SBS – Shaken Baby Syndrome
SBS (now officially renamed Abusive Head Trauma – AHT – by the American Academy of Pediatrics) is defined as a condition in infants and small children characterized by a combination of three symptoms:
1) Subdural hematoma (bleeding in the brain under the dura)
2) Retinal hemorrhage (also optic nerve hemorrhage)
3) Diffuse edema of the brain (swelling)
This combination of symptoms has been labelled the “Triad” within the medical community. The diagnosis is usually made post mortem.
The precise origins of the “triad” diagnosis are a bit murky, but they started with a paper published in 1946 by US pediatric radiologist Dr. John Caffey. There was a subsequent paper published in 1971 by British neuro-surgeon Dr. Norman Guthkelch. Both of these studies linked the triad symptoms with so-called “whiplash” injury. Since then, both the medical profession and the justice system have, through some convoluted process, embraced and adopted the triad as solely indicative of an infant that has been abusively shaken, frequently to the point of death.
The triad has also spawned an important and legally powerful corollary – that being “no lucid interval.” What this says is that if an infant suffers injury sufficient to cause triad symptoms, it will become immediately unconscious. That is, there can be no lucid interval between the time of injury and the loss of consciousness.
The justice system has taken this to the point that if an infant dies while in the care of a lone caregiver, and the baby presents triad symptoms at autopsy, this results in an “automatic, slam-dunk” conviction of the caregiver. This is enforced by the “no lucid interval” theory, because it dictates that if the infant lost consciousness in the prsence of the caregiver, the caregiver must have inflicted the injuries. Of course, the prosecutors love this.
Now …. it needs to be stated that the statistical populations in the original studies were alarmingly small – 6 in one case and 23 in the other. These studies were not properly controlled scientific experiments, but were merely anecdotal observations by two well-intended physicians. It should be crystal clear to anyone familiar with the scientific method and statistical analysis that the triad diagnosis and “no lucid interval” are a classic case of flawed inductive reasoning.
Unfortunately, proper scientific experimentation is out of the question. The idea of shaking 1,000 babies to death, and dropping another 1,000 babies on a hard floor, and then conducting autopsies is preposterous. However, over the last decade, science has begun to shine a light on the fact that there are many differential (alternative) diagnoses for triad symptoms, and that lucid interval can, in fact, occur. But the “old guard” persists, so while there are, sadly, people who shake their babies to death, there are, even more sadly, hundreds of people in prison for killing a baby when they actually did absolutely nothing. They are victims of the triad doctrine.
SBS defense cases are extremely difficult, largely because of the triad doctrine. My experience tells me that the bottom line for the defense is to have a recognized medical expert willing to testify. But keep in mind, the prosecution will have it’s own parade of medical experts to bring to the stand. The two sides of the issue have devolved into what could be characterized as a “religious war” – each side holding fast to the belief that the “other” side is wrong, and “confirmation bias” runs rampant. Unfortunately, the American Academy of Pediatrics officially supports the triad.
As mentioned above, real science is beginning to bring true understanding to the multiple possible causes of triad symptoms, but I offer this quote from Max Planck, Nobel Prize physicist and discoverer of quantum physics:
“A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.”
I’m afraid it will be a long time before we see the “death” of the triad, but we need to, and have to, continue to fight the good fight. Every time we can get the courts to listen to, and accept, the real science, we are not only helping a wrongly accused/convicted individual, but we are also educating that new generation who will eventually embrace, and act on, these new scientific truths.
Finally, Dr. John Plunkett, a US pathologist, has been laboring valiantly in support of SBS defense for a number of years. Here is a link to a very enlightening recent interview with Dr. Plunkett: