The SBS Wars

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:

10 responses to “The SBS Wars

  1. My son is in prison in Ohio, falsely convicted of beating a baby he fell with. They said that the head injuries the baby had could not have been caused by a fall. I have most of the information from his case. Is there anyone that you could put me in touch with that could possibly help us pro bono. We used all our savings on his trial. Please help us if possible. Thank You for working to bring out the injustice and facts about all the innocent people in jail. Your work is greatly appreciated.
    Donna Bailey

  2. Thank you, Phil Locke, for your insightful analysis of a tragic legal situation. You are absolutely right: Thirty years of sincere but unproven medical opinion have not only put innocent caretakers in prison but also denied some truly sick children the care they needed. Although a number of legitimate medical conditions can produce the triad, once the diagnosis of shaking is made, doctors quit looking for another explanation. For the story of a family finally exonerated when another son was correctly diagnosed with a genetic disorder, please see

    • Thanks, Sue. Your observation about doctors “quitting” once shaking is diagnosed is “right on”. Not only do they quit, they back away from it. Questioning the triad can be career endangering in pediatrics. I tried for 3 years to recruit a pediatrician (retired or practicing) in the Cincinnati metro area who would be willing to just advise us on SBS cases. None of them want to touch it. The Chair of the Pediatrics Department at Cincinnati Children’s Hospital declined to even speak to me. Finding medical experts able and willing to support an SBS defense case is extremely difficult, which is why I was really sorry I was not able to attend the Atlanta meeting on 2/19. Thank you again.

  3. My son passed away november 20th 2011 and he had the three triad symptoms, he also had a subdural hematoma from what they say which was located on the right front temporal area. My son had no obvious signs of abuse or trauma in any way shape or form, i was with him all through out the day up until about 1:15 and earlier that day around 12:30 he had hit his head on a metal bar on a public bus, the police have the video of that and everything but they are saying it wouldn’t of caused him to die. Well, my sons dad took him home around 1:30 and reportedly layed him down for a nap and also fell asleep and awoke to our child breathing irregularly, he explained it as short deep gasping breaths so he rushed him to a medical center where they preformed cpr because my son stopped breathing as soon as he got him to the medical center. I’m guessing their attempts were futile, they called the hospital from there and an ambulance showed up and they intubated my son and got him to have stable vitals before transporting him to the hospital. I arrived home around 3 almost 3:30 and recieved a phone call that i needed to get to the hospital because my son had stopped breathing, long story short my son was transfered to a childrens hospital in denver colorado because the hospital in pueblo colorado couldnt figure out what was wrong with him, they preformed cat scans and xrays but didnt see anything abnormal, the doctor at the childrens hospital looked at my son for maybe 10 minutes before pulling me aside and telling me my sons chances of survival were minimal from his opinion due to how long cpr was needed to be preformed on him, that he had went without oxygen to his brain for a little to long. In the end my son was declared brain dead, he was on life support for 2 days, he was taken off life support. They arrested my sons father and he is currently sitting awaiting trial on first degree murder charges and child abuse resulting in death…he’s facing life in prison. I’m 22 years old and I dont know alot but I’ve been researching alot of this and I truly believe maybe something could have been medically wrong with my son that just went undiagnosed because none of the hospitals he was in for those two days tested for vitamin deficencies or anything at all, once they suspected child abuse they pretty much just waited for the time to take him off life support. My sons dad isnt a perfect person but he was definately a wonderful father…I could use any help that any of you can offer, they ruled out shaken baby syndrome and are classifying his cause of death as blunt force trauma to the head, they said he had a traumatic brain injury…i just dont see how its possible without absolutely no bruising, red marks, swelling of any kind on the outside of his body or anything and they arent suspecting he was shook….please…any help is better then nothing

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