Sunday, 24 October 2010

SIDS: Pennsylvania statistics

Sudden Infant Death Syndrome, or SIDS, is the cause of nearly 100 infant deaths a year in Pennsylvania. Rep. Lawrence Curry of Montgomery County is trying to reduce that number. Story runs 40 seconds.

SIDS: American Lung Association list of resources

Sudden infant death syndrome (SIDS) describes the sudden, unexplained death of an infant less than a year old. It is also called "crib death," but cribs do not cause SIDS. Nobody yet knows the cause of SIDS, but researchers have identified several risk factors for SIDS. By understanding those things that might increase a baby's risk of SIDS, health experts have several specific pieces of advice for parents and anyone who cares for an infant to follow. Following this specific advice can help prevent SIDS.  Parents, siblings and other family members who are grieving for an infant who has died of SIDS need much emotional support. The American Lung Association can link parents and other family members with several organizations who can give them needed support and resources.

SIDS: Danger of overlay

Nancy Fowler Larson
October 19, 2010 — The value of breast-feeding should be considered before advising mothers not to share their beds with their infants, according to a British study published online October 18 and in the November issue of Pediatrics.
Nearly half of all English infants sleep in a parent's bed at times; one fifth does so regularly during their first year. The practice has been linked to sudden infant death syndrome, and many professionals and organizations, including the American Pediatric Society, advise against it.
However, bed sharing is also known to support breast-feeding.
"Both cross-sectional epidemiological and sleep laboratory studies showed close links between the frequency and duration of breastfeeding and the practice of bed sharing," write Peter Blair, PhD, Community-Based Medicine and Social Medicine, University of Bristol, United Kingdom, and colleagues.
The researchers sought to further the knowledge about bed sharing and breast-feeding through a longitudinal, population-based study using data gathered in 1991 and 1992 for the Avon Longitudinal Study of Parents and Children. To that end, they examined bed-sharing and breast-feeding habits during 5 periods (0 - 2 months, 6 - 8 months, 17 - 20 months, 30 - 33 months, and 42 - 45 months) in 7447 children.
Patterns of bed sharing were broken down into 4 unique groups: parents who never shared their beds with infants (66%), those whose babies slept with them in their beds only in infancy (13%), those who shared their bed with a child only after the first year (15%), and parents who shared their beds consistently for 4 years (6%).
Bed-Sharing Associated With Breast-Feeding
The results showed that mothers who shared a bed with their newborns were better educated and of a higher socioeconomic status, and that those whose children routinely slept in their beds during the first 15 months of life reported a significantly greater incidence of breast-feeding, among other findings:
  • all 3 categories of bed sharing had an important relationship with breast-feeding at 12 months (P < .001), whether the bed sharing occurred late (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.36 - 2.18), early (OR, 2.36; 95% CI, 1.87 - 2.97), or during the entire 4 years (OR, 5.29; 95% CI, 4.05 - 6.91);
  • 29% of the mothers who slept with their infants at 0 to 2 months (251/872 mothers) had university degrees compared with 14% of mothers (888/6464) whose babies slept separately during that period (P < .0001); and
  • the finding for education lessened for those who shared a bed with their 6- to 8-month-old-infants (17% vs 15%; P = .17) and there was a negative relationship with education for those sleeping with their 17- to 20-month-olds (11% vs 16%; P < .0001).
Because bed-sharing mothers of newborns were found to be better educated and more socioeconomically advantaged, their babies are at lower risk for sudden infant death syndrome because they will likely follow other infant safety guidelines, the researchers reasoned. Therefore, more lives could be saved if preventive messages focused on behaviors other than sharing a bed.
"Given the likely beneficial effects of bed sharing on breastfeeding rates and duration, risk reduction messages to prevent sudden infant deaths would be targeted more appropriately to unsafe infant care practices such as sleeping on sofas, bed sharing after the use of alcohol or drugs, or bed sharing by parents who smoke," the authors write.
Limitations to the study include the fact that using 5 time periods reduced the number of infants who could be studied (of the 14,062 mother–infant pairs on whom data was collected, only 53% [7447] provided information for all time points). In addition, most longitudinal studies have a larger dropout rate for socioeconomically disadvantaged participants — a situation that could skew the results toward those of higher socioeconomic status.
Regardless, the bottom line of the study results is a simple one: "Advice on whether bed sharing should be discouraged needs to take into account the important relationship with breastfeeding," the authors write.
The UK Medical Research Council, The Wellcome Trust, and the University of Bristol provided core support for the Avon Longitudinal Study of Parents and Children. The Foundation for the Study of Infant Deaths supported this specific study. The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online October 18, 2010.

SIDS: UK: Stafford

Inquest hears of tragic Christmas Day cot death

AN INQUEST heard how even the desperate attempts of a mother could not have saved the life of an 11-week-old boy.
Oliver William Tabberer, of Burton, was pronounced dead at Burton’s Queen’s Hospital at 8.38am on Christmas Day last year.
An inquest at Cannock Coroner’s Court revealed that, despite his mother Sarah’s desperate attempts to resuscitate him, he would never have survived.
Coroner’s officer Barry Johnson explained to Sarah and her parents the detailed report filed by Staffordshire Police.
He said: “Sarah placed Oliver to bed at around 7pm on Christmas Eve and later gave him a feed around 10.30pm.
“She again awoke to feed him at 3am and discovered that he was hot and he did not take his feed well.
“She got up on Christmas morning and took her older son, Reece, downstairs for breakfast and then returned to get Oliver.
“She found Oliver was not breathing and she described him as looking not real and like PlayDoh.
“She tried to begin CPR but struggled as she was hysterical and called for an ambulance.
“The ambulance crew arrived at 7.45am and they then took up the attempts to save Oliver’s life. The crew transported him to Burton’s Queen’s Hospital where he was declared dead.”
Police confirmed that there were no suspicious circumstances in Oliver’s death.
Pathologist Dr Nikola Ostojic told the inquest that through a process of exclusion the cause of death was sudden infant death syndrome – also known as cot death.
South Staffordshire Coroner Andrew Haigh gave his condolences to Sarah Tabberer and said he hoped the inquest would assist in some sort of closure for her.
He said: “This is a sad death but I would move to reassure you that nothing could have been done to save your son’s life.
“From all the evidence I have heard I rule in line with Dr Ostojic that Oliver’s death was by sudden infant death syndrome, also known as cot death.”

SIDS: Singapore: Open verdict on cot death

Oct 21, 2010

By Elena Chong

THE circumstances surrounding the death of a four-month-old baby girl remains a mystery.

A domestic worker had found the infant lying face down in her cot on the morning of March 5 when she wanted to feed her.
She alerted her employers who called for an ambulance. The baby, who had no pulse and visible injury, died about an hour later in hospital.
At an inquiry into the child's death on Thursday, the court heard that the baby was last fed by her father at around midnight on March 5.
A baby monitor device was placed beside the cot, and the other in the parents' room but they did not hear any sound during the night.
A senior consultant forensic pathologist, who performed the autopsy on the baby girl, was unable to ascertain the cause of death but did not rule out asphyxia or sudden infant death syndrome (Sids), which is one of the leading causes of death for children under the age of one. State Coroner Victor Yeo recorded an open verdict.

SIDS: Australia: Inquest questions, Chapman

   HELEN KEMPTON   |   October 12, 2010 08.08am
THE father of a seven-week-old baby boy who died in 2008 yesterday told an inquest into his death that his estranged wife had described how his son stared into her eyes as she smothered him.
Geoff Chapman, 48, of Burnie, told coroner Olivia McTaggart his wife Katrina had confessed to him that she had smothered their son Lennox Paul Chapman on December 2, 2008.
Mr Chapman told the inquest his wife had told him she had taken the infant to bed and put her hand over his mouth and nose.
"She told me his little eyes kept staring at her, saying, 'What are you doing Mummy'," Mr Chapman said.
"He had the most gorgeous eyes and I knew that she was telling the truth."
The inquest heard Mr Chapman went to the police a few days later.
"I couldn't live with that on my conscience," he told the inquest.
Mr Chapman said he started to question whether his son had died from sudden infant death syndrome after overhearing his mother-in-law telling his wife she needed to stick to her story or face time in jail.
"I was coming in from the front deck when I heard it," he told the inquest in Burnie.
He said his mother had heard the same snippet of conversation as she came into the room with washing.
Mr Chapman told counsel assisting the coroner, Simon Brown, that his wife had given him alternate stories of what had happened on the day their son died.
He told the inquest his wife had phoned him at work on the day of the baby's death.
"She said, 'Lennox is bleeding, he is turning blue and has blood on him'," he told the inquest.
Mr Chapman went home and found his wife kneeling over their son on the tile floor.
"She was sobbing and crying hysterically," he said.
Mr Chapman said he started giving his baby mouth-to-mouth resuscitation.
He told Mr Brown the baby was cold and a "funny grey colour". He said he could not hear him breathing.
Mr Chapman said that when the ambulance arrived at their West Ridgley home, Katrina told him she had taken the baby to bed but he was blue when she awoke.
He told the court that a couple of seconds later Katrina said the baby was in his cot and she had found him "blue" when she checked on him.
Mr Chapman said that his wife later talked of dropping the baby in the bath.
He told the inquest that, at first, he had thought the conflicting stories were the result of deep distress.
"It was horrible for both of us. I tried to reassure her that sometimes little bodies just stop," he said.
"I believed it was SIDS and that she was beating herself up. I was warned by medical professionals that both parents often blamed themselves.
"I still wonder what would have happened if I had stayed home that day and not gone to work. I wonder that every single day."
Mr Chapman told the inquest that some of his estranged wife's friends told him that Katrina Chapman had told them that she was responsible for Lennox's death.
The inquest will continue today.

SIDS: Australia: How to improve the statistics - fix the books

BUREAUCRATS have erased the deaths of 38 children from NSW's shameful reviewable death records by changing the definition of "known to DOCS".
The children all died last year and each of them, or their siblings, had been reported to the Department of Community Services in the three years leading up to their deaths. But their cases will no longer be reviewed by the NSW Ombudsman.
Community Services spokeswoman Linda Burney wrote in government documents released this week that, because the "definition was changed", the deaths of the 38 children "will not be classified as "known to Community Services".
For 33 of the children, DOCS workers had made only phone calls and requests for information before deciding the youngsters were not at risk of harm.
In the other five cases, DOCS said "no information was held which established any need for intervention".
A total of 147 children "known to DOCS" died last year - but, under the new definition, only 109 will be recorded. "They have, overnight and by definition, reduced the number of reportable deaths by a third," Opposition community services spokeswoman Pru Goward said.
"It makes the Government look better, they can say their reforms are working.
"The problem is if they had done an assessment and it has shown the child isn't at risk of harm and then not following up when the child is dead within 12 months of that assessment, they're not making sure their assessments are good enough."
Another 19 children died after Ms Burney said their "cases were closed without response even though it was not known whether intervention might have been required". Six died of illness, six were killed in car accidents, three babies died of sudden infant death syndrome and one young person suicided without receiving any help.
A spokeswoman for Ms Burney confirmed the definition change but said it was based on a recommendation by Justice James Wood in a Special Commission of Inquiry into child protection earlier this year.
"A child's death is no longer reviewed by the Ombudsman simply because they or their sibling was notified to Community Services at some point within the previous three years," she said

SIDS: Nort Carolina, causes of death not pursued

N.C. infants die every three to four days, on average, with little understanding of what killed them, you'd think the response would be a lot more urgent and considerably more dramatic.
A team of Observer reporters and editors this summer found that medical examiners often classify N.C. children's deaths as sudden infant death syndrome despite possible unsafe sleep conditions and other questions surrounding their deaths. That frequent diagnosis was likely masking the real cause: suffocation in pillows and blankets or even under an adult. The widespread use of that diagnosis slowed the education of parents about safe sleep habits. Law enforcement agents say a finding of SIDS prevents them from prosecuting neglect or other crimes.
The Observer series looked at 554 SIDS autopies over five years and found that authorities frequently fail to investigate the deaths thoroughly. Only about 25 babies, or five percent, were apparently sleeping safely, on their backs in their own cribs without dangerous bedding.
The diagnosis matters, because too-frequent SIDS findings make it harder to educate parents about safe sleeping. And that means we're not preventing as many deaths as we might.
The Observer series told the story of Autumn Brown, who died Nov. 20, 2007, at the age of 10 weeks in Alamance County. Her death was ruled SIDS, but her grandfather thinks she may have been smothered accidentally.
Makayla Peek was one month old when she died in Gaston County three years ago. Her death was also declared SIDS despite suspicions of foul play.
It's cases like these a legislative task force now hopes to minimize with changes in the state's response to child deaths.
Among the changes that the N.C. Child Fatality Task Force, chief medical examiner Deborah Radisch and others are examining:
All new law enforcement officers would be required to go through specialized training on child death scene investigations.
The state would hire trained investigators for regional offices, so all death scenes can be investigated properly.
Police would be urged to use a six-page, state-issued checklist at death scenes, which is now optional.
Those are important, and fine as far as they go. But why train only new law enforcement officers, and not all current ones? And task force co-chair Tom Vitaglione and N.C. Health Director Jeffrey Engel say state budget woes may delay the hiring of trained investigators for regional offices, something we obviously need. Also, why not require police officers to use the state-issued checklist, instead of just encouraging them to?
As long as meticulous investigations of child death scenes are optional, questions will loom about how N.C. infants are dying. And without information, parents and authorities can't address the problem.
We understand times are beyond tight for the state budget. We also know that taking basic steps that will help save babies' lives is money well spent.

SIDS: Georgia, playpen death

2010-10-10 Sandra Quinlan
Albany, GA—Family members of a 4-month old infant who died recently alleged the baby’s head became entrapped in the mesh netting of a playpen, causing him/her to suffocate to death. According to a September 22, 2010 WALB News report, Albany’s Child Death Investigation Team has launched a full probe into the tragic incident.

Reports indicated family members found young Travontae Goude unresponsive in a playpen at a home along Leonard Avenue in east Albany. The infant and his/her 14-year-old mother were reportedly visiting family members when the baby apparently suffocated.

According to Investigator Greg Blackmon, “Once I arrived they had actually placed the child on the couch area so they had removed the child from the bed to the couch. Actually the granddad had performed CPR on the child before EMS arrived on the scene.”

The baby’s body was expected to be sent to Atlanta or Macon so an autopsy could be performed.

The U.S. Consumer Product Safety Commission (CPSC) issued a report concerning the dangers of playpens in 2001. According to information provided, the CPSC received more than 200 reports of infant fatalities occurring in playpens from 1988 to 2001.

Nearly half of those deaths occurred in playpens that had “soft bedding or improper or extra mattresses” present. Additionally, many of those babies allegedly “died of suffocation or SIDS.”

The American SIDS Institute defines Sudden Infant Death Syndrome as “the sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history.”

Saturday, 23 October 2010

SBS: Torrey

A Candia woman who allegedly caused a severe brain injury to an 8-month-old boy she was babysitting in June is facing a new charge and possibly a longer prison term if she is convicted, according to indictments.

Elizabeth Torrey, 26, is now facing a charge of first-degree assault and a new charge of second-degree assault in Rockingham County Superior Court, after being indicted by a grand jury for allegedly causing injuries to the baby boy.
Torrey could be sentenced to 10 to 30 years in state prison on each of the charges if she is convicted.
Police first learned of the baby's injuries after Torrey's neighbor called 911 June 9.
The neighbor was outside mowing his lawn when Torrey came running out of her home, calling for help, according to prosecutors.
Investigators and doctors believe the baby likely sustained the injury from "violent shaking", according to a doctor's findings detailed in a police affidavit.
Candia police responded to a 911 call about an unresponsive child, and found the baby boy "unconscious and barely breathing," the police affidavit says.
Torrey was baby-sitting the child at her home at 101 Douglas Drive. She was hired by a local couple to care for the child, police said.
The baby showed no symptoms of injuries when the mother of the baby left her son in Torrey's care on June 9, according to the affidavit by Police Chief Michael McGillen.
Police and rescue crews were called to the home shortly after 4 p.m.
"Torrey's statement to police is that [the baby] was in her sole care and custody for the hour preceding the onset of symptoms," McGillen wrote.
A team of Boston doctors who examined the baby led to police deciding Torrey had to be the one who inflicted the injuries.
Dr. Alice Newton, leader of the child protective team at Boston Children's Hospital, issued a report on June 17, concluding that the injuries came from severe, abusive head trauma, the affidavit said.
The findings by Children's Hospital came after extensive evaluation and testing, McGillen wrote.
Torrey told police that she only left the baby alone after he vomited some formula on her and the couch. She told police that she left the baby on the floor to clean up, according to the affidavit.
Torrey remains free on bail.

SBS: Baumer not guilty after 4 years in prison

Posted: 10/15/2010
MOUNT CLEMENS (WXYZ) - Julie Baumer who spent more than four years in prison for a child-abuse conviction is now free after a jury found her not guilty of injuring her infant nephew by shaking him.
"It's been a long time coming," Baumer told Action News after this morning's verdict.
Baumer was let out on bond last December and granted a new trial when Macomb County Circuit Court Judge James Biernat vacated her conviction.  Her appeals attorneys had argued that she did not get proper representation at her first trial.
In 2005, a jury found Baumer guilty of abusing her nephew, Philip Francis Xavier Baumer, who is alive and has since been adopted. Baumer was sentenced to 10 to 15 years in prison. Baumer was caring for her nephew at the time because her sister was drug addicted. Her nephew was in her care since birth to six weeks, when Baumer took him to the emergency room because he had stopped eating.
In this second trial that concluded this morning with the not-guilty verdict, Baumer’s attorneys Charles Lugosi and Carl Marlinga called on experts from around the country who testified that the baby did not suffer from Shaken-Baby Syndrome, but a stroke that damaged the child.

SBS: Coalson, Tennessee

By Tom Smith

 October 15, 2010
A local man has been indicted for child abuse after he was accused of throwing an infant into a playpen to stop the child from crying.
Franklin County court officials said the indictment against Thomas Reece Coalson II, 27, 1210 Cave Hollow Road, Russellville, was issued during the September grand jury session.
Russellville police said the abuse reportedly occurred in July at the child's residence in Freddy Mills Trailer Park in Russellville.
Reports indicate the 18-month-old boy's head was injured and he had to be hospitalized for some time. Authorities said he is now doing well.
Police said Coalson, who was the boyfriend of the baby's mother at the time of the reported abuse, is accused of throwing and shaking the baby in an effort to get him to stop crying.
Franklin County District Attorney Joey Rushing said the case against Coalson will be set for arraignment Oct. 26 and could be placed on the December trial docket.
Investigators said Coalson is accused of putting one hand over the boy's mouth and the other hand at the back of boy's head, lifting the boy by head and throwing him into the playpen, causing a head injury.
According to research by the National Center on Shaken Baby Syndrome, crying is the number one action leading to incidences of violent shaking.
“(Shaken Baby Syndrome) is a common situation that is seen, particularly if a child is left in the care of someone who is not familiar with keeping a small child,” said Randy Parker, intern director of the Cramer Children's Center in Florence.
According to the Epilepsy Association of Central Florida, half the people who commit an act of Shaken Baby Syndrome are biological parents.
That report notes 17 percent are non-relatives and 17 percent are boyfriends of the child's mother, while 6 percent are stepparents.

SBS: Ferretti second trial

Christine Ferretti Mount Clemens - A jury deliberated for about four hours today without reaching a verdict in the second trial for a woman previously convicted of shaking her infant nephew, leaving him blind and brain-injured.

Julie Baumer, 34, of Harrison Township, was granted a new trial in November 2009 on claims her previous legal counsel was ineffective. Her new attorney, Carl Marlinga, has presented an alternative theory that it was a childhood stroke that caused Philipp Baumer's condition, not abuse. Philipp, now 7, has since been adopted and renamed Ben Zentz. Baumer was convicted of first-degree child abuse in 2005 on claims she violently shook the then-six-week-old boy in October 2003.
The Macomb County Circuit Court jury today asked to review all of the child's medical records, the transcript from his birth video, medical testimony and about 20 photographs of the boy taken just after birth. Judge James M. Biernat dismissed the panel for the day at 5 p.m. Deliberations are set to resume at 9 a.m. Friday.
Assistant Prosecutor Richard Goodman told the jury Philipp was thriving until he was admitted to a hospital in October 2003 and his injuries are not consistent with the childhood stroke condition defense is contending, he said.
Marlinga said the case against Baumer is "highly circumstantial." She had no motive to injure the nephew she planned to adopt and he'd been a sickly child since birth, Marlinga said.
If Baumer is convicted, she will return to prison to finish out the rest of her term.

SBS: Woman who admitted to killing child commits suicide in prison , Amber McIntyre-Roden

October 14, 2010 A West Michigan woman who admitted to killing her baby has committed suicide in prison. Amber McIntyre-Roden was serving an 18 to 50 year sentence.
She died Friday in her cell at Huron Valley Women's Correctional Facility.
In October of 2008 Roden pleaded guilty to second-degree murder in the death of her eight-month-old daughter Tamiah.
Doctors diagnosed the child in July of 2008 with shaken baby syndrome.

SBS: Tuerkheimer debate

October 19, 2010, 5:05 pm
Sometimes a healthy debate takes place at some distance from the point of origin of a Times news story or column. That was the case with “Anatomy of a Misdiagnosis” by Deborah Tuerkheimer, an Op-Ed piece published on Sept. 21.
Tuerkheimer, a DePaul University law professor, discussed changing perspectives on the medical aspects of the syndrome, which is at the center of many criminal cases involving infant death. A National Public Radio health blog, CommonHealth, linked to the Times article and a vigorous debate among commenters ensued, some contending that Tuerkheimer was off-base.
Carey Goldberg, a reporter for the NPR blog and a former Boston bureau chief for The Times, emailed me to say that reporting on this issue is important because, among other things, it can influence how the legal system deals with such cases, as well as how educational efforts can influence parental awareness of the dangers of shaking a baby.
Here are some links to the original story and to comments on it:

SBS: Two Years Leads To Alford Plea

 Darien Laird October 19, 2010

Since April 2009 Hannah's day care provider, Patricia Ann Widerburg, has been accused of involuntary manslaughter of the child. Doctors determined it was Shaken Baby Syndrome in an autopsy after her death.
Widerburg pled guilty with an Alford plea, which means she does not admit to being guilty, but does admit that if the case was presented to a jury, there might be enough evidence to be found guilty.
Emotions ran high for both sides as Widerburg sat in front of the family and friends of Hannah, especially because this means some sort of closure for every party involved.
"I mean obviously we can't bring Hannah back,” said Angela Lloyd, Hannah’s aunt, “but it has made us draw closer as a family and we will always remember her. She will always be in our hearts."
Widerburg said the only reason she is finally submitting to this plea is to give her family and friends their life back, even if it means five months at the South Boise Women’s Correctional Facility and possibly another three to seven years in jail.
“She’s not guilty,” said Corbet Miskin, Widerburg’s neighbor and friend. “She's spent over two years now, well approaching two years now, being run through the ringer. She lost her business. She lost her ability to make money. She lives in a community where everyone looks at her with a question mark."
The Covington family said they are trying to come out of the situation with a desire to help. Hannah’s grandmother, Karla Covington, has plans to start a support group for mothers and women who need someone to call when they feel the desire to shake or harm a child.
"Just in Hannah's death alone, there were five or six of us that had Patricia come to me and said, 'Karla, I need help,' she was a good enough friend of mine that I would have stayed home that day, gone over and taken the grand kids, my daughter would have gone over to help," said Covington, "but there's shame in our society for saying I need help."
According to a study performed in four children centers around the country by Children's Hospital of Pittsburgh, the increase of Shaken Baby Syndrome per month has risen to 9.3 percent per month since December 2007. Experts equate this to the economic crisis.

Thursday, 21 October 2010

SBS: Shaken Baby Syndrome: evolving law and the quest for justice

Oct 12
Children tend to cause more problems than any other area of family law. Few areas change so much, or are as nuanced and complex. I’ve recently read a wealth of legal articles and cases that illustrate the breadth of issues affecting them, but there is one type of case in particular that speaks to my own personal experience.
In many ways the real reason children cases cause so much difficulty is because the professionals involved care so deeply about their welfare. At times we seem to collectively become their guardians, as they cannot protect or speak for themselves. They are wholly innocent in matters of which they have little, if any, comprehension, and they are often terribly vulnerable.
These cases include children born to rich but unmarried and bickering parents, with the financial figures involved for the reasonable support of these children akin to telephone numbers. Children currently permitted under our law to be taken by one parent to another country, and so effectively ending any relationship with the other parent (see my recent post for an example).  And those who become embroiled in dramatic cases of child abduction, or are at the centre of arguments involving legal principles that are more complicated than they could ever understand.
Shaken Baby Syndrome
But there is one type of case that stands out for me. These cases cover the topic of babies who die or are gravely injured after falling victim to the phenomenon called Shaken Baby Syndrome. These are babies who never make it past infancy, or if they do may be disabled for life. They are shaken and sustain a type of whiplash injury, usually when a carer or parent can not cope any longer with a crying child. The three classic injuries (known as the triad) caused by this syndrome are haemorrhages in the eyes, bleeding around the brain and swelling of the skull.
When I was a student, working on a placement at a criminal law firm, I went with one of the partners to visit a female client on remand at Risley Prison in Lancashire. The client explained how she had killed her baby. She had taken the child and on more than one occasion thrown it backwards behind her head and then upwards, with the baby banging its head on the ceiling. According to the autopsy, the baby had first been blinded and then died. When the police came to arrest the mother and her boyfriend, who was jointly charged with murder, they found excrement smeared on the walls of their home.
It was such a hideous case that I have never forgotten its details. The dull woman, the offhand way she described killing her baby, the condition of her home from the photographs I saw, and the shocking images from the baby’s autopsy – whose pain and terror can’t even be imagined.

Guilt beyond reasonable doubt
There was no dispute as to what happened to that baby. But there have been other cases in which a baby has died or been badly injured, and where it has been very difficult to prove exactly what did happen and therefore the guilt of the defendant. Every professional involved in these cases is acutely aware of their duty to the child and wishes to secure a just outcome. The judge is tasked with deciding what to admit as evidence, as well as summing up medical evidence for the jury. In turn members of the jury have to be sure that the English standard of guilt beyond reasonable doubt is met after assessing the medical opinions they hear. One expert may have one view, while another may have a different opinion entirely. Whose evidence should the jury accept in the face of a flat denial from the defendant?
These cases bring forth a whole host of other questions. What should happen in a criminal trial where there is only medical evidence on which to rely? How can a jury be certain beyond reasonable doubt that the person in the dock is guilty or innocent? Making the wrong call will lead to a miscarriage of justice, from which a wrongly convicted defendant may never fully recover.
A report on Sudden Unexpected Deaths in Infancy was published in September 2004 and led by The Royal College of Pathologists and The Royal College of Paediatrics. It was much needed, directly following as it did a raft of cases involving mothers prosecuted for the alleged murder of their infant children. These children had died suddenly, and where incriminating evidence was limited to medical opinion, public opinion was on the whole strongly in favour of their guilt. However the medical evidence soon became hotly disputed. The credentials of experts, both their knowledge in specific areas and their competency, were called into question. Extreme theories had been propagated by some of them and demonstrated to be inaccurate. Statistical evidence was given where the expert involved was not a qualified statistician.  Ultimately, women were convicted of murdering their babies and languished in prison on the strength of this evidence.  As information concerning a number of cases emerged, public opinion swiftly changed.
Sally Clark and establishing medical expertise
I had something to do with putting this situation right, although I stumbled into it. I was involved in the case of Sally Clark, one of the first mothers to be freed by the Court of Appeal. The argument centred on medical evidence given in the trial and the deliberate failure by a medical witness to disclose a microbiology report relating to one of the dead infants. After the trial and the failure of a subsequent appeal, I became voluntarily involved and subsequently managed (using my well known charm!) to persuade the relevant hospital to produce this report. It had been withheld by the medical expert for the prosecution. Crucially, it showed the child had most likely died of a virus. Sally was released from prison, although she never recovered from her ordeal and died shortly afterwards. Other mothers were subsequently acquitted, but their lives were also traumatically affected. It was clear the conduct of medical experts needed to be examined.
The 2004 Report, chaired by Baroness Kennedy, set out a checklist of matters to be established about a medical expert before their evidence is admitted in court. In particular doctors were warned “not to fly their personal kites or push a theory from the far end of the medical spectrum”. Questions to be asked of potential expert witnesses included:
  • Are they still in clinical practise?
  • Are they expert in the specific field on which they are giving evidence?
  • Have they recent clinical experience of the specific type of case?
  • To what extent is the expert’s view widely held?
Establishing that the expert is in clinical practise at the time of his or her report is of great significance. It means theoreticians are unlikely to give medical evidence in cases of this nature.
The correct approach
The report and its recommendations were approved and mentioned along with other matters by Lord Justice Moses in a leading Court of Appeal judgment delivered this year: R v Henderson, Butler and Oyediran (2010) EWCA 1269. The court had to consider two infant deaths, one caused by manslaughter and the other by murder, as well as a case of grievous bodily harm. All three cases involved similar facts and alleged that Shaken Baby Syndrome had been the cause of death or injury. All three were heard one after the other and medical evidence was divided about the causes. Were the defendants telling the truth, or were they lying? All three had been convicted by juries in the lower courts.
The judgement of Lord Justice Moses is complex but gives valuable guidance to other courts in which similar cases are heard. The court accepted an important starting point, one that was originally stated in the Angela Canning case of 2004 (another of the cases from that period mentioned above), that “even where every known cause has been excluded, the cause may still remain unknown”. This is an important principle of jurisprudence because it does not assume, as experts in the past have done, that a dead child is necessarily a murdered child. However, while that might be fine if the defendant is innocent, it may not be if there has indeed been wrong doing. With this in mind, how can a defendant be proved guilty beyond reasonable doubt?
Expert evidence may be the only evidence relied upon to prove that the defendant was lying in their account of how the injuries or death occurred. Lord Justice Moses stated that a conviction could only be safe if the case proceeded on “a logically justifiable basis, for accepting or rejecting the expert evidence”. This is central to what he called “the correct approach.” In each of the three cases, he applied the logic of medical expert evidence to the facts. Defendants who were alleged to have killed their infants had their convictions upheld in both cases. In the third case, where the child had fully recovered by the time of trial, the conviction was quashed. It was said that the recovery “was powerful evidence which told against shaking and in favour of an unknown cause”.
Sometimes new medical evidence comes to light after the trial has taken place. In truth such information is only likely to offer a new opinion, since it is unlikely that medical reports will ever again remain hidden in cases of this type. The Court of Appeal has now made it clear that an appeal in these cases is not a second bite of the cherry or an opportunity to hear from yet more new experts. Only rarely would the court permit repetition, or near repetition, of evidence to the same effect by another expert. The defence should not seek to “put a defence case which should have gone to the original jury”.
Managing the case
The case management of a prosecution and defence in such cases is therefore vitally important. It calls for experienced counsel able to identify both the issues on which the court can concentrate, and the evidence on which it can resolve those issues. It is not the type of case for novices, as far too much hinges upon the outcome.
In the Sally Clark case I have often wondered why the misleading statistical evidence given by one expert was not more robustly challenged. I believe it should have been excluded by the judge and wonder why the medical report I obtained, known all along to have existed, was never more thoroughly ferreted out by all concerned and produced to the court. I’m certain that had it been, a conviction would have been avoided. But hindsight is a wonderful thing. Coming late to the case, I simply asked myself:  “If she wasn’t a killer, what had caused the deaths?” A medical answer seemed to be the only logical answer, and when the missing report came to light my deduction proved to be correct.
As I’ve mentioned above, I don’t think such a report would be withheld nowadays. I also believe that experts in these cases are more likely to err on the side of caution in providing evidence.
The courts cannot always help though. The quality and extent of the evidence will vary. As Lord Justice Moses pointed referenced R v
Harris and Others (2005) EWCA crim 1980
when he said that a triad of injuries “is a strong pointer to non-accidental head injury”. But also went on to say that no appellate jurisprudence could provide authority for a medical proposition.
What it now boils down to is how the case is managed from both sides: what evidence is obtained and how it is presented; how well medical evidence in the case is focussed; and whether the evidence the expert gives makes logical sense to the jury. There are those experts who argue Shaken Baby Syndrome doesn’t exist. There are those who point to the injuries sustained by a baby and say that it can be nothing else. The competency of  experts may also now be  taken into account in order to assess differing opinions, as was outlined in Baroness Kennedy’s report.  But the overall role of the judge in instructing the jury to deal with conflicting evidence cannot be over emphasised. For example, a judge may ask the jury to consider certain questions: Do they believe the expert has gone outside his area of expertise? Can they point to a recognised peer-reviewed source to support their opinion?
Of course even the best summing up from the judge, and a logical argument in relation to the medical evidence, doesn’t guarantee the jury will come back with the right result, but the rights and wrongs of trial by jury are a different set of issues altogether. Nevertheless, in as much as it is humanly possible we now have a powerful legal system, which at all levels strives to obtain justice for those small children who are unable to obtain it for themselves. A system of which we can all  be extremely proud.

Read more: Shaken Baby Syndrome: evolving law and the quest for justice | Marilyn Stowe Family Law and Divorce Blog

SBS: Repeated and missed signs of child abuse|

October 12, 2010

In the September 2010 issue of Pediatrics, Catherine Adamsbaum,M.D., Sophie Grabar, M.D., Ph.D., Nathalie Mejean, M.D. and Caroline Rey-Salmon, M.D. published a retrospective observational study entitled “Violent and Repetitive Shaking is Common in AHT”, Pediatrics, Vo. 126, No. 3. The interesting study examined 112 cases. 29 included confessions by the perpetrator, and 83 did not. In the confessed cases, previous signs of child abuse were found in the medical records of 27% of the children - 93% of whom were under one year of age. The most common sign of abuse was bruising in non-ambulatory infants - found in the records between 1 week to 2 months before infliction of the acute catastrophic abusive head trauma. The authors reported that in none of these cases did the presence of the bruising lead to suspicion of the diagnosis of child abuse. Also, with respect to the act of shaking the infant (as opposed to inflicting previous abuse such as tissue damage which resulted in bruising, etc.), 55% of the confessed perpetrators described repeated episodes of violent shaking. The mean number of shaking episodes for the repeat shakers was 10. 62% of those repeat shakers described immediate periods of exhaustion in which the child would go to sleep after they shook the infant. All of the repeat shakers reported that they shook the babies to stop them from crying.

SBS: Pickett, Decatur, Illinois

DECATUR - Savannah Pickett, the 17-year-old mother of Amarrius Rice, the 5-month old boy who died from blunt force to his head and torso last month, pleaded not guilty to first-degree murder at her preliminary hearing.
During the hearing Wednesday morning in the courtroom of Associate Judge James Coryell, details emerged about the circumstances surrounding the death of the infant.
Pickett, who has been held in the Macon County Jail on $500,000 bond since her arrest Sept. 28, sat at the defense table with public defender Greg Mattingley.
Decatur police detective Brad Allen testified that an aunt of Pickett's had custody of the baby during the last 30 hours of his life.
Amarrius suffered injuries, including a fractured skull, lacerated liver and bleeding along his spinal cord, during the night of Sept. 15 and morning of Sept. 16. He was pronounced dead at Decatur Memorial Hospital at 3:24 a.m. Sept. 18.
The aunt or her boyfriend called 911 on Sept. 18, when they thought something was wrong with the way the baby was breathing.
Allen testified that Pickett said she was alone with the baby when he was injured. She claimed the injuries were accidental.
She claimed the multiple skull fractures resulted from dropping him on the floor. At the time of the incident, Pickett and her son were at a home in the 1300 block of East Condit Street, which she listed as her residence on a court form.
The detective said Pickett initially denied that she had struck the child but later acknowledged she dropped him on the floor, shook him and punched him.
Pickett told police she struck him five to seven times in the stomach in a playful manner, but three of the times she probably struck him too hard, Allen testified.
Under cross-examination, Mattingley asked Allen if officers had asked Pickett if she knew the consequences of shaking a child.
"She indicated she knows you're not supposed to shake a child," Allen said, adding that Pickett said she had previously shaken Amarrius.
According to the autopsy report, the bleeding along the spinal column resulted from the baby being violently shaken.
When the judge asked Pickett, who sat silently through the hearing, whether she understood that she must appear in court in the future, she nodded. Coryell then asked her to reply out loud. In a voice just above a whisper, she said, "Yes."
Pickett, who was assigned an assistant public defender, is scheduled to appear in circuit court for a pretrial hearing Nov. 17.

SBS: Elliott appeal rejected, Iowa

Court of Appeals of Iowa.

Filed October 6, 2010.

Alexis Gilbert was only seven months old when her short life came to a violent end on January 21, 2008. Matthew Elliott was charged with her murder and ultimately convicted of willful injury causing serious injury and child endangerment resulting in death. On appeal, Elliott claims the district court erred in certain evidentiary rulings and in its response to a question from the jury during deliberations. He additionally claims his trial attorneys were ineffective in failing to challenge the marshalling instruction for willful injury causing serious injury under our supreme court's recent holding in State v. Schuler,774 N.W.2d 294 (Iowa 2009). Finding no error prejudicial to Elliot, we affirm his convictions and sentences.
I. Background Facts and Proceedings.
Alexis was born in June 2007, to sixteen-year-old Kristina. They lived with Kristina's mother, Jean, and Jean's eight-year-old son, Benjamin, in a two-story house in West Des Moines. Sometime after Alexis was born, Jean allowed Matthew Elliott move into the house after he escaped from the Fort Des Moines Correctional Facility. Jean instructed the family members to keep quiet about Elliott's presence in the home, as it would violate her housing contract. About a week and one half before Alexis died, Jean's twenty-year-old son, Matthew Gilbert (Gilbert), joined the household.

SBS: Child abuse theory disputed in retrial

Christine Ferretti / The Detroit News

Mount Clemens - In a second trial for a Harrison Township woman previously convicted of violently shaking her infant nephew, defense attorneys presented an alternative theory that it was a childhood stroke that left the boy blind and brain-injured, not abuse.
Julie Baumer, 34, was convicted of first-degree child abuse in 2005 on claims she violently shook six-week-old Philipp Baumer in October 2003. Philipp, now 7, has since been adopted and renamed Ben Zentz.
Baumer served four years of a 10- to 15-year sentence, but was released in December after Macomb County Circuit Court Judge James M. Biernat granted her a new trial.
The November decision followed a series of evidentiary hearings in which her new attorney, former Macomb County prosecutor Carl Marlinga, presented experts who testified that the boy's injuries were consistent with venous sinus thrombosis or a "childhood stroke," rather than shaking.
Today, both sides reiterated their theories for a Macomb County jury during closing arguments in Baumer's second trial.
Assistant Prosecutor Richard Goodman told jurors Philipp had no history of illness and was thriving until he was admitted to a hospital with "severe dehydration" in October 2003.
"He was doing fine and meeting milestones," Goodman said in his closing arguments today.
Goodman argued the medical witnesses defense produced are attempting to "disprove" shaken baby syndrome. But the facts show, he says, the child's injuries weren't consistent with the stroke condition defense is contending.
Goodman said the injuries Philipp had only occur in certain cases; automobile accidents, high falls and abuse. The first two don't apply here, he said.
"Accept only what the facts show you," he said. "That's that the defendant is guilty of child abuse."
But Marlinga argued the prosecutions case is "highly circumstantial" and the timeline for when the abuse allegedly occurred doesn't add up.
Marlinga characterized Baumer as a "loving person," who had no motive to injure her nephew. Philipp had always been a sickly child, Marlinga said, and the boy had no visible injuries when he arrived at the hospital that October.
"Sometimes the evidence is just not there," Marlinga said.
Prosecutors called about 10 witnesses during the trial that's spanned more than two weeks. Among the witnesses were doctors and the child's birth and adoptive mothers. Defense has called six doctors, Baumer and about 10 character and fact witnesses.
Marlinga made a motion today asking the judge to render a directed verdict.
A directed verdict would bypass a jury verdict and instead let the judge decide.
Biernat took the request under advisement. If a guilty verdict is rendered by the jury Biernat can override their decision.
If Baumer is convicted, she will return to prison to finish out the rest of her term.
Closing statements are expected to resume tomorrow.

SBS: rib fractures, Burridge Appeal, England

A BABY boy whose tragic death led to his father being jailed for murder may instead have suffered from abnormally weak bones, a top scientist has told the Court of Appeal.
Rees Burridge was only eight weeks old when he died in September 2006 after suffering a catalogue of injuries, allegedly as a result of his dad, Michael, violently shaking him.
In March 2008, the now 30-year-old Burridge, of Tavistock, was found guilty of murder by a jury at Plymouth Crown Court and sentenced to life behind bars.
But he is now appealing and yesterday judges heard the evidence of the histopathologist whose opinions form the backbone of Burridge's challenge to the guilty verdict. Professor Archie Malcolm, an expert in the microscopic examination of tissues, told the judges that examination of Rees suggested he may have suffered from weakened bones.
At the trial, the prosecution evidence said the newest of the several rib fractures would have required "considerable force", beyond that used in CPR techniques, to inflict.
Prosecutors said that Burridge must have been responsible for that later injury and, by inference, was much more likely to have inflicted earlier fractures to Rees' ribs.But Professor Malcolm believes there may be another explanation for the fractures, which would not rule out the possibility of Rees having suffered a fracture to his fifth rib during attempts to resuscitate him.
"If the fifth rib was normal, I think the risk of it fracturing in CPR would be extremely unlikely," he told appeal judges, Lord Justice Leveson, Mr Justice Irwin and Mr Justice Holroyde.
"But because the rib is abnormal, and I believe is less strong, I feel you have to entertain the possibility that CPR could have fractured through the abnormal rib.
"My opinion is that the bone is not normal, it is weaker than normal. It could be a non-accidental injury, or it could be fairly zealous CPR."
When pressed on the matter by Burridge's counsel, Henry Blaxland QC, the professor said it was "reasonable" to consider that CPR as the cause of the fracture.
Earlier this week, Mr Blaxland described Professor Malcolm's evidence as "absolutely critical" in the case and urged the judges to rule that it renders the conviction "unsafe".
There was no evidence that Burridge caused the earlier rib fractures, leaving only the well-known "triad" of shaken baby syndrome injuries as evidence against him.
Although those injuries – eye damage, brain dysfunction syndrome and blood on the brain – pointed towards non-accidental head injury, they did not confirm it, he said.
But yesterday another expert in the professor's field, Professor Tony Freemont, said he found it very unlikely that CPR had caused the "key" fracture to a bone that, he said, was essentially normal.
Professor Freemont, who gave evidence at the trial, agreed that Professor Malcolm is an "extremely respected" professional with a valid opinion, but said differences of opinion do still occur.
"I do not think the CPR of the type we have heard described would fracture a bone that was practically normal," he told the appeal judges.
Lawyers for the Crown, led by William Boyce QC, are contesting Burridge's attempt to clear his name in the appeal, which is expected to continue until the end of the week.

SBS" Gorecki, Utah,

CEDAR CITY — An infant police say was shaken and critically injured by his father — now a convicted felon — died two weeks ago after several months on life support.
The death occurred just one day after another Cedar City child died from what police believe is another incidence of child abuse.
The 11-month-old child was just a few months old when his grandmother found him not breathing at his father's Cedar City residence. Police were contacted after she took him to Valley View Medical Center on Dec. 18, with severe internal injuries, which medical experts later concluded was consistent with shaken baby syndrome, according to court documents.
Police confirmed the infant was Tayshaun Michael Gorecki.
The boy's father, 25-year-old Andy Gorecki, was arrested for investigation of child abuse in December after police say his story about what happened to the child didn't match injuries. Prosecutors later charged him in the 5th District Court with second-degree felony child abuse, which police say would likely be amended to child abuse homicide.
The Cedar City man pleaded not guilty on Feb. 2 during the arraignment and a jury trial was set for Dec. 9 and 10. As of Oct. 13, new charges had not been filed.
Gorecki, who pleaded guilty to third-degree felony forcible sex abuse in 2006, has remained in the Iron County Jail since his arrest in December.
"Personally, I have a hard time relating to people who can do that," Cedar City Police Sgt. J.R. Robinson said. "This doesn't happen often in Cedar City."
But just last Friday police were forced to handle another child abuse-related homicide.
This time a 24-year-old man was arrested in connection with the death of a 14-month-old child.
Police booked Thomas Harry Canum III into the Iron County Jail for investigation of child abuse homicide. Officers were called to Valley View Medical Center around 6:30 p.m., on Sept. 28, after doctors had started treating the toddler for serious head injuries.
The child was later flown by medical helicopter to Primary Children's Medical Center for emergency surgery but the toddler died during the operation. Police said Canum had been watching the child that night but that his statement was inconsistent with the toddler's injuries. Prosecutors later charged him with first-degree felony child abuse homicide and a preliminary hearing is set for Nov. 3, according to court documents.
In the Tayshaun Gorecki's obituary, family described the child as an "innocent and graceful gift from God, no one can ever replace."
"His presence brought joy and brightness into our lives! We will miss the warmth and peace Tayshaun brought our way. We will forever love and miss you! May you walk with God! Be sweet," it stated.

SBS: Dailey, Denver, Colorado, pleads guilty in 8-week-old son's death

Stephen Dailey, 21, faces up to 38 years in prison for causing his son's death after he pleaded guilty to child abuse resulting in death in a Denver courtroom on Friday.
Investigators say the abuse happened on Sept. 25, 2009, when Matthew was 8 weeks, 2 days old. He was taken off life-support and died six weeks later.
Dailey was initially charged with first-degree murder, but pleaded guilty as part of a plea deal.
"Investigators said he (Matthew) was shaken and violently thrown against furniture and had gone without oxygen for quite some time. Then my husband at the time called 911," said Valerie Cox, Matthew's mother.
Cox got the call while she was at the grocery store on a quick errand. She'd fed her baby and left him at home sleeping 15 minutes earlier.
"They told me Matthew was not OK and I had to get to the hospital. My heart stopped and I took a deep breath. I threw my cart and ran out of the store," she said. "There isn't a moment that goes by that I don't think about him."
She says she never expected this could happen. She says she and her former husband had planned the pregnancy and were thrilled when their son was born.
"I remember Stephen carried him around everywhere saying, 'This is my baby!' " she said.
Crying is the common trigger for shaken- baby syndrome. The stress of not being able to calm a crying baby can cause some caregivers to become aggressive.
Cox believes other pressures also led to her son's abuse.
"(Dailey) said he was really stressed out. He was going to work. He was going to school full time. He just decided he was just too stressed out and he had to get it out," she said.
Cox is working to get the message out to never shake a baby. She is pleading with anyone who will listen
"Babies can't defend themselves. They are fragile. It is never OK to take out a bad day or a bad moment on them," she said.
"If you are a new dad and you need to go out and go for a walk, don't feel guilty, go do it. If you are a mom and you need a break from your baby, don't feel guilty, go do it. In the meantime, you need to be discussing how you are feeling with someone and reaching out for help."
Lynn Kimbrough, spokesperson for the Denver district attorney's office, said, "Any time you have a parent, in this case a father, who is responsible for their child's death, there is no more tragic a case. It is difficult for the families, for investigators and for the community. It is difficult for everyone involved."
Said Cox: "I just really want people to know that babies are fragile. I want people to know that they can't shake babies. It isn't just shaking a baby; it is brutally beating a baby. I want Matthew to be a prime example of why things must change."

SBS: Opposition to Tuerkheimer's views

Comments on this post — The Real Consensus On Shaken Baby Syndrome? — continue to roll in. One of the most eloquent arrived in the form of an email rather than a comment: A letter to The New York Times from Marjory Fisher and Leigh Bishop, Queens prosecutors who handle many “shaken baby” cases. Ms. Bishop told me that after several editing back-and-forths with the Times, an editor told her that it was too late to run the letter.
In it, the prosecutors decry the New York Times op-ed piece in which law professor Deborah Tuerkheimer wrote that “experts are questioning the scientific basis for shaken baby syndrome.”
They accuse her of “a feeble attempt to elevate and equate fringe supposition contrived strictly for use in the courtroom to the level of widely-accepted medical science and research that has been supported by hundreds of studies and millions of hours of clinical experience around the world.”
Here it is:

Response to NY Time Op-Ed

In last week’s New York Times Op-Ed page, Professor Deborah Turkheimer claims that mainstream medicine doubts the existence of Abusive Head Trauma/Shaken Baby Syndrome (AHT/SBS).  As prosecutors of these cases, which are the leading cause of all child abuse deaths in the United States, we are appalled.
What confounds the vast majority of medical and legal experts in the field of AHT/SBS is that Professor Turkheimer, a Yale law graduate and former Assistant District Attorney in Manhattan, has been informed about the credible science in the field of AHT/SBS and the investigative methodology of resulting prosecutions, and yet, still chooses to ignore the overwhelming medical evidence that shaking an infant can and does severely injure and kill babies hundreds of times each year. The American Academy of Pediatrics (AAP) defines the types of forces associated with this devastating form of child assault/homicide: “The act of shaking leading to shaken baby syndrome is so violent that individuals observing it would recognize it as dangerous and likely to kill the child.”  Here in New York City, the Office of Chief Medical Examiner published a study in 2009 that examined 49 child homicides involving AHT and concluded that shaking alone kills babies.
There is widespread consensus that shaking babies is dangerous and often lethal:  mainstream scientists and medical organizations, such as the American Academy of Pediatrics; the National Association of Medical Examiners and the American Academy of Ophthalmology have published positions statements recognizing SBS and each describe their discipline’s role in its diagnosis and response. This year, the Centers for Disease Control and Prevention (CDC) published a SBS prevention guide for health departments and community organizations and recognize SBS as a “public health issue.” The Department of Defense authorized an SBS prevention initiative in 2007 and continues to provide this prevention education throughout the world.  Several states, including New York, Texas and Ohio, have passed legislation that require SBS training for child care providers and/or distribution of SBS prevention materials to parents of new babies.  This year the United States Senate again passed a resolution declaring the third week of April 2010 as “National Shaken Baby Syndrome Awareness Week.”
“The triad of symptoms alone cannot prove beyond a reasonable doubt that an infant has been fatally shaken,” says Professor Deborah Turkheimer of Depaul University in the NY Times Op-Ed piece.  And she is right.  A simple triad of medical findings is never the sole basis for a prosecution in an AHT/SBS case.  To be sure, if certain unexplained medical findings in an infant are detected, including but not limited to subdural hematoma, retinal hemorrhages, brain injury and brain swelling, AHT/SBS will be a part of the initial differential diagnosis and further medical and legal investigation will be initiated.  But the medical diagnosis and subsequent prosecution depend on a combination of the infant’s medical history, the infant’s medical findings and the ability of the doctors to rule out by scientific means other potential causes for the infant’s findings such as leukemia, bleeding disorders or accidental injury. Situations involving these easily identifiable and legitimate disorders are not diagnosed as child abuse and never make it to court…and they don’t need to be addressed by Professor Turkheimer or the Innocence Project.
Also surprising is Professor’s Turkheimer’s claim that the AAP “recommended that the diagnosis of shaken baby syndrome be discarded and replaced with abusive head trauma.” Dr. Robert Block, slated to become President-Elect of the AAP in October, said, “Nothing could be farther from the truth. Sadly, people injure and kill their babies through a variety of mechanisms including shaking and blunt force trauma.  When severe forces are associated with these mechanisms, babies suffer brain injury and can die.” He also notes that a recent paper published by the AAP’s Committee on Child Abuse and Neglect “in no way discards the diagnosis. It simply recognizes that there are multiple ways for an adult to inflict severe injury on a child’s brain.”
“Child abuse diagnoses are taken very seriously and are made after careful consideration of every medical fact and circumstance…these are not rushes to judgment,” said Dr. Carole Jenny, Professor at Brown University Medical School and Chief of the Child Abuse Consultation Team at Hasbro Children’s Hospital in Rhode Island. “The overwhelming combination of medical literature and clinical experience tells us that shaking can and does kill.  Those outspoken few on the fringe in medicine who claim this diagnosis does not exist may have other motivations worth considering.”
Not to mention the number of perpetrator confessions, which often include demonstrations of what was done to the baby.  “In addition to numerous published studies in the medical literature from around the country and from around the world that describe perpetrator admissions, we see confessions to shaking an infant many times each year in Queens County alone.  Perpetrators describe how they held the baby, usually underneath the baby’s arms, and then how the baby’s head flew back and forth repeatedly during the violent shaking. Perpetrators also describe how the baby immediately becomes “sleepy” or unresponsive. Unfortunately, all too often these confessions describe exactly how children are killed, and the medical findings bear it out: violent shaking kills, leaving retinal and subdural hemorrhages to tell the story of the baby’s death.  It is inconceivable to us that Professor Turkheimer fails to credit hundreds of cases where descriptions of shaking are given by the perpetrators, and the babies die with exactly the findings she condemns and dismisses.  These descriptions are consistent with what medical research and clinical experience tells us about traumatic brain injury in infants,” said Marjory Fisher, the Bureau Chief of the Special Victims Bureau at the Queens County District Attorney’s Office in New York City.
These are the words of people who have actually shaken their babies to death.
Last year, a perpetrator in Queens confessed to prosecutors on video: “I knew it was wrong to shake my baby. I watched the shaken baby video in the hospital and I’ve seen the ads on TV.  Assholes shake their babies and today I was that asshole.”
Another perpetrator confessed on video saying, “My baby wouldn’t stop crying…I got frustrated…I held him in front of me and I shook him.  I don’t know how many times, but when I shook him it was hard.  He was limp and wasn’t breathing.”
Yet another perpetrator said, while demonstrating how he had inflicted he fatal injuries on his baby, “My mother-in-law, my mother, my wife and all my immediate family have told me its not good to shake [my baby] because it can give him brain damage…if he’s crying for no reason, I say to him, ‘You have no reason to cry.  Shut the fuck up.  I fed you and I burped you.’  And then I’ll just shake him.”
And then, of course, there are the guilty verdicts.  Decisions that are unanimously reached by jurors, often after months of evidence presentation at trial and hours of thoughtful deliberation. “We have presented our cases to juries time and again.  The investigations have been thoroughly and competently challenged in court and juries just don’t buy the alternative courtroom diagnoses presented by defendants.  Medical findings are not presented in a vacuum. Juries base their decisions on all of the facts and circumstances of each case and consistently reject defense claims that a short fall, a vaccine, meningitis, West Nile virus or CPR caused the injuries,” said Leigh Bishop, Senior Trial Attorney in the Special Victims Bureau in Queens.
Professor Turkheimer, in conjunction with the Innocence Project, an organization known for bringing claims concerning DNA evidence after rape convictions, recently published a law review article in which she attempts to discredit shaken baby syndrome as a medical diagnosis and as a basis for criminal prosecution.  In her paper, she presents alternative theories to Shaken Baby Syndrome/Abusive Head Trauma to support her position that there are rampant miscarriages of justice in this field.
However, her assertions are just that: they are not supported by credible medical research and ultimately result in a feeble attempt to elevate and equate fringe supposition contrived strictly for use in the courtroom to the level of widely-accepted medical science and research that has been supported by hundreds of studies and millions of hours of clinical experience around the world.
“Education is the key to stopping this deadly form of child abuse,” says Marilyn Barr, the Executive Director of the National Center for Shaken Baby Syndrome.  We think it is time for Professor Turkheimer to go back to school.
Marjory Fisher, Bureau Chief
Special Victims Bureau, Queens District Attorney’s Office
Queens, New York
Leigh Bishop
Senior Trial Attorney
Special Victims Bureau, Queens District Attorney’s Office
Queens, New York

Tuesday, 19 October 2010

SIDS: Sudden Infant Death Syndrome (SIDS) Awareness Month

October 2010
October is Sudden Infant Death Syndrome (SIDS) Awareness Month. It is an opportunity to learn how to reduce the risk of SIDS and unintentional injury while an infant is sleeping by promoting Next link will take you to another Web site Safe Sleep.
The Government of Canada is committed to working with its partners to raise awareness of SIDS and to educate Canadians on how to create safe sleep environments. SIDS refers to the sudden death of an infant of less than one year of age, which remains unexplained even after a full investigation. In Canada, many jurisdictions now use the broader term Sudden Unexpected Infant Death (SUID) which includes SIDS and infant deaths from unintentional injury, enabling a better understanding of the risks associated with unsafe infant sleep environments. Examples of unsafe sleep environments include an infant sleeping on a couch or an infant sleeping in a cluttered crib.
Since the launch of Safe Sleep campaigns in Canada, surveys have shown that parental awareness of the need to place infants on their backs to sleep has increased substantially.  Largely due to Back to Sleep initiatives, this practice has contributed to the 50 per cent decrease in the rate of SIDS observed in Canada between 1999 and 2004.
The Public Health Agency of Canada (PHAC) recently released the Next link will take you to another Web site Safe Sleep for Your Baby parent brochure.  This new brochure recommends that parents and child care providers adopt the following four practices to create a safe sleep environment for babies:
  1. Provide a smoke free environment - both before and after birth
  2. Always place your baby on his or her back to sleep - night time and nap time
  3. Place your baby to sleep in a crib next to the adult's bed for the first six months
  4. Provide a safe crib environment that has no toys or loose bedding (use only a fitted sheet)
On September 29, 2010, Health Canada launched a public consultation soliciting the views of Canadians on a proposed prohibition of the future sale, advertisement and importation of the traditional style of drop-side cribs in Canada. Canadians are invited to provide Health Canada with comments on the proposed options for regulatory action regarding cribs, cradles and bassinets.
In addition, Health Canada will undertake a multi-year project on safe infant sleep to raise awareness of SIDS in First Nations and Inuit communities.  This project will build on the success of the national Next link will take you to another Web site Back to Sleep campaign through a culturally-relevant and community-based approach.
I encourage all expectant and new parents, their families and friends, and child care providers to become familiar with the risks associated with Sudden Unexpected Infant Death (SUID) and to learn about how to create safe sleep environments for babies.
For more information about safe sleep environments please visit the Public Health Agency of Canada or read Next link will take you to another Web site A Baby's Safe Sleep Environment brochure.  Additional information on SIDS and creating a safe sleep environment for infants is available through the Next link will take you to another Web site Canadian Foundation for the Study of Infant Deaths.
Leona Aglukkaq
Minister of Health
Government of Canada

SIDS: Prolongation of the QT interval and the sudden infant death syndrome.

August 1998
 New Engl J Med. 1998;338:1760. Schwartz et al performed a remarkable feat by prospectively collecting the electrocardiograms of over thirty-four thousand Italian newborns between 1976 and 1994 and then performing a follow-up at one year. There were 34 deaths, with 24 due to sudden infant death syndrome (SIDS). The authors found a strong association between the prolongation of the heart rate-corrected QT interval and SIDS. The authors propose that a simple screening EKG could provide "early identification of a substantial percentage of infants at risk for SIDS." An accompanying editorial by Towbin and Friedman describes the existence of several chromosomal abnormalities associated with long QT syndromes, but points out that it is yet too early to recommend either genetic or EKG screening as routine tests.

How do these papers relate to the practice of anesthesiology? All of us who care for children are concerned about the possibility of postoperative apnea, bradycardia, and unexpected death. Many of us in practice have heard of cases where an infant had a completely uneventful anesthetic/surgical procedure and appeared well in recovery only to be discovered dead in bed later that day. The vast majority of these cases are never reported in the medical literature because they are the subject of litigation and as such the records are generally sealed. The EKG and genetic findings discussed above, I think, may offer some hope in terms of improving our ability to identify such patients who are at risk and also happen to have an anesthetic/surgical procedure. These tests may also offer the potential for determining the possible cause of such tragedies, so that the anesthesia/surgical team is not held responsible. Who knows? perhaps a rhythm strip collected at the beginning of each case and some blood sequestered in the lab for later genetic testing may be useful, both for counseling families and protecting anesthesiologists. I am not advocating, by any means, that such approaches be integrated into current practice‹our paranoia regarding litigation is already so high that I do not want to add to it. But if further studies confirm these observations, someday it may be common practice to perform such screening prior to discharge from the newborn nursery.


Background. The sudden infant death syndrome (SIDS) is multifactorial in origin, but its causes remain unknown. We previously proposed that prolongation of the QT interval on the electrocardiogram, possibly resulting from a developmental abnormality in cardiac sympathetic innervation, may increase the risk of life-threatening ventricular arrhythmias and contribute to this devastating disorder. We prospectively tested this hypothesis.

Methods. Between 1976 and 1994, we recorded electrocardiograms on the third or fourth day of life in 34,442 newborns and followed them prospectively for one year. The QT interval was analyzed with and without correction for the heart rate.

Results. One-year follow-up data were available for 33,034 of the infants. There were 34 deaths, of which 24 were due to SIDS. The infants who died of SIDS had a longer corrected QT interval (QTc) than did the survivors (mean [±SD], 435±45 vs. 400±20 msec, P<0.01) and the infants who died from causes other than SIDS (393±24 msec, P<0.05). Moreover, 12 of the 24 SIDS victims but none of the other infants had a prolonged QTc (defined as a QTc greater than 440 msec). When the absolute QT interval was determined for similar cardiac-cycle lengths, it was found that 12 of the 24 infants who died of SIDS had a QT value exceeding the 97.5th percentile for the study group as a whole. The odds ratio for SIDS in infants with a prolonged QTc was 41.3 (95 percent confidence interval, 17.3 to 98.4).

Conclusions. Prolongation of the QT interval in the first week of life is strongly associated with SIDS. Neonatal electrocardiographic screening may permit the early identification of a substantial percentage of infants at risk for SIDS, and the institution of preventive measures may therefore be possible. (N Engl J Med. 1998;338:1709-14.)

SIDS: Understanding and preventing SIDS

Mysterious deaths of babies during sleep have been recorded since antiquity. But the term sudden infant death syndrome, or SIDS, wasn't coined until the 1960s, when it was declared a medical disorder. Some facts about SIDS:
What is SIDS?
Often called "crib death," SIDS is the sudden death of an infant under age 1 that remains unexplained after a thorough investigation, including autopsy, examination of the death scene and review of the medical history.ow is it diagnosed?
SIDS is a diagnosis of exclusion. An autopsy is used to rule out other medical causes. Authorities rely on a death scene investigation to provide evidence of causes, such as suffocation, that aren't detectable by autopsy.
What causes SIDS?
Scientists don't know. There have been many theories over the years.
One in the 18th century focused on the possibility that an enlarged thymus gland produced a mass of tissue at the back of the neck that could close off the baby's windpipe. This and other theories, such as allergies to milk and "poor mothering," were discarded over the years.
Since the early 19th century, some experts theorized that infants who died unexpectedly had "faulty constitutions," according to the textbook "Crib Death."
Early researchers also considered the possibility that sleep apnea (short periods of not breathing during sleep) or other abnormalities of breathing control were related to unexpected infant deaths.
In 1972, the journal Pediatrics published an article by Dr. Alfred Steinschneider, who theorized SIDS was caused by apnea and that the syndrome could also be genetic. His study referred to a "Mrs. H" who lost five children to SIDS. His work was discredited in 1995 when a jury convicted Waneta Hoyt — Mrs. H — of killing all five of her children.
Today, many experts espouse the "triple-risk" theory, believing SIDS can result when three factors come together in a sort of perfect storm. The factors are: a critical period in the baby's development, an underlying vulnerability and an outside stressor, such as sleeping face down or becoming entangled in soft bedding.
The critical stage is the first six months of life, when babies' immune, cardiovascular and respiratory systems are developing. Experts disagree on what the vulnerabilities might be. But some ideas are respiratory infections, genetic susceptibility and defects in the brain stem.
The most recent finding, announced in February, suggested that brain stems of SIDS babies contain low levels of the hormone serotonin, which controls vital functions during sleep, such as breathing, heart rate and blood pressure. Researchers from Children's Hospital Boston think this would explain why some infants are at risk.
Infants in certain sleep environments are more likely to re-breathe exhaled carbon dioxide, which can be lethal. Normally, babies in that situation would turn their heads to get fresh air. But babies who die of SIDS don't respond or cannot wake up when they experience breathing difficulty.
Lessening risk
SIDS deaths have been considered unpredictable and unpreventable. But it has become clear over the years that certain factors put infants at higher risk.
They include: stomach- and side-sleeping; maternal smoking or drug use during pregnancy; secondhand smoke; overheating; soft sleeping surfaces; bed-sharing; little or no prenatal care; prematurity or low birth weight; and being male, African-American or Native American.
In 1992, the American Academy of Pediatrics recommended that babies sleep on their backs. After a nationwide "Back to Sleep" campaign launched in 1994, SIDS deaths nationally dropped about 50 percent.
By 2005, the academy for the first time warned parents against bringing infants into their adult beds. That recommendation remains controversial because many parents' groups support bed-sharing, in conjunction with breast-feeding, as a way for parents to bond with and stimulate their babies. Some parents also believe that if they're sleeping with or near their babies, they're more likely to wake up if the babies stop breathing.
After years of looking for other causes and trying to protect parents from unnecessary guilt, researchers have returned to the idea that many deaths previously ruled SIDS could, in fact, have resulted from unintentional suffocation.
Today, many SIDS experts are intent on identifying and reclassifying potentially preventable suffocation deaths so that researchers can focus on finding the medical cause of remaining unexplained infant deaths.
How should you put your baby to bed?

•Place the baby's feet at the foot of the crib.
•Lay the baby on his or her back.
•The blanket should be a thin one that goes no higher than the infant's armpits and be tucked under the mattress, says nurse educator Lisa Vallee of Presbyterian Hemby Children's Hospital in Charlotte, N.C.
Causes of death in infants

The most current data available from U.S. vital statistics reports is from 2004. It shows that the most common causes of death per 100,000 infants born in the U.S. are:
•Congenital malformations, deformations and chromosomal abnormalities (137 per 100,000)
•Disorders related to early birth and low birth weight (112 per 100,000)
•Sudden infant death syndrome (55 per 100,000)
•Newborns affected by mother's complications during pregnancy (42 per 100,000)
•Accidents, unintentional injuries (26 per 100,000)