Science

The Shaken Baby Problem

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Emily Bazelon has a long, well-reported feature in the New York Times Magazine on new doubts about the diagnosis of shaken baby syndrome.

I wrote about this issue in 2009, and my column then inspired some spirited email responses. There is a small but growing part of the medical community that is skeptical of the diagnosis, and a very adamant larger group that says there's no legitimate debate, here—the diagnosis is sound, and the skeptics are either nuts or are guns for hire.

I'm obviously not a doctor, but it strikes me that there's something tantalizingly easy about the shaken baby diagnosis. It is based on just three symptoms, all internal, and can be made even when there are no external signs of abuse. Some experts and prosecutors claim that the diagnosis is enough by itself to prove (a) a crime has been committed, (b) who committed it (conventionally, the diagnosis implicates the last person who was alone with the child before the death or injury), and (c) the suspect had the requisite intent (the diagnosis includes the conclusion that the injury could only be caused by intense, vigorous shaking, which prosecutors usually argue in court shows anger and intent to harm).

If doctors find the triad of symptoms, there's really no defense, unless the suspect attempts to show that someone else was also alone with the child shortly before the symptoms began to appear. (The symptoms are bleeding at the back of the eye, bleeding in the protective area of the brain, and brain swelling.)

The emerging group of skeptics attack both the diagnosis itself and how it's used in court. They argue the triad of symptoms can be caused by incidents or medical conditions other than shaking, and that the injury itself could occur days before the symptoms begin to appear, instead of the hours or minutes often claimed in court. If true, both of those claims would destroy the half to two-thirds of shaken baby diagnoses in which the child showed no other signs of abuse.

One other note: It's interesting how quickly the skeptics are dismissed as defense experts for hire. I'm sure there are no shortage of quacks offering their services to criminal defense attorneys. But regular readers of this site have seen enough horror stories by now to know that there's nothing about testifying for the state that cleanses an expert of bias, either. If they're outside consultants, they too are paid for their services. And if they actually work for the state as a medical examiner or in a state crime lab, the biases are built into the system.

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  1. And regular readers of this site have also seen in a variety of contexts, that the first sign of a questionable scientific or medical theory is for the supporters of the theory to attack skeptics as ignoramuses or “hired guns.”

    1. And then you have the “hired guns” who helped drive Dow Corning into bankruptcy over breast implants, so “hired guns” sometimes really are “hired guns.”

    2. your just a shill for big shaken baby inc.

  2. I’m no doctor, either, but those symptoms sound as much like “OMG, I dropped baby on the floor” syndrome or “my 5-year old whacked baby in the back of head” syndrome as they do shaken baby syndrome.

    1. Rabbit,

      Some information for you.
      http://www.dontshake.org/sbs.p…..ubNavID=21

      Gist…no, those things don’t cause these symptoms.

  3. I like my baby straight up, and stirred – not shaken

    1. How do you make a dead baby float?

      1. Just guessing…..pour root beer over two scoops of dead baby?

        1. This is from the Reason cruise recipe book?

        2. Two scoops of dead baby,
          In Kellogg’s Dead Baby Bran

      2. Just guessing…..pour root beer over two scoops of dead baby?

      3. They all float down here.

      4. I always made mine by taking my foot off it’s head.

    2. Damn, it took me an hour and a half to make the same joke.

      I even perused the thread looking for the stirred baby joke before I made it. I figured that someone would use it. Guess I missed it.

  4. Even if this diagnosis is shown to be bullshit, I think we can guarantee that all the people convicted of this won’t get new trials. What a “justice” system we have!

    1. Oh they will, after serving another 20-40 years in jail.

  5. Stop linking the NYTs please. Fucking PITA. Not only do I have to delete their cookies but now I have to search for the story as well.

  6. The first time I was in Mexico, in 2001, it was in Juarez (it was a lot safer back then than it is now).

    Anyway there was a guy on the street, and for $5, you could throw his kid into a wall. The kid was wearing a beat-up, battered, barely holding together plastic bicycle helmet.

    So anyway, there’s a line of people there, all tourists, mostly white, waiting to pay $5 to throw a kid head first into a brick wall. I’d be lying if I said I wasn’t tempted, but in the end, the desire to hold onto one last tiny shred of my dignity led me to walk on by with my snoot in the air.

    In summation, Somalia, roads, China / yellow menace, [insert LotR or Dune reference of choice], and Steve Smith.

    1. That’s a nice story.

    2. Pictures or it didn’t happen.

      1. “Pictures or it didn’t happen.”
        I’m gonna go with this.
        There’s no doubt that there are jackasses who’d throw a kid against a wall, but you’re going to have to go looking for them.

  7. Given that shaking is a form of torture employed by the Israeli government, it’s not hard to imagine that shaking a baby might lead to some serious injuries.

    1. Since American agents aren’t being tried for it, do you think the courts would have a problem with waterboarding babies?

      How else are you gonna get them to sleep?

      1. Whiskey, lemon, and honey.

    2. Well no shit Paul. Nobody denies that vigorously shaking a baby can cause serious, even fatal, injuries. Do you have a point?

      1. Ah, you didn’t read the linked article, did you?

        Later experiments confirmed this finding and have made some doctors and biomechanical engineers skeptical that shaking alone can cause severe brain damage or death.

        They’re fucking full of shit. Writ fucking large.

        The colossal elephant-in-the-living-room point that you missed like a 747 slamming through your bedroom room while you sat their with a dumbfounded look on your face saying “What?” is that the not-so-subtle suggestion that “shaking alone [cannot] cause severe brain damage or death” couldn’t be further from the truth.

        Please, I probably know more than average about mistaken cases of infant abuse and markers which are often mistaken as such. But to suggest that shaking a baby alone can’t cause severe brain damage or death? You’re high as a kite.

      2. But hey, don’t take my word for it, take theirs.

    3. Shaken can cause serious injuries. But don’t you think it’s common sense that if you should a baby hard enough to cause brain damage, it would have other signs of abuse? Such as damage to the neck, seeing as it’s getting whipped back and forth? Or bruises or broken ribs?
      Use your head.

  8. We’re all hired guns…maybe mother Teresa is the perfect judge and jury…except for that part about expert testimony.

    1. Mother Teresa may not be the best example to go with there.

      http://www.daylightatheism.org…..eresa.html

  9. This is a tough one to call. Unlike BS “science” like secondhand smoke, the physics seem to make this a legitimate problem, large mass on a small pivot.

    … Hobbit

    1. The Bearded Hobbit|2.11.11 @ 7:52PM|#
      “This is a tough one to call. Unlike BS “science” like secondhand smoke, the physics seem to make this a legitimate problem, large mass on a small pivot.”

      I don’t think the physics are in question, it’s the claim that X did Y which caused Z.
      No doubt doing Y will cause Z, but Z can also be caused by other circumstances.
      Not to mention the question of whether Z is truly evident, or just a convenient box to check on the form.

    2. Jesus, you too? Apparently a point is being missed by more than one person here: Nobody claims that shaking a baby can’t or won’t cause serious injuries. Of course it can and does.

      The question is whether other things that are not child abuse (e.g. accidental falls, etc.) can also cause the same symptoms that have, until now, been claimed to only result from shaking a baby vigorously enough to injure.

      1. Bohica…

        You should read the linked article. There is indeed a suggestion that shaking alone can’t cause the symptoms. That is, of course, incorrect. While you are correct that Balko is not suggesting this…it seems some of the “hired guns” questioning the diagnosis are, indeed, questioning whether shaking can cause those injuries.

        1. No one here is discussing that though.

          1. Incorrect. See Paul’s comment above, for instance.

            And then there is this from the Balko.

            The emerging group of skeptics attack both the diagnosis itself and how it’s used in court. They argue the triad of symptoms can be caused by incidents or medical conditions other than shaking [note: no one claims otherwise, but those other events are not routine…they require similar violent force], and that the injury itself could occur days before the symptoms begin to appear [possible, perhaps, but unlikely in most cases as the symptoms being discussed indicate a sever TBI, not a minor incident], instead of the hours or minutes often claimed in court.

            They are argue this, but most of their arguments are pretty thin gruel that don’t hold up to scrutiny.

            1. I don’t think you’re quite catching the point, Paul and NM.

              What they are saying is that you can’t diagnose shaken baby syndrome from the symptoms given, any more than you can diagnose brain cancer from a headache. Lots of other things can cause headaches, headaches can be symptoms of many other conditions, etc.

              Shaken baby syndrome in its strongest form is the assertion that this cluster of symptoms can only be caused by somebody having shaken a baby very recently. That’s what their challenging, not the idea that shaking a baby isn’t bad for it.

              1. R C Dean|2.12.11 @ 10:52PM|#

                I don’t think you’re quite catching the point, Paul and NM.

                I am catching the point.

                What they are saying is that you can’t diagnose shaken baby syndrome from the symptoms given, any more than you can diagnose brain cancer from a headache.

                Yes, that is what they are saying. They are not, however, correct in that assertion.

                Lots of other things can cause headaches, headaches can be symptoms of many other conditions, etc.

                A bad analogy…the symptoms we are talking about come from a very specific events…the brain accelerating/decelerating and twisting within the skull.

                Shaken baby syndrome in its strongest form is the assertion that this cluster of symptoms can only be caused by somebody having shaken a baby very recently.

                The strongest form would be that these symptoms are most likely to have been caused by the baby having been shaken. There are other potential events that can cause these symptoms, but they are similarly violent…things like a car crash.

                That’s what their challenging, not the idea that shaking a baby isn’t bad for it.

                Depends upon who you mean by they. From the linked article there are those that are questioning whether or not shaking can cause the injuries associated with shaken baby syndrome…They are claiming that a blunt force trauma is needed and that shaking alone can’t get you to the severe damage associated with shaken baby syndrome.

            2. Paul == You in this case. Both of you are pointing out the same thing that no one here is disagreeing with.

              1. Paul’s comment and mine were directed at those in the linked article that were questioning that shaking alone could cause the cluster of symptoms associated with shaken baby syndrome.

                It ain’t always about you.

        2. They are not questioning whether shaking can cause these injuries, they are questioning if those three signs “the triad” immediately point to shaking. They are suggesting that in order to prove the injury IS from shaking, there would be other signs of abuse, such as bruises, broken bones, or neck damage.
          You are clearly not reading into this correctly.

          1. And also, there are MANY other conditions, that happen naturally that mimic shaken baby syndrome. There are vitamin deficiencies, infections, and much more.
            Do your research before you assume you know everything.

            http://www.cbc.ca/fifth/2011-2012/diagnosismurder/

  10. I prefer my babies stirred, not shaken…just different that way.

    1. I admire your ideas, and am interested in subscribing to your newsletter

  11. Just in time for the new Chilean earthquake story.

  12. I don’t know anything about shaken baby syndrome, or what I should expect shaking would do to a baby, but I can imagine confirmation bias being a problem here. Has anyone ever studied normal, healthy babies to see if they could find the same symptoms?

    1. They have, but finding normal, healthy babies proved very difficult. All the subjects they encountered had difficulty communicating or even understanding simple instructions. In severe cases the subjects exhibited severe emotional outbursts and demonstrated little or no control over their bodily functions.

      1. Hugh Akston|2.11.11 @ 8:50PM|#
        “They have, but finding normal, healthy babies proved very difficult..”

        Not to mention getting them government-certified as “normal, healthy”. That can take years.

        1. That’s the trouble, by the time they are certified they are too tough to eat.

        2. And, having been certified these babies were found to have to disqualifiying characteristic of still being alive.

  13. Typical libertarian drivel. “It is my right to shake my baby to death. Government get away from me at all costs.”

    I’ll throw in my lot with Obama and his enlightened crew, thanks.

  14. I am benefited from it instead much!

    1. There should be a government regulation against spam. But, you ‘tarditarians would have none of that. Hypocrites.

    2. What a girl needs

  15. Shaken Baby Syndrome exerts an upward pressure on the price of babysitting. Soon, only Mexican cartels will be willing to face the heightened risk of being the last person left alone with a small child!

  16. How do you stop a baby crawling around in circles?

    1. Take it off the record player.

  17. We need clinical trials to provide a definitive answer.

    1. I know you were joking, but seriously, the way to do the trials to shake baby monkeys or something.

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