A History of Shaken Baby Syndrome

In a classic case of Shaken Baby Syndrome (SBS), the allegation of shaking is based on the triad that includes the following:

1. Bleeding between the brain and skull (subdural hematoma)
2. Bleeding behind the eye (bilateral retinal hemorrhaging)
3. Swelling of the brain

VIRGINIA JASPERS

• Many of the theories surrounding SBS came out of the case of Virgina Jaspers from the 1950s.
• She was an American baby nurse (nanny) and was charged for killing three children who were under her care.
• In total 15 children were injured by her.
• She admitted to having shaken some of the babies.
• A Newsweek article published in 1956 entitled "The Boys Jeered Her" details the life of Jaspers and what may have led her to injure children under care.

HENRY KEMPE

• Kempe published an article that concludes all children with subdural hematomas and retinal hemorrhages were abused by shaking "The battered child syndrome" Journal of the American Medical Association, 1962.
• There was no data, or evidence to support this conclusion.
• A Time magazine article talks about this new 'battered child syndrome' on July 20, 1962.

NORMAN GUTHKELCH

• In 1971 a two-page article was published in the British Medical Journal entitled "Infantile Subdural Hematoma and Its Relationship to Whiplash Injuries."
• Dr. A. Norman Guthkelch, a British pediatric neurosurgeon, noticed that in his area of Northern England, many parents thought it was acceptable to shake a child to gets its attention and/or to discipline the child.
• This shaking appeared to produce two symptoms: retinal bleeding and subdural bleeding.
• These symptoms appeared without any evidence of external injury to head.
• To support this suggestion, Guthkelch references 23 cases of children that were either proven or suspected of parental assault.
• Out of the 23 children, seven suffered from subdural hemorrhaging.
• From those seven children, five had no external marks or injuries.
• Guthkelch theorizes that repeated shaking rather than direct impact was the cause of these hematomas (bleeding).
• He compares his theory of shaking to the two cases of adults suffering subdural hematoma from whiplash after a car accident.
• He references Dr. Ayub Ommaya 's article "Whiplash. Injury and Brain Damage" Journal of American Medical Association, 1968.
• Following his 1971 article, Guthkelch did not produce any more research on this subject.
• Instead, a Dr. John Caffey from the United States picked up Guthkelch's observations and continued on with his own studies.

JOHN CAFFEY

• In 1946 he describes four cases of children who had subdural hematomas and long bone fractures in his article "Multiple Fractures in the Long Bones of Infants Suffering from Chronic Subdural Hematoma," published in Radiology.
• The article concludes that infants with such fractures also have subdural hematoma, thus further investigation is needed into what brought on the subdural hematoma.
• This article is often cited as evidence for proof of SBS.
• SBS is later given more attention through Caffey's article "On the Theory and Practice of Shaking Infants" (American Journal of the Disease of Children, 1972).
• SBS is further discussed in his article "The Whiplash Shaken Infant Syndrome: Manual Shaking by the Extremities with Whiplash-Induced Intracranial and Intraocular Bleedings, Linked With Residual Permanent Brain Damage and Mental Retardation" (Pediatrics, 1974)
• He references Guthkelch's article "Infantile Subdural Haematoma and its Relationship to Whiplash Injuries" (British Medical Journal, 1971), the work of Ommaya, and the Newsweek article "The Boys Jeered Her", 1956.

AYB OMMAYA

• His research on the impact of adults suffering subdural hematoma as a result of automobile whiplash resulting from a rear-end collision is published in his article in 1968 and used by Caffey and others in support for possible explanations of subdural hematoma in babies.
• In 2002, he began to question the application of his research to support SBS "Biomechanics and Neuropathology of Adult and Pediatric Head Injury" (British Journal of Neurosurgery, 2002).
• He confirmed that in his article the impact of shaking alone produces an acceleration that is "well below thresholds for [head] concussions, subdural hematoma, subarachnoid hemorrhage (space surrounding the brain), deep brain hemorrhages and cortical contusions (traumatic brain injury)."
• He stated that Caffey, Gulthkelch and others, referenced his research to support SBS without taking into consideration that his research was based on subjects facing an acceleration of 30mph (~50km) speeds in a car crash.

POINTS TO PONDER

• Caffey admits that his conclusions of infants suffering from the effects of whiplash without any external trauma to the head and the face presents a contradiction."
• This diagnostic contradiction opens itself up for further investigation.
• The issue remains the lack of evidence of external trauma (bruises, bleeding, cuts, broken bones, etc.) when a baby is diagnosed with SBS.
• The question remains: how can a baby be shaken with enough force to cause brain injury and leave no external evidence of trauma?
• Many of those skeptical of SBS point to the fact that SBS is a theory "based on anecdote and experience."
• The obvious problem to resolving this question being that no studies involving actual babies being shaken can done for ethical reasons.

ANN-CHRISTINE DUHAIME

• In 1987, Dr Duhaime a pediatric neurosurgeon in the United States, used model dolls fitted with accelerometers, and then shaked them in an attempt to resolve this dilemma.
• From her study, she concluded that the shaking occurred by these dolls, in terms of velocity and acceleration, is well below the injury range.

MICHAEL PRANGE

• The results from Duhaime's experiment are again repeated by Bioengineer Dr. Michael Prange and his team and published in the Journal of Biomechanical Engineering in 2003, entitled "Anthropomorphic Simulations of Falls, Shakes and Inflicted Impacts in Infants."
• They used a more realistic baby model.
• They concluded that shaking could not produce enough force to cause brain injury, including subdural hematoma.

SUBDURAL HEMATOMA & RETINAL HEMORRHAGE

• Much of the focus in SBS lies in explaining what causes subdural hematoma and retinal hemorrhages in babies.
• Complications at child birth can be a trigger of subdural hematoma, bleeding disorders, infections, or vitamin deficiencies.
• Increased pressure inside the skull which puts more pressure on the brain can trigger both subdural hematoma and retinal hemorrhaging.

Ground-breaking cases in Shaken Baby Syndrome

AUDREY EDMUNDS

• In 1995, Audrey Edmunds, a mother of two at the time, looked after some of the neighbourhood children in her house.
• A baby in her care suddenly became unresponsive, and was rushed to the hospital. She died soon after.
• The baby was found to have a severe case of classic shaken baby syndrome symptoms.
• Edmunds was accused of killing the baby by shaking.
• She was sentenced to 18 years of prison in 1995.
• However, in 2008, in an appeal, State vs Edmunds, she was exonerated.

LOUISE WOODWARD

• In 1997, Louise Woodward then 19 years old from England, was an au paire working in Boston.
• She looked after two children every day.
• One day she found the eight-month old responsive and called the ambulance.
• The baby died from both subdural hematoma and a fractured skull.
• A very public and lengthy court case ensued.
• Her case opened up the door for skeptics of SBS to question the assumptions made by SBS supporters.
• At the end of the case, Woodward spent 279 days in jail, and was deported back to the UK.