Is it Shaken Baby or Barlow’s Disease Variant?
C. Alan B. Clemetson, M.D.
ABSTRACT-Retinal petechiae, subdural hemorrhages, and even broken bones do not always indicate trauma or child abuse. Infantile scurvy or a variant form still occurs today and can be mistakenly diagnosed as nonaccidental injury (NAI). Histamine levels, which are characteristically increased in vitamin C depletion, may reach a toxic level owing to infection or the injection of foreign proteins. Histamine intoxication can cause a variant of Barlow.s disease, with weakness of the retinal vessels and the bridging veins and venules between the brain and the dura mater in infants.
Elevated blood histamine caused by vaccinations and Vitamin C deficiency may mimic the shaken baby syndrome
The findings of subdural hematoma and retinal hemorrhages in infants, without any documented history of major trauma, do not always indicate child abuse. A combination of ascorbate depletion and the injection of foreign proteins can cause a very high blood histamine level, leading to capillary fragility and venular bleeding. This can be prevented by the administration of vitamin C. PMID: 15050101 [PubMed - indexed for MEDLINE]
WAS THAT BABY REALLY SHAKEN?
C. Alan B. Clemetson, M.D. Well-meant child-abuse laws have given rise to many inappropriate accusations of shaken-baby-syndrome, without any real evidence that the infants were ever shaken or assaulted in any way.
SBS or Vaccine-Induced Encephalitis?
Harold E. Buttram, M.D. The shaken baby syndrome theory, as it stands today, assumes that findings of brain and/or retinal hemorrhages in the absence of known major accidental trauma are diagnostic of shaken baby syndrome (SBS), sometimes also referred to as non-accidental injury. For reasons that will be reviewed in this article, this theory is being increasingly challenged in the scientific literature.
Shaken Baby Syndrome on Shaky Ground
Viera Scheibner, PhD. Published in the “Journal of Australasian College of Nutritional & Environmental Medicine”, Vol. 20 No. 2; August 2001. ABSTRACT -An epidemic of accusations against parents and baby sitters of Shaken Baby Syndrome is sweeping the developed world. The United States and the United Kingdom are in the forefront of such questionable practice. Brain (mainly subdural, less often subarachnoid) and retinal haemorrhages, retinal detachments, and rib and other bone ‘fractures’ are considered pathognomic. However, the reality of these injuries is very different and well documented: the vast majority occur after the administration of childhood vaccines and a minority of cases are due to documented birth injuries and pre-eclamptic and eclamptic states of the mothers.
RULES OF EVIDENCE IN THE COURTS
Harold E. Buttram, MD. Court rules of evidence affect SBS defenses. Among the many adversities and difficulties facing the American family today, there is a relatively new and growing hazard — one featuring a parent or caretaker who may be falsely accused of murdering or injuring an infant by shaken baby syndrome, when the true cause of death or injury arises from other sources. Very tragically, child abuse does occur and deserves appropriate punishment. However, it is equally tragic when a family, already grieving from the sudden and unexpected death of their infant, finds a father or mother unjustly accused, convicted, and imprisoned for murder of the infant, a murder of which he or she is innocent. I know of an attorney, an anesthesiologist, a Mormon mother, an Amish mother, and others accused and/or imprisoned (many believe falsely) on charges of injuring or murdering an infant by SBS. It could happen to anyone regardless of race, sex, education, finances, or social status.
Shaken Baby Syndrome: Pitfalls in Diagnosis and Demographics
F. Edward Yazbak, M.D., FAAP. Medical Studies.
Multiple Vaccinations And the Shaken Baby Syndrome
Child abuse is a terrible crime and the failure to recognize it is unforgivable. An erroneous diagnosis of inflicted head trauma is just as tragic and the resulting destruction of a family is one of the gravest injustices of modern times. Many have recently questioned the existence of the so-called “Shaken Baby Syndrome” and the concept that the last caretaker must have been guilty. Careful reviews often uncover relevant findings that were missed or ignored. Recent pediatric vaccinations have been suspected as precipitating factors. A recent combination of seven antigens is the focus of this investigation. The three vaccines in question were 5 in 1 vaccine combination, HIB conjugate vaccine, 7-valent pediatric pneumococcal vaccine.
SUDDEN, UNEXPLAINED INFANT DEATH INVESTIGATION
CDC. I the world of death investigation, infant death investigation is unique. From scene through certification, these investigations require skill and knowledge drawn from disciplines outside those typically considered a part of medicolegal education. This chapter presents an overview of sudden, unexplained infant death, its typical causes, and the importance of the death scene investigation to accurate cause and manner of death determination.
Shaken Baby Syndrome and the Death of Matthew Eappen
A Forensic Pathologist’s Response
John Plunkett, M.D. The American Journal of Forensic Medicine and Pathology 20(1):17-21, 1999.
Subdural hemorrhage, retinal hemorrhage, and cerebral edema have been considered diagnostic for a “shaken infant” since the syndrome was described almost 30 years ago. However, the specificity of these findings has been disputed by defense witnesses in recent U.S. criminal prosecutions. This review examines the scientific basis for the shaken baby syndrome.
Articles by Archie Kalokerinos, MD
Sudden Infant Death and the Shaken Baby Syndrome: How They Are Connected!
Lecture Was Given by Archie Kalokerinos, MD
Dr. Kalokerinos believes that the pathologies found at autopsy on many of these “shaken” babies, which include intracranial and retinal hemorrhages and bone changes that can be mistaken for fractures, are due to processes involving infections and toxins produced by the infections, along with an increased utilization of vitamin C. Dr. Kalokerinos has reasons to believe that there is a relationship between SIDS (sudden infant death syndrome) and the pathologies found in SBS (shaken baby syndrome.)
The evidence base for shaken baby syndrome
BMJ 2004 328:719-720 Editorial
The phrase “shaken baby syndrome” evokes a powerful image of abuse, in which a carer shakes a child sufficiently hard to produce whiplash forces that result in subdural and retinal bleeding. The theory of shaken baby syndrome rests on core assumptions: shaking is always intentional and violent; the injury an infant receives from shaking is invariably severe; and subdural and retinal bleeding is the result of criminal abuse, unless proved otherwise.1 These beliefs are reinforced by an interpretation of the literature by medical experts, which may on occasion be instrumental in a career being convicted or children being removed from their parents. But what is the evidence for the theory of shaken baby syndrome?
VITAMIN C and SBS
Child Abuse or Life-Threatening Medical Misdiagnosis?
No reliably-witnessed case of shaking in America has ever produced the symptoms associated with SBS, so accusations are based on assumptions, which in turn are based on symptoms alone–symptoms that singly and as a group have medical causes unrelated to abuse. The fact is, there are tests that can separate the innocent from the guilty, but doctors refuse to run them (DIFFERENTIAL DIAGNOSIS–eliminating medical causes to support an assumption of abuse).This only happens in suspected SBS cases in spite of pediatric emergency medical guidelines compelling doctors to do so. The question is, “Why?”
Shaken Baby/Impact Syndrome: Flawed Concepts and Misdiagnoses
(Based on a Review of Twenty-Two Cases) Harold E Buttram, M.D.
The following article represents a review of twenty-two cases of shaken baby syndrome (SBS) accusations and/or convictions over a period of approximately three and a half years. Its primary purpose is to offer a composite of information gained from study of these cases to parents or caretakers who have been accused and/or convicted of child abuse in the form of SBS, information which may be of value in their defense. Every effort has been made to maintain simplicity and clarity in the organization of the material. Each section is designed to be complete in itself, and for this reason some portions are repetitious.
In the News:
Review of infant deaths urged
New look at 142 `shaken baby’ cases over 2 decades justified, Ontario chief forensic pathologist says.
The deaths of 142 Ontario babies since 1986 were attributed to a cause many scientists now believe has been discredited – shaken baby syndrome – the province’s top forensic pathologist testified yesterday.
At the time, the fact that most of the injuries were to her neck, shoulders and head was considered highly unusual and suggestive of a homicidal stabbing. However, Dr. Pollanen said that recent studies have shown that, unlike attacks on adults, dogs frequently savage those portions of a child’s anatomy.
Michael Pollanen told Mr. Justice Stephen Goudge that skepticism about SBS is so great that he should consider urging a review of the cases when he produces his report next spring.
Dr. Pollanen said he did not know how many of the 142 cases were investigated as suspicious deaths, resulting in criminal charges, convictions or the seizure of siblings from the parents of the pediatric victims.
“To be very straightforward, this would generate a lot of controversy in the community… because it is very polarized,” Dr. Pollanen said.
The inquiry was launched last spring to look at how the province’s former star pathologist, Charles Smith, was able to rise to the top of his profession despite a series of autopsy errors that led to miscarriages of justice.
However, Dr. Pollanen’s revelation yesterday went beyond Dr. Smith to include the work of other pathologists who diagnosed SBS – a conclusion that was typically made upon the discovery of brain swelling and retinal bleeding combined with tissue damage to the linings of the brain.
Dr. Pollanen said that in recent years, a significant segment of the scientific community has come to believe that these symptoms can be found in babies who suffer an accidental blow to the head or an innocent fall.
He testified that Britain took the lead a couple of years ago, systematically re-examining a large number of SBS cases in what became known as the Goldsmith review.
“In the U.K., some of these convictions were quashed,” he said. “The scope of the problem is not clear in Ontario. There needs to be some consideration of whether we should undertake something like the Goldsmith review.”
Similar reviews may follow in other countries, Dr. Pollanen said.
“One of the factors to put fuel on the fire in the U.S. is that traditionally, sentences have been robust in these kind of cases – the death penalty or life imprisonment.
“In the face of what some people believe to be remarkable miscarriages of justice in some of these cases, it really has polarized groups of experts.”
Dr. Pollanen also testified that:
A 1991 ruling by a judge of the Ontario Court of Justice who acquitted a 12-year-old of murdering a baby was “a masterful analysis of the case … that was slightly ahead of its time.” Dr. Pollanen was effectively endorsing the judge, Mr. Justice Patrick Dunn, who rejected Dr. Smith’s testimony in acquitting the babysitter. The inquiry has heard that Dr. Smith often told colleagues that Judge Dunn later confided he regretted the acquittal and should instead have convicted the babysitter.
With not a single medical school in Canada offering forensic pathology training as an area of subspecialty, “I would say we have lagged about 40 years behind in comparison to other systems.”
Forensic pathologists working in provincial coroners’ systems are “prohibitively” underpaid in comparison to their counterparts in the private sector.
Defence counsel in Ontario will never have more than one or two forensic pathologists willing to work on homicides unless legal aid funding improves substantially and experts get over their revulsion for disputing conclusions by colleagues testifying for the Crown.
Advances in forensic pathology have made it even more clear that a Kingston baby known as Sharon definitely died of bites from a pit bull.
Tom Blackwell / National Post-Canwest News Service January 28, 2008
TORONTO – Dr. Charles Smith apologized for his mistakes again Monday and admitted his knowledge of forensic pathology was “woefully” inadequate during his years as head of Ontario’s pediatric forensic pathology unit.
Smith began his much-anticipated testimony at the inquiry examining his discredited work by acknowledging and voicing regret for his well-documented failings.
As several of the people wrongly prosecuted for homicide in his cases looked on, he conceded he had little training in the forensic field or in courtroom testimony and sometimes behaved unprofessionally.
“I have come to appreciate mistakes I have made and I am sorry for them,” a solemn-looking Smith told the inquiry. “I also recognize that at times my conduct was not professional and I deeply regret that.
“I do accept full responsibility for my work and for my opinions and for my actions.”
The inquiry was called last year after a panel of international experts found he had made serious errors in 20 of 45 criminally suspicious deaths he helped investigate between 1991 and 2001. Parents or other caregivers were charged in most of the cases, though many have since been cleared.
The outside experts told the inquiry Smith came to conclusions that were clearly unjustified, gave speculative and misleading testimony and seemed to have no training in forensic pathology.
Top officials of the coroner’s office said they generally overlooked the mistakes for more than a decade.
Colleagues testified to Smith’s disorganized, tardy work habits.
Though he was certified as a pediatric pathologist, he conceded Monday he received virtually no formal training in forensic pathology – dealing with cases that have a legal aspect.
“It was self taught, it was minimal,” he said of his knowledge of the field. “In retrospect, I realize it was woefully inadequate.”
He also confessed to receiving little training in being an expert witness at criminal trials, apart from a two-day course he took in the United States.
“I thought I knew it, but I realize now just how profoundly ignorant I was.”
Sherry Sherret, convicted of infanticide in the 1996 in the death of her four-month-old son Joshua, said she has many questions she wants to hear answered by the pathologist, whose evidence was key in her case.
“I would want to ask him . . . why did he do it, how does he feel, does he regret anything that he did,” she said, but conceded that others bear some of the blame for what happened, too.
“In the long run, it’s not 100 per cent his fault, because obviously, someone wasn’t watching him.”
Doubts about shaken baby syndrome
…is the science related to it conclusive enough to convict beyond reasonable doubt when there is little other evidence pointing to guilt?
Shot in the dark
Heartbroken woman wonders if vaccines killed her infant son
Shaken Baby Syndrome: Debunking the Myth
In 1997 the world held its breath as the media followed closely Louise Woodward’s “nanny” trial. She had allegedly committed the crime of shaking a baby, which resulted in the death of infant Matthew Eappen. Miss Woodward was a 19-year-old British au pair with no criminal record, yet she was “disliked” by the camera and as is often the case in crimes involving children, was presumed guilty.
Two British pathologists have found that a combination of injuries used to diagnose abuse, known as the “triad”, can happen naturally.
Dr Irene Scheimberg, from London’s Bart’s Hospital, and Dr Marta Cohen, from Sheffield Children’s Hospital, warn that bleeding on the brain and retinas, swelling of the brain and oxygen deficiency do not only occur through vigorous shaking.
Their discoveries could have a dramatic effect on future child abuse trials and child protection hearings.
Dr Scheimberg said: “When there is no evidence of physical abuse, apart from the haemorrhaging, we may be sending to jail parents who lost their children through no fault of their own.
“As scientists it is our duty to be cautious when we see the triad and to take each case on its merits. We owe it to children and their families.”
The study, published in the journal of Paediatric Developmental Pathology, found that the symptoms of shaken baby syndrome can happen in babies before they are taken home from hospital.
The authors looked at 25 babies who had died shortly before delivery and 30 newborns who had haemorrhages and found similar damage to the brains of all the babies.
The study concluded that the symptoms are common in young babies and could be caused by a traumatic birth or other conditions.
Dr Scheimberg and Dr Cohen believe that what they have found means police and lawyers will need more evidence than bleeding in the brain to prove that a baby has suffered child abuse.
Dr Scheimberg said: “We now know that mothers who have babies through normal vaginal delivery can have a child with a subdural haemorrhage and also retinal bleeding.
“We also know that many of these bleeds resolve themselves – with no outward sign of damage in the first few weeks of life and these children grow up to live a normal life.
“The other group are those children who present with signs of shaken baby syndrome whose bleeding has continued and got worse. These are the children who the courts suspect have been harmed by their parents.”
The evidence could now be used in a string of appeals, including the case of childminder Keran Henderson, who is serving three years for the manslaughter of 11-month-old Maeve Sheppard.
Medical experts argued that Maeve’s injuries indicated that she had been violently shaken.
But Henderson, of Iver Heath, Buckinghamshire, said the baby had a fit while she was changing her nappy.
Her lawyer, leading child abuse expert Bill Bache, said he was “absolutely sure” the research will be used in appeal cases.
“It is very likely we will use it in Keran Henderson’s appeal,” he added.
Mr Bache said the evidence may also be used in at least four further cases.
The “triad” of symptoms first came to public attention in 1998 in the US trial of British au pair Louise Woodward, who was found guilty of the second-degree murder of eight-month-old Matthew Eappen in October 1997. She was sentenced to a minimum of 15 years to life in prison.
Her conviction was then reduced to involuntary manslaughter. Her sentence was also reduced to time served on remand, 279 days, and she was freed.
Around 200 cases of shaken baby syndrome are diagnosed in Britain every year and many accused of abuse strenuously deny any wrongdoing.
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