cause severe brain damage, resulting in lifelong disability. Estimated death rates (mortality) among infants with SBS range from 15 to 38%; the median is 20–25%.[2] Up to half of deaths related to child abuse are reportedly due to shaken baby syndrome.[5] Nonfatal consequences of SBS include varying degrees of visual impairment (including blindness), motor impairment (e.g. cerebral palsy) and cognitive impairments.

 

Commission: Halverson to be removed from bench

Elizabeth Halverson, the Las Vegas Judge, was removed from the bench today.  Click here.

Judge Halverson has been in the news of late.  Initially the mobile chair bound woman was seen in the Clark County courthouse as a clerk.  She ran and won for Judge and immediatley started making news.

She was accused of sleeping on the bench during trial; of  Inappropriately talking with jurors without counsel present and eating lunch with jurors.

She was the subject of a public nuisance complaint brought by her neighbors.  She was ordered to clean up her yard.  Of most recent, Judge Halverson, was the subject of a beating by her husband requiriing hospitalization.  She is bringing charges against him.

Voters hopefully learned to pay attention to issues involving the candidates they vote for.  This certainly was not a good choice and I do not think any would who voted would disagree with that.

Good luck to Judge Halverson.

New Study Support Blink

A new study reveals by Italian and American neuroscientists In Nature Neuroscience reveals that ,  a simple decision-making task does not involve the frontal lobes, where many of the higher aspects of human cognition, including self-awareness, are thought to originate. Instead, the regions that decide are the same brain regions that receive stimuli relevant to the decision and control the body's response to it.

And for anyone who read Malcolm Gladwell's "Blink," there is support for the assertions that decisions are deeply seeded resonses.

Read more here.

Visit my website by clicking here www.titololawoffice.com.

Wisconsin parents win $11.4 million in malpractice suit

Another verdict for a boy suffering brain damage.

A jury has awarded the parents of a brain-damaged boy $11.4 million in a medical malpractice case.

Chad and Amy Jelinek of Eastman claimed in a 2006 lawsuit that negligent care by a nurse and nurse midwife at Gunderson Lutheran Medical Center in La Crosse resulted in brain injuries to their son Laine during his birth in 2005.

A Crawford County jury sided with the Jelineks on Oct. 17 after a three-week trial. The Jelineks' attorney, Jeff Goldberg, says the money is barely compensation but should improve Laine's life.

The hospital issued a statement saying it believes the care was appropriate.