Thursday, 30 September 2010

CHILD PROTECTION SERVICES, UK:: Association of Directors of Children's Services survey finds 52% increase in number of children referred to social workers

Child protection services risk being overwhelmed by a big increase in the number of at-risk children referred to social workers or removed from their families, according to the Association of Directors of Children's Services. It says rising workloads since the Baby Peter case and funding cuts are putting unsustainable pressures on budgets.
Its survey of local authorities, published today, reveals that the number of children referred to social workers owing to suspected neglect or abuse has increased by 52% in three years. It calls on ministers to ringfence funding for early intervention projects.

Wednesday, 29 September 2010

SIDS: placenta abnormality research study

To determine whether placental abnormality (placental abruption or placental previa) during pregnancy
predisposes an infant to a high risk of sudden infant death syndrome (SIDS), the authors conducted a
population-based case-control study using 1989-1991 California linked birth and death certificate data. They
identified 2,107 SIDS cases, 96% of whom were diagnosed through autopsy. Ten controls were randomly
selected for each case from the same linked birth-death certificate data, matched to the case on year of birth.
About 1.4% of mothers of cases and 0.7% of mothers of controls had either placental abruption or placenta
previa during the index pregnancy. After adjustment for potential confounders, placental abnormality during
pregnancy was associated with a twofold increase in the risk of SIDS in offspring (odds ratio = 2.1, 95%
confidence interval 1.3-3.1). The individual effects of placental abruption and placenta previa on the risk of SIDS
did not differ significantly. An impaired fetal development due to placental abnormality may predispose an infant
to a high risk of SIDS.
Am J Epidemiol 1999; 149:608-11.

SIDS: minorities statistics

• Currently, the national infant mortality rate for Black babies is 13.7 per 1,000, compared to a rate of 5.6 per 1000 for White babies, 3.5 per 1000 for Asian babies, and 5.3 to 6 per 1000 for Latino babies.
• Black babies are four times as likely to die as infants due to complications related to low birthweight as compared to non-Hispanic white infants.
• African Americans have 2.3 times the infant mortality rate as non-Hispanic whites
• African Americans had 1.8 times the sudden infant death syndrome mortality rate as non-Hispanic whites.
• College- and graduate-school educated black mothers have a higher infant mortality rate than white moms who didn’t finish high school
• The infant mortality rate for African American mothers with over 13 years of education was almost three times that of non-Hispanic white mothers.
• Black women who get prenatal care in the first trimester have double the infant mortality rate of white mothers with first-trimester care
• Only 17 percent of all U.S. births were to African-American families, but 33 percent of all low-birthweight babies were African-American, according to one report.
• Black women with similar levels of prenatal care as Hispanic women (generally less educated and with lower incomes than blacks) have higher rates of low birth weight, preterm deliveries, and infant mortality.
• According to Dr. Michael Lu, assistant professor of obstetrics and gynecology and public health at UCLA, researchers have found that even when they control for such varied factors as poverty, housing, employment, medical risk, abuse, social support and so on, 90 percent of the differences in birth weight between black and white moms remains unaccounted for. “Most studies have looked at black-white differences during pregnancy, for example, differences in prenatal care utilization or maternal behavior,” he says. “What we’re finding is that these differences really explain very little of the disparities in birth outcomes.”

SIDS: Infant Sleep Apnea: Basic Facts About Sleep Apnea in Babies

Sep 5, 2009
Rina Magallanes
It is estimated that around 2,500 children in the US die from Sudden Infant Death Sydrome (SIDS) each year. Sudden Infant Death Syndrome is a phenomenon that takes away the life of even the healthiest of babies without warning. Also referred to as “crib death”, SIDS affect infants with ages 1 month to 1 year. SIDS can be caused by a number of factors. One of these factors is infant sleep apnea.
What is Infant Sleep Apnea?

Infant sleep apnea is a condition where the baby experiences a pause in breathing. Usually, this happens for twenty seconds but sometimes, the pause may be longer. Infant sleep apnea can happen to any babies that are between the age of 1 month to 1 year; however, premature babies and those that are suffering from illnesses and certain medical conditions are more at risk of this condition. Infant sleep apnea may not be much to worry about if the symptoms are mild as it may likely just go away as the baby matures. Nonetheless, a physician should be consulted if the symptoms persist and the pause in breathing lasts for more than 20 seconds. In these cases, the baby may be at risk.
What are the Symptoms of Infant Sleep Apnea?
The symptoms of infant sleep apnea do not have much difference when compared to the symptoms of sleep apnea in adults. Common symptoms of sleep apnea in infants include but may not be limited to the following:
  • cessation or pause in breathing that lasts for 20 seconds or more
  • snoring
  • restlessness during sleep
  • breathing through the mouth instead of through the nose
  • a change in color (the baby may become bluish or pale)
It is normal for infants to experience pauses in breathing during sleep. In fact, it is believed to be part of infants’ respiratory behavior. The pauses in breathing are caused by the immature breathing reflexes in babies, which are normal characteristics of newborns. However, when this occurs more often and longer than the normally accepted range, this can be a sign of infant sleep apnea and must be consulted with a physician.
What are the Causes of Infant Sleep Apnea?
Scientists still have not come up with a concrete explanation of why sleep apnea happens in some infants while it may not affect other babies. However, they have attributed a number of factors as the possible causes of infant sleep apnea. These factors include:
  • blockage of the airways, which may be caused by a relaxed tongue or by enlarged tonsils and adenoids
  • congenital conditions such as Down Syndrome
  • birth defects including abnormalities in facial characteristics (i.e, cleft palate and receding chin)
  • weight problems
  • gastroesophogeal reflux
  • low blood and sugar
  • internal bleeding in the brain during delivery
Allergies and medical conditions such as asthma and other respiratory problems may cause enlarged tonsils and may therefore, also become causes of sleep apnea in babies.
Dangers Associated with Infant Sleep Apnea
Infant sleep apnea can put babies at risk when not immediately detected and given medical attention. Prolonged pauses in breathing can deprive the brain of oxygen, resulting to complications. Babies who experience longer pauses of breathing may become blue or pale and may suffer from a condition known as ALTE (Apparent Life-Threatening Event). Worst, babies suffering from prolonged pauses in breathing may suffer from SIDS.
How to Reduce the Risks of Infant Sleep Apnea
The risks associated with sleep apnea in babies can be minimized and prevented. Once parents notice that their child is experiencing prolonged cessation of breathing, it is imperative that they immediately consult a physician as soon as possible. It is also advisable to follow the recommendations of the physician when the baby is diagnosed with infant sleep apnea.
Here are some ways of reducing the risks of sleep apnea in babies:
  • Never let your baby sleep on his chest. Lying on the chest may cause labored breathing to the baby. In short, let the baby sleep in a position where his airways may not be blocked in any way.
  • Ensure that the baby’s sleeping zone is clean and from dusts, mites and any other objects which may likely cause respiratory problems and trigger sleep apnea.
  • Do not put babies on bouncy baby carriers, swings or seats that may curl them forward.
  • Avoid exposing babies to tobacco and cigarette smoke.
  • Ensure that baby’s bed is free from things that may accidentally suffocate him.

SIDS: Generations disagree on safe sleep practices for babies

SIDS: North Carolina Child Protection Team

NEW HANOVER COUNTY, NC (WECT) - New Hanover County needs some serious help when it comes to how children are cared and provided for, according to the county's Community Child Protection Team, or CCPT.
In an annual report to county commissioners, presented Monday morning, CCPT identified five major issues with child services in the county.
Major problems noted by the team include, among others, a "dramatic decrease" in the quality of mental health services for children as well as the loss of preventative services in New Hanover County when it comes to child abuse and neglect.
The Community Child Protection Team was formed because of a state law established in 1991.  The CCPT is mandated to find and address problems with child services in the county. 
The team is made up of child advocates, citizens-at-large, and representatives from agencies including the Wilmington Police Department, New Hanover County Sheriff's Office, and the Department of Social Services (DSS).  The team, however, is not a division of DSS, but a separate community entity.
Each year, CCPT submits a report to the county commissioners. This year's report will be discussed at a pre-agenda meeting Thursday afternoon and again at the regular board meeting on Monday morning, September 20.
In the report, the CCPT pointed out five problems with New Hanover County's services for children.
First, the team stated the county does not have enough local therapeutic foster homes able to meet the needs of our children.  The lack of foster homes is also evident in regard to medically fragile kids.
Second, the members of the CCPT noted a "dramatic decrease" in the quality of mental health services for children.  They indicated a steady decrease in quality since 2004 and blame, in part, constant policy changes that result in inaccessible or inadequate services for children.
Next, the team addressed funding, saying New Hanover County doesn't have enough money to assist income-eligible families that may be struggling to stay employed or trying to complete education goals.
According to the report, there were 981 families on a waiting list for assistance in New Hanover County as of August 31, 2010.
Another issue tackled by the CCPT deals with child fatalities.  The team stated that too many child deaths are classified as Sudden Infant Death Syndrome (SIDS) by a medical examiner before a thorough investigation is conducted.
The CCPT said it has continually expressed serious concerns about the way child fatalities are handled, and it will continue to push for an autopsy to be performed on every child with a questionable or undetermined death.
Finally, the team expressed that it is "tremendously concerned" with the loss of preventative services in New Hanover County when it comes to child abuse and neglect.  The CCPT cited the economic downturn and rising poverty rates as reasons to expect abuse and neglect to get worse in New Hanover County and elsewhere.
"One more burden and it becomes too much," said CCPT Chairperson, Elizabeth Mandel. "It becomes just the catalyst for them to sink. We want to be there to support them. We can't help everybody. We can't do it alone."
The team is asking for more help from the county and especially the state.
"We're asking for your clout," a team member told the commissioners, who wanted firm numbers on what kind of financial help children's programs in the county need.
The team said it will work on getting solid figures for the commissioners, but in the meantime, asked for help in lobbying state lawmakers to stop making cuts to child services and start rebuilding an ailing system.
At the end of the report, the CCPT pointed out that North Carolina ranks 37th of 50 states when it comes to child well-being, according to the new Annie E. Casey Kids Count report.  North Carolina also ranks 36th out of 50 in a measure of children living in poverty.
"That's not a number that any of us should be proud of," said Mandel.
LaVaughn Nesmith, the director of New Hanover County's Department of Social Services agreed, and emphasized that something needs to be done quickly, with both poverty and child abuse on the rise.
"The end result is death," said Nesmith. "That is not acceptable. Not in a society that we live in."

SIDS: New Zealand

Sudden unexpected death is extremely rare for babies protected by the safety formula. Photo: File.

Sudden unexpected death is extremely rare for babies protected by the safety formula. Photo: File.

The tragic deaths of two Tauranga babies have prompted the coroner to warn parents of the risk of sharing a bed with their infant.

The inquests of the 4-month-old babies, who died within a month of each other last year, were held at Tauranga yesterday.

The names of the babies and their parents were suppressed.

Coroner Dr Wallace Bain said it was important to get the warning out about the risks of bed-sharing.

In the first case, the baby had been sleeping between its teenage mother and the mother's younger sibling.

But when the mother woke in the morning, her son was not breathing. She immediately started CPR and an ambulance was called, but the baby could not be saved.

The court heard evidence that the baby had been wheezing, and only a month earlier had spent a few days in hospital being treated for a respiratory virus.

The pathologist said the post-mortem findings were consistent with an "asphyxial mode of death", and consistent with consideration of a sudden infant death syndrome.

The baby's parents were not present in court.

In the second case, the baby's father had placed his son into his wife's arms while she was lying in bed.
All three went to sleep.

But when the mother woke at 4am, she found her baby lying face up between her and her husband. He was not breathing, was cold to the touch, and had no pulse.

She immediately started CPR and an ambulance was called.

The pathologist who performed the post-mortem examination said the baby's death was consistent with asphyxia.

The baby's mother told the coroner that sleeping with her baby was a cultural practice.

But she had since had another child, and her new baby slept in its own cot with a monitor.

The coroner applauded that decision, and said it was important to tell other parents about the need for separate, safe sleeping places for little babies. The mother, who attended with the baby's father, agreed.

It's not the first time the risks of parents bed-sharing with babies has been highlighted.

Dr Bain said he and the Wellington coroner dealt with at least a dozen similar co-sleeping deaths in 2008, and there continued to be cases all around the country.

Dr Bain reserved his decision in relation to the cause of death of both infants.

The issue of safe sleeping practices has also been raised by health officials in Christchurch following the destructive earthquake two weeks ago.

Dr Pat Tuohy, Ministry of Health chief adviser child and youth health, said many babies are sleeping in makeshift beds away from their own homes - and this meant some might be placed to sleep in dangerous places. Dr Tuohy said there were three things parents and caregivers should remember wherever and whenever baby sleeps.

"They should be face-up, face-clear and smoke-free."

The doctor also warned parents who were tired, or had consumed alcohol, not to share a bed with their baby, because it put the baby at high risk of being suffocated.

"Sudden unexpected death is extremely rare for babies protected by this safety formula."

The Ministry of Health is recommending its "Safety formula" to reduce the chances of babies dying in their sleep:

FACE UP: Babies should sleep on their back. In this position it's easier for them to breathe and allows their strong gag and swallow reflexes to protect them if they spill. A clear face protects babies from suffocation.

FACE CLEAR: Babies need to be in a safe place, and shouldn't sleep on a couch or a bed with bedding or pillows that could block breathing.

SMOKE-FREE: All smoking harms babies, especially in pregnancy. Smoking takes oxygen and weakens vital systems as babies develop. When born, babies need extra protection, especially those born early.

Risks of sharing a bed with your baby 

Plunket advises parents on its website that bed-sharing increases the risk of sudden infant death syndrome (SIDS). If a parent wants to share a bed with their baby, it was important to:

* Have a smoke free pregnancy and home.
* Make sure that your baby sleeps on its back.
* Ensure that the adults in the bed have not been using alcohol or drugs, or are particularly tired.

Plunket also advises ensuring that bedding does not cover the baby's face or bed, the baby can't become wedged between or under others, and the baby doesn't get too heated or cold.
The risks of bed sharing are greater for premature and low birth weight babies and those who have been exposed to smoke, Plunket says.
"Most babies who die of SIDS share a bed with others, and have been exposed to smoke during pregnancy and after birth."
La Leche League New Zealand spokeswoman Lisa Manning said many New Zealand parents from different cultural backgrounds shared sleep with their babies, for all or part of the night.
"Rather than condemning what is an important strategy used by some to make parenting easier and more pleasurable, accurate messages on how to safely share sleep and when to avoid it need to be given."
Ms Manning said British research by Helen Ball had found that mothers who slept next to their breastfed babies were sensitive to their baby's presence during the night.
They maintained a safe sleeping position which protected the baby's from over-lying. 

SIDS: North Carolina improved statistics

North Carolina’s infant morality rate declined in 2009 to the lowest level on record.
The state Department of Health and Human Services said Friday there were 7.9 deaths for every 1,000 live births in 2009, compared to 8.2 deaths the year before. The rate has improved by more than 35 percent since the late 1980s.
The mortality report showed the number of deaths attributed to sudden infant death syndrome fell from 136 children under 1 year old in 2008 to 98 last year. SIDS deaths went up sharply in 2008 but Tom Vitaglione with the North Carolina Child Fatality Task Force said there’s still no explanation why.
The mortality rate among infants identified as minorities rose last year.

SIDS: Statistics and Advice

Timothy Bolger
September 21st, 2010
Nassau County health officials released a report Tuesday attributing 10 of 29 infant fatalities in the county since January 2009 to Sudden Infant Death Syndrome (SIDS) and offered recommendations for new parents to prevent similar tragedies.
The independent report was conducted by the Nassau County Child Fatality Review Team (NCCFRT), which was formed in 2008 to investigate otherwise unexpected or unexplained deaths of county residents younger than 17 years old.
“Every death of a child is a tragic event and our goal is to prevent these deaths,” said Nassau County Department of Health Commissioner Dr. Maria Torroella Carney at the agency’s Uniondale headquarters. Behind the podium, a bright orange poster read: Baby Safety Begins With You, referring to parents of newborns. 
Out of the 10 unexplained or unexpected deaths, ages ranged from 9 days to 5 months old. The U.S. Centers for Disease Control and Prevention has called SIDS the third leading cause of death nationally in children less than one year old and is often found to result from unsafe sleeping practices, such as parents sharing beds with babies.
“The safest place for an infant to sleep is alone,” said Julia Weiser-Shlefstein of the Nassau County Department of Health, adding that babies should sleep “on his or her back, in a safety approved crib with nothing else in the crib. No pillows, no blankets, no quilts, no comforters, no sheep skins, no stuffed toys or any other soft objects or loose bedding.”
According to the American Academy of Pediatrics, 20 percent of SIDS deaths occur while the infant isn’t with a parent. 
“Every baby deserves a safe place to sleep,” Weiser-Shlefstein said. “What is important to stress that deaths due to accidental suffocation and strangulation are potentially preventable.” 
Officials offered the following recommendations, which is in brochures the NCCFRT has mailed to parents with newborn babies, pediatricians and daycare centers:
-Always place your baby on his or her back to sleep, for naps and at night.
-Place your baby on a firm sleep surface.
-Keep soft objects, toys, and loose bedding out of your baby’s sleep.
-Do not allow smoking around your baby.
-Keep your baby’s sleep area close to, but separate from where you and other sleep.
-Think about using a clean, dry pacifier when placing the infant down to sleep.
-Do not let your baby overheat during sleep.
-Avoid products that claim to reduce the risk of SIDS.
-Do not use home monitors to reduce the risk of SIDS.
-Reduce the chance that flat spots will develop on your baby’s head.

SBS: Texas: New Results Of Autopsy Spur Plea

LISE OLSENSept. 14, 2009,

The Harris County Medical Examiner’s office has quietly rewritten the results of a 1998 autopsy, prompting renewed innocence claims on behalf of a baby sitter sent to prison nearly a decade ago for allegedly shaking a 4-month-old infant hard enough to cause fatal injuries.

The original autopsy classified the baby’s death as a homicide and was used by prosecutors as a key piece of evidence against Cynthia Cash, now 53, a former nurse convicted of fatal injury to a child after 4-month-old Abbey Clements died after being rushed to the hospital from Cash’s home.
But the modified autopsy report made public in a new appeal calls the cause of death “undetermined” and found no evidence of “trauma” in the postmortem exam. Those changes came five years after local officials announced a review of problematic autopsies conducted by a former Harris County associate medical examiner, Dr. Patricia Moore. Moore, who declined requests for comment, left Harris County in 2002 but still works for Southeast Texas Forensic Center, a Conroe-based company that provides forensic work for six counties.
It is at least the fourth time Harris County officials have reclassified a child’s autopsy that Moore originally labeled as a homicide. Two women have been cleared in other cases — including Brandy Briggs, who was jailed at 19 after rushing her baby to the hospital and who spent several years in a prison isolation cell before being freed in 2005. Dr. Luis Sanchez, head of the medical examiner’s office, did not respond to Chronicle questions about Cash’s case or whether he has finished an audit he promised to conduct after finding problems in the Briggs case.
After learning about the new autopsy results, Cash’s husband contacted Briggs’ attorney, Charles Portz, to file an innocence claim on her behalf. The pending appeal asks for her release or a new hearing — though Cash now has only six months left to serve on her seven-year sentence for felony injury to a child. The case is being considered by Harris County District Court Judge Mark Ellis, who oversaw the original trial a decade ago.
Assistant District Attorney Lynn Hardaway said prosecutors remain confident about their case based on other “evidence presented at trial from doctors who thought she was a victim of shaken baby syndrome.”

Conflicting opinions

Abbey Clements received three vaccinations at a checkup a few hours before Cash, her baby sitter, claimed to have found the baby blue in her crib after a nap. Cash had kept Abbey and her brother along with her own son and five other children.
Abbey died at Texas Children’s Hospital. Doctors there later testified that though she did not have any external injuries, she suffered swelling of the brain and retinal hemorrhages — injuries they described as consistent with so-called shaken baby syndrome.
A neurologist expert for the defense testified at trial that he found none of the broken bones, external bruises or other injuries considered to be classic signs of shaken baby syndrome and the girl likely suffered an extremely rare fatal reaction to vaccines. Dr. Richard M. Hirshberg also reviewed the new autopsy and repeated his argument for Cash’s appeal: “It’s my firm belief now as it was during the Feb., 5, 1999, trial that this defendant is innocent.”
The modified autopsy issued in February 2008 says “a diagnosis of trauma cannot be substantiated,” though no other cause of death was determined. The report also says that doctors who testified in Cash’s trial made some “erroneous” conclusions, wrongly describing bleeding patterns found in the examination of the child’s brain as evidence of trauma.
The revised autopsy, however, also says it could not substantiate claims made by defense experts that the baby likely died from anaphylactic shock — a severe allergic reaction to vaccines. Such rare reactions are well documented in medical literature but generally occur soon after a vaccination is administered.
Paul Clements, Abbey’s father, said he had been briefed on the new results but said “one ME changing an autopsy still doesn’t change what we think happened because of all the other evidence presented at the trial.”
Clements said he also bases his conviction that Cash was guilty on his experience of seeing his daughter “right after it happened and discussing it with the doctors in the hospital. They had never seen a baby shaken as badly as Abbey.”
Cash’s husband, Ken Cash, and her attorney, Portz, both claim that Cash never would have been indicted if the autopsy had been conducted correctly in the first place.
“All I want for her is justice,” said Cash, who sold his house to help pay legal fees and raised their young son on his own after his wife was imprisoned. “They railroaded her in that autopsy report. She is innocent.”
The Harris County District Attorney’s office, however, opposes the appeal.
“The Court of Criminal Appeals held that a claim of actual innocence based upon newly discovered evidence should not be overturned lightly and the burden on the defendant who has had error-free proceedings is exceedingly heavy,” the prosecutor’s answer in the case says, later continuing: “There is considerable evidence in the record to support the … conviction.”


Dr. Patricia Moore, a former associate medical examiner in Harris County, was repeatedly disciplined for failing to follow procedures and for favoring the prosecution in 1998 and 1999, Harris County personnel records show. She left Harris County in 2002 for personal reasons, but her work on children’s autopsies here continues to be challenged:
• New innocence claim: After a baby’s 1998 death was reclassified from homicide to undermined causes last year, family and an attorney for 53-year-old former baby-sitter Cynthia Cash recently filed an appeal claiming innocence and seeking her release.
• Mother freed in 2005: Moore’s original autopsy called 2-month-old Brandon Lemons’ 1999 death a homicide, but it was reclassified years later as “undetermined.” The new report suggested that the baby may have died from lack of oxygen because of a medical error. Lemons’ mother, Brandy Briggs, was subsequently freed.
• Mother cleared in 2004: Prosecutors dropped charges against another woman originally accused of reckless injury to her newborn after Moore’s autopsy was challenged and the baby’s cause of death was changed to undetermined.
• Other cases questioned: Trenda Kemmerer, a woman convicted in 1997 in another child’s death remains in prison, though the child’s autopsy was changed and Moore reprimanded for failing to show objectivity in the case. And Moore herself changed the results of a Montgomery County child’s autopsy in 2007.


SBS: Hospital defends its accusatory stance toward parents when child was brought in.

 Anthony Gottschlich

October 10, 2006
SUGARCREEK TWP., Montgomery County — As she cradled her infant son in the Intensive Care Unit at Children’s Medical Center of Dayton, Amber Shawen sat mystified at the 2-month-old’s sudden death.
Then hospital staff members approached her and her husband, Preston, with the unthinkable.

“They told us it was Shaken Baby Syndrome,” Amber Shawen recalled Monday from her home. “They pried my son out of my arms and told me I was under investigation.”
But Ethan Alan Shawen did not die from Shaken Baby Syndrome on Aug. 20. He died from meningitis, according to the autopsy report released by the Montgomery County Coroner’s Office last week. An unknown organism caused the blood clots and swelling in Ethan’s brain, the report states. No child abuse was found.
The report closes the Kettering Police Department’s investigation of the case (the Shawens lived in Kettering when Ethan died) but brings little solace to the newlywed couple.
“If someone would have caught (the meningitis diagnosis) sooner, Ethan would still be alive,” Amber said.
Thomas Murphy, Children’s vice president for medical affairs, said he couldn’t talk about the Shawen case specifically because of privacy laws. He said that each patient death is reviewed at multiple levels, including after an autopsy, and that the Shawen family could meet with hospital staff members to discuss the case if desired.
The treatable but sometimes fatal meningitis, or swelling of the outer layers of the brain and spinal cord, can be caused by a bacterium or virus. It shares several symptoms with Shaken Baby Syndrome, including vomiting, lethargy and seizures.
The similarities raise questions about parents imprisoned for child abuse based on a Shaken Baby Syndrome diagnosis. Some medical experts and watchdog groups say the babies may be victims of undiagnosed vaccine damage.
If it weren’t for the coroner’s office, Amber said, “My husband would probably be sitting in jail, and so would I.”



"What’s needed is a comprehensive study of shaken baby syndrome to resolve the outstanding areas of disagreement. The National Academy of Sciences, which last year issued a comprehensive report on the scientific underpinnings of forensic science, would be the ideal institution to undertake such a study.

In the meantime, however, there remains the question of justice. In Ontario, an official investigation concluded that there are deep concerns about the science underlying the triad, and now the province is reviewing all convictions based on shaken baby syndrome. Similar inquiries should be conducted on a statewide level here in the United States." (Publisher's note: Ms. Tuerkheimer is referring to the Goudge Inquiry which reviewed many case of the disgraced pathologist Dr. Charles Randal Smith.")

DEBORAH TUERKHEIMER; OP-ED; NEW YORK TIMES; Deborah Tuerkheimer, a professor of law at DePaul University, is a former assistant district attorney in Manhattan."


Background: The inquiry focused largely on the flawed work of Dr. Smith — formerly the province's chief pediatric pathologist and a self-styled member of the prosecution team — whose "errors" led to innocent people being branded as child murderers. The 1,000-page report by Justice Stephen Goudge slammed Dr. Smith, along with Ontario's former chief coroner and his deputy, for their roles in wrongful prosecutions and asked the province to consider compensation. The provincial coroner's office found evidence of errors in 20 of 45 autopsies Dr. Smith did over a 10-year period starting in the early 1990s. Thirteen resulted in criminal charges. William Mullins-Johnson, who was among those cases, spent 12 years in prison for the rape and murder of his four-year-old niece, whose death was later attributed to natural causes. In another case, Dr. Smith concluded a mother had stabbed her seven-year-old girl to death when it turned out to have been a dog mauling. Several of the cases involved the harm caused to innocent persons because of Smith's use of the so-called "shaken-child syndrome" to ground a finding of criminality. The inquiry heard that Dr. Smith's failings included hanging on to crucial evidence, "losing" evidence which showed his opinion was wrong and may have assisted the accused person, misstating evidence, chronic tardiness, and the catastrophic misinterpretation of findings. The cases, along with other heart-rending stories of wrongful prosecutions based in part on Smith's testimony, also raised a host of issues about the pathology system and the reliance of the courts on expert evidence."

SBS: Is Everything We Know About Shaken Baby Syndrome Wrong?

 AmyReiter on September 21st, 2010
For years, mothers couldn’t turn around without hearing about shaken baby syndrome. I remember being compelled to watch a video about it and sign a form saying that I understood the dangers before being allowed to leave the hospital after giving birth to my son.
Recently, though, the diagnosis of shaken baby syndrome has come under sharp scrutiny. As DePaul University law professor Debrah Tuerkheimer writes in an op-ed in Tuesday’s New York Times:
For the past 30 years, doctors have diagnosed the syndrome on the basis of three key symptoms known as the “triad”: retinal hemorrhages, bleeding around the brain and brain swelling. The presence of these three signs (and sometimes just one or two of them) has long been assumed to establish beyond a reasonable doubt that the person who was last taking care of the baby shook him so forcefully as to fatally injure his brain.
But closer scrutiny of the body of research that is said to support the diagnosis of shaken baby syndrome has revealed methodological shortcomings. Scientists are now willing to accept that the symptoms once equated with shaking can be caused in other ways. Indeed, studies of infants’ brains using magnetic resonance imaging have revealed that triad symptoms sometimes exist in infants who have not suffered injuries caused by abuse. Bleeding in the brain can have many causes, including a fall, an infection, an illness like sickle-cell anemia or birth trauma.
Tuerkheimer points out that hundreds of people — mothers, fathers and babysitters among them — are currently serving time in prison because they have been accused of causing shaken baby syndrome based on evidence that, once believed to be convincing, has now become suspect. Noting that Ontario, Canada, has taken on a review of all convictions for shaken baby syndrome, she laments the slowness of the U.S. legal system to revisit its own shaken baby syndrome cases, in which people were convicted, essentially, for murder, and calls on it to show greater skepticism about the diagnosis in the future.
“The triad of symptoms alone cannot prove beyond a reasonable doubt that an infant has been fatally shaken,” Tuerkheimer, who is a former assistant D.A. in Manhattan, asserts, adding that the fact that there may be a delay between the time of an injury and a baby’s death adds even more confusion, given that it was long assumed that the person who was caring for a baby displaying the triad of symptoms at the time it died must necessarily have caused the fatal injury.
Lord knows that no one is in favor of shaking babies (ugh, perish the thought), but if mothers, fathers, sitters and other caretakers have been wrongly imprisoned, some of them for years, based on faulty science, for crimes a review of evidence shows that they did not commit, our legal system needs to figure that out. Otherwise, the terrible tragedy of these babies’ deaths has only been compounded.

SBS: Trial in Newfoundland, Canada

A doctor testifying during a Newfoundland second-degree murder trial said yesterday that the baby boy who died may have been shaken.
Dr. Dorothy Bautista, a pediatric ophthalmologist, was testifying in the trial of Jeffery Isaac Tippett in provincial court in Corner Brook. Tippett was charged in the 2007 death of 11-month-old Tameron Rose of Corner Brook.
Bautista, who examined Rose's eyes at the Janeway Children's Hospital, said that she found retinal hemorrhages in both of the child's eyes.
Bautista also testified that her recommendation was to investigate the possibility the child had been shaken.
She said the severity of the injuries were consistent with a being shaken, especially in the absence of no obvious trauma to the outside of the child's body.
Court has also heard testimony that revealed the child's autopsy showed he had a skull fracture.
She said she had seen similar injuries in a child who had fallen from a third-storey balcony in her past clinical experience.
Under cross-examination, Bautista told defence lawyer Keir O'Flaherty that she later learned Tameron Rose had, in fact, suffered a skull fracture, which was not discovered until his autopsy.
O'Flaherty asked Bautista if she had been aware, at the time of her examination, that Tippett's partner - Tanya Tulk, who was caring for Rose with Tippett on Jan. 30, 2007 - had told police the child had banged his head on a crib earlier in the day. Bautista said she wasn't.

SBS: Trial in British Columbia, Canada

Avtar Rashi Basi testified yesterday that he lied during a police interview two days after Baby E was admitted to Victoria General Hospital with a catastrophic brain injury in November 2008.
Basi is charged with the aggravated assault of the 11-week old baby girl who was living in the foster home run by his girlfriend Micheline Slader.
The 33-year-old, who has taken the stand in his own defence, testified Monday that he shook the baby to try and revive her.
Basi told the court that he began to cry and panicked when Baby E went limp in his arms and stopped breathing. He testified that he lifted her up, called out her name and listened for breaths.
Yesterday, prosecutor Nils Jensen asked Basi about a statement he gave to Central Saanich police Cpl. Dave Hodgson on Nov. 28, 2008. During the interview, Basi told Hodgson he had nothing to hide.
According to the transcript, Hodgson didn't believe him.
"My logic says that in my experience as a police officer, here's a guy who did something that he can't admit to," Hodgson told Basi.
"No. I would admit it in a second, sir. If I did something, I honestly would," Basi replied.
"I think it's eating you up," said Hodgson.
"No," Basi replied.
Jensen asked Basi if he had lied to the police officer.
"Yes," he replied.
Later in the interview, Hodgson told Basi there's only one way the baby was hurt.
"No officer. I've told you guys everything," Basi insisted.
"You're one or the other. You intentionally did it or you accidentally did it," said Hodgson.
Basi continued to deny he had anything to do with the baby's injuries.
The prosecutor also asked Basi why he didn't tell Slader he had shaken the baby when she phoned from the hospital to tell him the doctors believed Baby E had been shaken.
"It was a brief conversation," said Basi. "Listen, I tried everything. I tried saving the kid."
After the phone call, Basi immediately accepted he was the one who caused Baby E's injury, he testified.
"You know you caused the injury because you shook that baby hard," said Jensen.
"I don't recall how hard it was. I was panicky at the time," said Basi, who became teary-eyed.
Jensen insisted Basi shook the baby hard.
"I don't recall how much force was used. I just wanted some sort of noise or cry out of the baby. I don't know how hard I shook her."
"It wasn't a gentle rocking, was it, sir?"
Basi did not reply.
The case for the defence continues today with evidence from Dr. Charles Ferguson, director of the child protection centre at the Children's Hospital in Winnipeg.

SBS: California appeals court

Two-month-old J.M. came to the attention of the Los Angeles County Department of Children and Family Services (Department) because she was found to have a medical condition of chronic subdural hematomas. Her parents L.Z. and O.M. had no explanation as to how the injuries occurred. An expert concluded that birth trauma was a possible explanation for the injuries. Others said it was unlikely. At the time of her injuries, she was under the exclusive care of the parents. J.M's 14-month-old sister, L.C., whose father is J.C., had no evidence of injury.

Child abuse: Indiana

 LIZ SHEPARD September 22, 2010
Port Huron Police Detective Brian Kerrigan held a binder on his forearm, demonstrating the way Scott Syzak showed him he had put oil on his 4-month-old daughter during a bath in 1995.
The detective then violently flipped his arm over, throwing the notebook to the ground, the same way he said Syzak demonstrated he put his daughter down.
The smack of the notebook hitting the ground in District Judge John Monaghan's courtroom seemed to send a tremor through the room, with those watching Syzak's preliminary examination gasping, covering their faces and dabbing away tears.
Kerrigan said that, while Syzak demonstrated how he put his daughter down, he spoke of his frustration with life and difficulties adjusting to life outside of prison at the time of the incident.
Syzak had been charged with abusing a 6-month-old child he was baby-sitting in 1989 in Tuscola County. He was sentenced to 32 to 48 months in prison.
Kerrigan said Syzak also told him during an interview that he did not like to be alone with the 6-month-old.
Syzak, 43, of Hobart, Ind., was bound over to circuit court on a charge of open murder, habitual offender fourth, after about two hours of testimony Tuesday.
In 1995, Syzak and his wife, Candace Syzak, told authorities the baby had fallen while getting a bath from her mother.
Kerrigan said he traveled to Indiana on Aug. 26 to interview Syzak after law-enforcement officials informed Port Huron authorities Syzak had made comments about the death of his daughter.
Kerrigan said Syzak's story of what happened the day his daughter was injured changed. In the first scenario, she had slipped out of his arms. In the later scenario, he had put her down with too much force.
Officials have said Jessica Syzak died of her injuries about a month afterward. The family was living in Port Huron at the time of the child's death.
Richard Anderson, the acting medical examiner in 1995, said he performed an autopsy on the infant.
He said the girl had a large skull fracture and the brain tissue underneath it had disintegrated.
"That is a massive injury," Anderson said, adding his findings were not consistent with a fall of about two feet.
As the doctor detailed the injuries he found on the girl, Syzak looked toward the courtroom windows, his legs constantly moving, making his shackles and the attached chains jingle.
Anderson said that in 1995 he ruled the death might have been caused by a seizure, but that was a direct result of the head injury.
He also found hemorrhaging behind the girl's eyes, a sign of shaken baby syndrome, he said.
Jessica also had nine broken ribs in the process of healing, Anderson said.
"That indicates child abuse," he said.
Anderson said he also believed the scene at the Syzak's home had been staged.
He said Jessica was wearing a blue sleeper, which was very clean.
"That's very unusual for a death scene," Anderson testified.
He said the child also showed signs of rigor mortis, which can take hours to set in after a death.
A circuit court arraignment date has not been scheduled for Syzak.

SBS: California appeal court decision

U.B. was severely injured while in his foster home. Through his guardian ad litem Dorothy Garcia, he sued, among others, the County of Tulare and its departments or divisions, the Health & Human Services Agency and Child Protective/Welfare Services (together the County), as well as its employees Adelita Felix, Marie Hernandez, Sharon Howell and Maria Focha (the County employees) (collectively the County defendants). U.B. sought damages for the alleged negligence of the County defendants in failing to consider that he might be the victim of child abuse after his biological mother reported three times that she saw bruises on him. The trial court granted the County and County employees' motion for summary judgment. U.B. appealed from the resulting judgment. We hold, there being no factual dispute, that as a matter of law, the County and its employees are immune from liability for conduct in deciding whether to intervene in and remove a child from a placement. Accordingly, we affirm the judgment.

SBS: Kansas

Prosecutor Christina Trocheck pushed a button Monday afternoon and a large photograph of an infant lying on a pink blanket appeared on a screen in Saline County District Court.
"There are some facts that are not disputed in this case," said Trocheck, an assistant county attorney, in her closing argument. "One is that N.B. was an infant -- unable to care for herself, protect herself or tell anyone about the events of March 5, 2009."
There is a reason the jury wasn't shown a current photo of the child, who is now more than (?) 10 years old, said attorney Roger Struble, who represents Patrick Armer, the baby's father.
"I would suggest her injuries are resolved and she would appear to be normal," Struble told the four-man, eight-woman jury.
After hours of deliberation, those jurors found Armer guilty of child abuse and intentional aggravated battery causing great bodily harm in connection with injuries the child suffered. His sentencing was set for 9:30 a.m. Nov. 22.
Armer testified in his own defense Monday. He said he didn't tell investigators for several hours that he'd fallen on top of the baby because they were asking how he had shaken the baby.
"They insisted that I shook her and the injuries came from shaking her, and I did not shake her," Armer said.
Armer agreed that he had become angry and frustrated when the baby cried, "indirectly yelling" obscenities at her, kicking her crib on a couple of occasions and once stating that he would "give her something to cry about."
Initially, Armer told authorities he had no idea how the child could have sustained retinal hemorrhages in both eyes, bleeding around the front and back of her brain, and new and partially healing rib fractures.
He said Monday he initially denied knowledge because doctors had said the child's injuries were caused by shaking and he had never shaken the baby.
Police officers testified previously that after Armer was handcuffed to a table and told he was being arrested, he tearfully said he wanted to tell the truth and described the fall.
"They convinced me through eight hours of interrogation that I hurt her," Armer testified Monday. "So, if I did it, it was through a fall and an accidental fall, at that."
Armer said he thought he'd heard the baby cry downstairs and went down to pick her up from her crib. He said he headed quickly back upstairs with the child to continue watching a movie.
On the third or fourth step, he stumbled and fell forward, landing on top of the little girl, he said. He said the child's head struck a metal strip on the lip of a step.
"I'm 210 pounds, and she's 6 pounds and some ounces," he said. "I could have swore I heard a crush."
He said the baby didn't cry and appeared to be "knocked out." He said she was overly warm, so he removed her clothing and laid her on the bed. He described her as pale, having difficulty breathing, and her right eye was rolling to the side and toward the back of her head.
Trocheck asked the jury to thoroughly consider testimony from several medical professionals that a fall of the type Armer described could not account for the child's injuries. She said that despite what he told the jury, the baby's injuries and the fact that she became unresponsive and started having seizures while in his care were evidence that he physically shook her to get her to stop crying.
"Simply because Ms. Trocheck suggests to you that the baby was shaken doesn't mean it happened," Struble argued in his closing. "Just because she says Mr. Armer did it doesn't mean he did."
Trocheck said the evidence from medical professionals who treated the child and research on infants who have been violently shaken by an adult would suggest otherwise.
"Infants don't just develop those conditions unless someone inflicts them," she said.

SBS: Maryland

WORCESTER —  Jury selection began yesterday for the Worcester Superior Court trial of a Gardner woman charged with murder in the death of her 2-year-old daughter.

Michelle L. Lepkowski, 35, formerly of 45 Grant St., Gardner, has pleaded not guilty to charges of murder, assault and battery on a child causing substantial bodily injury and reckless endangerment of a child in the May 18, 2007, death of her daughter, Raelynn T. Mascal.

The child died after being taken from her mother’s apartment to Henry Heywood Hospital in Gardner suffering from injuries to her head, face and torso, according to authorities.

Assistant District Attorney Paula J. Frasso, who is prosecuting the case, said during a pretrial hearing last week that the 2-year-old died as a result of blunt force trauma and shaken baby syndrome.

A total of 16 jurors, including four alternates, will be seated for the trial, which is expected to last about 10 days. Jury selection was scheduled to resume today after nine jurors were chosen yesterday.

Ms. Lepkowski is represented by lawyer Barry P. Wilson. Judge Janet Kenton-Walker is presiding over the trial.

Luke Malizia, 24, of Gardner, Ms. Lepkowski’s boyfriend at the time of her daughter’s death, is awaiting trial on accessory and reckless endangerment of a child charges.

SBS: Wisconsin trial

Cassandra Colson .
A Black River Falls day care provider accused of child abuse made her initial court appearance on Monday and was released on a $5,000 signature bond.

Judge Todd Ziegler, who appeared via telephone, released Tamara J. Millis, 51, on the bond under the condition she not provide any child care or supervision for children other than her own or her relatives. She also is to have no contact with the alleged victim or the victim’s family.

Chippewa County Assistant District Attorney Wade Newell and Millis’ defense attorney John Hyland agreed on the terms and will schedule a pre-trial conference within the next month.

Millis was charged in Jackson County Circuit Court last month with child abuse for the January incident in which she is accused of injuring a 10-month-old boy.

A hospital report indicates the boy’s injuries are consistent with shaken baby syndrome.

Kellie Murphy contacted authorities Jan. 13 after she found her child unresponsive when she picked him up at Millis’ home on 10th Street and took him to Black River Memorial Hospital. The boy reportedly suffered bleeding in the brain and was airlifted to Gundersen Lutheran Medical Center in La Crosse, according to the Black River Falls Police Department.

Millis told investigators the boy had been sitting on a rug when another child ran into him and landed on top, causing the boy to hit his head on the floor, according to the criminal complaint. However, doctors stated the boy’s injuries were not consistent with him striking his head on the floor.

Murphy stated her child appeared unresponsive and his eyes were rolling when she arrived to pick the boy up at about 2:45 p.m., according to the complaint. She stated Millis told her another child fell on the boy, and he “just wasn’t himself” after waking from a nap and recommended he be taken to a hospital.

Millis was neither a licensed day care provider nor a certified child care provider at the time of the incident, according to the Wisconsin Department of Children and Families and the Jackson County Department of Health and Human Services.

Day care providers must be licensed if they care for four or more children younger than 7 and are compensated. Care providers have then option of being certified by the county if they care for three or fewer unrelated children younger than 7.

The county previously did not divulge whether it knew how many children were cared for at the Millis residence.

Millis faces a maximum sentence of 10 years imprisonment and a $25,000 fine if convicted of the felony charge.

SBS: California

police arrested 24-year-old William Aguirre-Fajardo for the death of an 8-month-old baby.
Aguirre-Fajardo had told officers the child had fallen while his 17-year-old girlfriend left them alone. The Lucile Packard Children Hospital, however, told police the baby died of shaken baby syndrome.

SBS: Florida

SEBRING - Police arrested a Sebring man Tuesday on a warrant accusing him of throwing a 3-month-old child onto a bed so hard that it caused the infant to stop breathing.
William Clay Hunter, 31, is charged with cruelty toward a child that causes great bodily harm, a first-degree felony.
He remained in the Highlands County Jail todayunder a $100,000 bond.
The incident reportedly happened on Aug. 8, according to the arrest report. The child was taken to an undisclosed medical center, where it was determined she suffered abusive head trauma, or "shaken baby syndrome."
Sebring Police Sgt. Curtis Hart said Wednesday that the infant is currently stable and out of the hospital.
The arrest report indicated that there was also past evidence of injuries to the child, but Hart couldn't get into the extent of those injuries.
A child protection team physician diagnosed that the child will have long-term mental problems, according to the report.
Hunter denied abusing the infant in his initial statements to authorities.