The evidence base for shaken baby syndrome

BMJ 2004; 328 doi: http://dx.doi.org/10.1136/bmj.328.7451.1316 (Published 27 May 2004)
Cite this as: BMJ 2004;328:1316

Recent rapid responses

Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on bmj.com. Although a selection of rapid responses will be included as edited readers' letters in the weekly print issue of the BMJ, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window.

Displaying 1-10 out of 27 published

Editor:

This response is by many people (listed below the references) from all walks of life that share serious concerns with the current state of the multi-“disciplined” child “protection” agencies in this country and countries abroad. This serious dysfunctional “system” needs immediate redress before many more innocent families are destroyed. We know that we, the signers of this letter, are just the tip of the ice-berg of the seriously concerned.

The recent letter by Reece et al published by the British Medical Journal is more of the same opinion-based literature which has severely impaired the investigation into the numerous alternative causes of symptoms which are too often diagnosed as nonaccidental trauma, shaken baby syndrome, inflicted head injury, etc. And in using SBS as a catch-all diagnosis, they have greatly over-stepped their bounds—resulting in great suffering to many innocent families and society in general.

Donahoe recently reviewed literature and found serious flaws in reports. (1) He pointed out that most of the reports were opinion, small case studies and had poor controls. No where in any literature that he reviewed did he find any report that was acceptable by the criteria for evidence-based medicine. The literature that was not covered by Donahoe, according to Reece and 105 et al, has the same flaws as again cited by Plunkett and Geddes in their response to Reece. (2)

We invite Reece and 105 et al, to explain their claims in light of the few biomechanical studies by Duhaime et al. and Prange et al. that demonstrated shaking doesn't generate enough force for concussion, let alone subdural hemorrhage or traumatic axonal injury. (3,4). Nor could they demonstrate enough force for such brain injury via inflicted impact against a padded surface as thin as 4 inches of unencased foam. (4) Reece and 105 et al. cite the Prange study as a more biofidelic model, but then state it is premature to make conclusions from such. We assert that the premature suffering and conclusions started 30+ years ago from such flawed and opinionated work and we demand nothing less than solid research before continuing to haphazardly dismantle families.

More examples of these flawed non-accidental trauma studies were done in part by Dr. Runyan (a Reece and 105 et al. cosignatory and Helfer Society co-founder), and was an epidemiological study where infants “injuries were considered inflicted if accompanied by a confession or a medical and social service agency determination of abuse.” (5) We assert that this study is flawed from the very get-go as many “confessions” are hardly reliable. Many confessions are false and provided under investigator lies, threats, promises of leniency (if you admit as we know you did it … someone said you did), promises to keep kids in the home if you name your partner, etc. Thus, studies based from confessions cannot be used to generalize. We now have a form of medicine that has been evolving for quite some time and has reached its pinnacle; it is called CBM (confession-based medicine). Of course, conviction and confession are interchangeable in “high quality” CBM. Furthermore, it’s known that as much as 85% of social service claims of abuse are false. (6)

Another example of such “studies” was to determine the incidence of inflicted and non-inflicted TBI before and following natural disasters (i.e. hurricane Floyd). (7) We’d love to know the causal connection between a hurricane and simultaneous increases of both accidental traumatic brain injury and non-accidental child abusive head injury. We’re thankful for the contribution these studies have provided in protecting children and diagnosing abuse?

We suggest the huge amount of governmental funding that supports such studies (http://bmj.bmjjournals.com/cgi/eletters/328/7451/1316#62462) could be more appropriately utilized. That some go to those, who ironically have difficulty obtaining funds, with true interests in scientifically studying the biomechanics, physiology, pathophysiology, pathoneurology, nutrition and health effects on injury/injurability.

In the March 27 issue of BMJ, Geddes and Plunkett called attention to the findings of Donahoe and also of Lantz, who reported in the same issue, a child with eye pathology that had been previously associated only with shaking injury or abusive head trauma, and despite every indication otherwise, some still consider the case presented by Lantz et al as abuse. Lantz, like Donahoe, reviewed the available literature and could find no report which could qualitatively and appropriately support the claim that retinal hemorrhages, perimacular folds and retinoschisis cavities were pathognomic for abusive injury. (8)

Geddes, Plunkett, Lantz and Donahoe are right to point out the problems with the literature and also to point out new findings which conflict with abusive head injury. Don’t we all deserve the truth? It would be negligence if they hadn’t. Thus, the combination of flawed literature and extensive refuting literature shows that the child protection “experts” court testimony and claims have gone far beyond their limits and have done society a great disservice.

Numerous studies have demonstrated short falls can be fatal and result in SDH and/or RH. (9,10,11,12,13,14,15,16,17,18,19,20,21) Plunkett documented many such instances in his report. Certainly short falls are the cause of many deaths involving the elderly who have more space between their brain and skull due to atrophy. It is also documented that infants have increased space. Some have more than others as evidenced by hydrocephalus, craniocerebral disproportion and benign extra-axial spaces and have been shown to suffer SDH and/or RH with minimal or no trauma. (20,22,23) Yet, and despite this data, the child protection “experts” still cite studies that claim hydrocephalus is a result of shaking. (24,25) Or would have us believe a child, which had a chronic SDH, that had a minor fall out of a hospital bed, and required acute surgical evacuation of a large acute SDH actually supports re-inflicted intentional abuse/injury/trauma. (25) Chalk it all up to just another misquote/misunderstanding.

There are numerous examples of literature cites and expert testimony that it requires massive forces of a multi-story fall, high speed car crash or equivocal forces from violent shaking and/or impact to cause a SDH and brain injury. (26,27,28,29,30,31,32,33) Then, out of the other side of their mouth (double standard), Reece and 105 et al. state “that 30%-40% of newly diagnosed shaken baby cases had medical evidence of previously undiagnosed head injury. These infants had such mild or non- specific symptoms and signs that their trauma was previously not diagnosed. The diagnosis was ultimately made when the children had subsequent severe episodes of abuse, with computer tomographic evidence of both acute and older subdural haematoma and brain injuries..” We find some serious discrepancies here. How could the initial SDH, which requires such massive intentional and inflicted forces to occur, as testified and seen in the literature … go undetected? Could any normal person, “lay” or otherwise not be able to see abnormal behavior or injuries that result from such massive/violent forces?

What about the fact that chronic SDH’s can rebleed with minimal or no trauma? (25,34,35,36,37) In light of this fact, Reece and 105 et al. have seriously misrepresented the facts when they state the old SDH was subsequently discovered after “severe” episodes of abuse (the cited data shows it does not require any trauma let alone severe). The discrepancies are further highlighted by the fact that infants and children which are asymptomatic (appear/act normal) with a Glascow coma score of 13 – 15 following MILD trauma can have abnormal brain imaging scans which show edema, subdural or epidural hemorrhages, which may ominously progress. (38,39,40,41,42)

Consider the very likelihood if we have a normal acting asymptomatic child (as shown above), that really has a bleeding or swelling brain (i.e. chronic SDH or hydrocephalus), and since infants with chronic subdural hemorrhages or hydrocephalus can rebleed or bleed with minimal or no trauma (20,22,23,25,34,35,36,37,38,39,40,41,42), we basically could have a ticking time bomb. A time bomb that falls unresponsive with little or no trauma, with little or no explanations or as a result of cumulative “minor” trauma/rebleeds. In which a care taker may have mildly shaken, slapped … to revive the infant, may fear they did something wrong, and then are subsequently convinced they did by the authoritative assumptive child protection “experts”, then confess under extreme duress (via aforementioned scenarios), are left helpless, confused and with significant collateral time bomb damage in the form of charges, convictions and familial dismantling. Don’t forget that up to 9% of normal births have SDH and some of these may not be clinically apparent until 6 weeks of life. (43,44) What if that SDH episodically rebleeds spontaneously or from minor trauma/child-play, disease or vaccine reaction, hypertension … brain irritation until collapse occurs. Reece and 105 et al. would not like anyone to consider this as they continue to collude with and co-train with social service workers, investigators, prosecutors … on the most efficient way to obtain a conviction while rebutting any plausible alternative explanation, in their national SBS conferences. (dontshake.com)

Visiting the National Center for Shaken Baby Syndrome brings one to citing of a manuscript written by Reece himself. It cites the short-fall study by Helfer. (45) Other commonly cited studies eluding that short falls are not fatal are by Williams and Chadwick et al. (32,33) These studies are greatly flawed. The authors forget to tell us, and more importantly the courts, that the data is severely impaired. There is no discussion of the biomechanics of the falls, the behaviors prior, during and following the falls, the part of the body impacted, differences among impacted surfaces, did something brake the fall, was it a free fall, was it translational or rotational ...? Maybe they feel that biomechanics is irrelevant. Yet, despite this they conclude and correlate (as pre- determined?) that it is extremely rare to have serious injury following "trivial" falls. The Chadwick study had a fatality of several stories that was found outside a multi-story window, but no one knew how the infant got there. These types of studies lack any external validity (ability to generalize to the population) whatsoever, let alone citation in a court of law.

These studies point out another child protection “expert” double standard in that the short fall studies by Helfer and Chadwick (a co- signator to the Reece letter), for example, state that care-takers description of events are biased and that is why Helfer et al. claim their “studies” are “less” biased than parental descriptions. Chadwick, himself, states that his data is absurd in that it shows short falls are more likely to be fatal than long falls. The double standard is clear as they claim the care-takers descriptions of falls…are biased and unreliable, but then accept whole heartedly their descriptive “confessions” as scientifically reliable. Of course, the “confessions” conformed to the hypothesis -- their belief is “confirmed” -- just what they needed. We invite Reece and 105 et al. to please explain these inconsistencies.

Let’s not forget another “article” written in 1994 by Chadwick concluding that “given the availability of prompt and appropriate medical care, falls contribute minimally to deaths in childhood. Death from a fall is now considered very unlikely when the fall is less than 20 feet, and accumulating experience may soon extend that.” (46) We ask, does this also apply to the aforementioned infants with chronic subdural bleeds, hydrocephalus, or the ones with potential asymptomatic bleeds/swelling following minor trauma, vaccine reactions or natural diseases? If this statement applies to the ones with chronic subdural bleeds and now have an acute bleed, have these children now fallen 20 feet, twice? What about the ones that end up fatal; did the physicians not give prompt and appropriate care as discussed by Chadwick? Did the parents not rush their infant that fell 20 feet to a hospital or call an ambulance? Again, we invite Reece and 105 et al. to please explain these huge discrepancies.

Then there are the testified, televised and written statements the injury occurred the instant of unconsciousness…that there is no lucid interval. We declare that this is another bunch of biased opinion as the literature is replete with examples of lucid intervals. (9,13,38,39,40,41,42,47,48,49) Additionally, if only CT scans are utilized, the timing is not reliable as Dr. Patrick Barnes gives an example where court testimony stated that the “inflicted” SDH injury on CT scan happened the instant the child became seriously ill or was “abused,” but MRI demonstrated the bleeding was actually three days old. (49) We invite Reece and 105 et al to explain this discrepancy of actual imaging limitation evidence and court testimony. It is quite evident the testimony went well beyond the scientific limits.

Retinal hemorrhages have never been proven to be a result of acceleration/deceleration forces. Just a time-related association. Recall that the SBS supporting literature is greatly flawed and opinion, as well, inclusion criteria is often based on “confessions,” so how can any correlation between SDH and association of RH be made? Conversely, retinal hemorrhages have been reported in many other conditions besides supposed acceleration/deceleration injury. (3,8,20,44,50,51,52,53,54,55,56,57,58,88,89)

Recently, Adams et al. report a case of retinal hemorrhage occuring, either spontaneously or from the very mild pressure exerted on the eye from a retcam examination. (95) The hemorrhages were widespread and of various shapes (dot, blot, flame) indicated bleeding in different depths or layers of the retina. They state that this report illustrates how fragile the infant retinal vasculature is. This fragility completely contradicts the statements and court testimony by Reece et al. and SBS proponents that massive forces are required.

Other than the numerous conditions previously mentioned, the differential diagnosis for the signs/symptoms of so called SBS/SIS, non- accidental trauma or inflicted head injury is long, and thus, the SBS triad is far from a unique single all-encompassing diagnosis as the child protection “experts” would have us believe. (59 thru 89) We ask Reece and 105 et al. why as recent as 2001, the American Academy of Pediatrics Committee on Child Abuse states that “cerebral edema with subarachnoid hemorrhage may be the only finding”, (90) and how this correlates with the totality of findings and the “triad” espoused by Harding, Risdon and Krous. (91) Krous is a co-signator to the Reece letter and a member of the committee.

We ask why neck or cervical cord trauma is not a main component of the “triad” as found by Geddes and as Ommaya et al. state that such trauma would occur before any brain injury. (92,93,94) It is only common sense that such neck injury would accompany the violent shaking, child protection physicians claim and demonstrate in court and on computer models, that is “pathognomonic” of SDH or RH or edema -- singular or combined. Geddes found a predominance of hypoxic axonal injury. Doesn’t shear injury require, for the most part, two opposite forces pointing towards or away from each other to tear such axons (basic physics/mechanics)? So, to sustain global brain injury, wouldn’t these opposing forces need to occur in hundreds or thousands of different planes (axons in the brain travel different directions)? We invite Reece and 105 et al. to please explain the biomechanics behind their claims of shear injury, from violent shaking, causing diffuse axonal injury in comparison to Geddes findings. How does this occur during acceleration/deceleration or impact? Is the head shaken side-to-side, up-and-down, forward-and- backward and any combination of these? If they cannot explain such, then Geddes work stands as the most reliable research on the brain injury of these infants/children.

We suggest that instead of attacking those who choose to search for answers, Reece et al review their own literature and try to find the scientific basis of such. Opinion does not make it true. We propose that CBM is far from meeting the criteria for beyond a reasonable doubt or medical certainty. And the innocents devastated from CBM should be allowed due recourse.

We, the signers of this letter, are banded together by one belief. We believe that true investigation need occur before any person can be accused and convicted of shaken baby syndrome.

We applaud Geddes, Plunkett, Donahoe, Lantz and others for bucking the norm and reporting findings and concerns about this hypothesis. The very fact that these concerns exist warrants further investigation and thought.

1) Donohoe M. Evidence-Based Medicine and Shaken Baby Syndrome. American Journal of Forensic Medicine and Pathology 2003; 24: 239-42.

2) Plunkett J, Geddes J F. The evidence base for shaken baby syndrome: Authors’ reply BMJ, May 2004; 328: 1317.

3) Duhaime A. et al., The Shaken baby syndrome. A clinical, pathological, and biomechanical study. J Neurosurg 1987; 66:409-415.

4) Prange M. et al. Anthropomorphic simulations of falls, shakes, and inflicted impacts in infants. Journal of Neurosurgery 2003 99: 143-150.

5) Keenan HT, Runyan DK, Marshall SW, Nocera MA, Merten D, Sinal S. A population-Based Study of Inflicted Traumatic Brain Injury in Young Children. JAMA, August 6 2003, Vol. 190 #5:621-26.

6) http://www.redflagsweekly.com/conferences/shaken_baby/aug27_Fishman.html

7) Keenan HT, Marshall SW, Nocera MA, Runyan DK. Increased incidence of inflicted traumatic brain injury in children after a natural disaster. Am J Prev Med. 2004 Apr;26(3):189-93.

8) Lantz PE, Sinal SH, Stanton CA, Weaver RG Jr. Perimacular retinal folds from childhood head trauma. BMJ. 2004; 328:754-6.

9) Plunkett J. Fatal pediatric head injuries caused by short-distance falls. Am J Forensic Med Pathol 2001;22:1-12.

10) Aoki N, Masuzawa H. Infantile acute subdural hematoma. Clinical analysis of 26 cases. J Neurosurgery 1984;61:273-80.

11) Hall JR, Reyes HM, Horvat M. The mortality of childhood falls. J Trauma 1989;29:1273.

12) Berney J, Froidevaux AC, Favier J. Pediatric head trauma: influence of age and sex. II. Biomechanical and anatomo-clinical correlations. Childs Nerv Syst 1994;10:517-23.

13) Greenes DS, Schutzman SA. Occult intracranial injury in infants. Ann Emerg Med 1998;32:680-6.

14) Di Rocco C, Velardi F. Epidemiology and etiology of craniocerebral trauma in the first two years of life, in Eds Head Injuries in teh Newborn and Infant. New York: Springer-Verlag, 1986;125-39.

15) Canestri G, Monzali GL. Cranial injuries in childhood. Clinico- statistical data on patients hospitalized in a 5-year period. Minerva Pediatr 1970;22:1687-9.

16) Wissow, LS, Wilson, MH. The use of consumer injury registry data to evaluate physical abuse. Child Abuse and Neglect. 1988;12:25-31.

17) Shane SA, Fuchs SM. Skull fractures in infants and predictors of associated intracranial injury. Pediatr Emerg Care. 1997 Jun;13(3):198- 203.

18) Browne GJ, Lam LT. Isolated extradural hematoma in children presenting to an emergency department in Australia. Pediatr Emerg Care. 2002 Apr;18(2):86-90.

19) Goldsmith W, Plunkett J, A Biomechanical Analysis of the Causes of Traumatic Brain Injury in Infants and Children. The American Journal of Forensic Medicine and Pathology. June 2004,Vol. 25 No. 2:89-100

20) Piatt JH. A Pitfall in the Diagnosis of Child Abuse: External Hydrocephalus, Subdural Hematoma, and Retinal Hemorrhages. Neurosurg Focus 1999:7(4).

21) Denton S, Mileusnic D. Delayed Sudden Death in an Infant Following an Accidental Fall. American Journal of Forensic Medicine and Pathology December 2003: Vol. 24 No. 4:371-6.

22) Pittman T. Significance of a Subdural Hematoma in a Child with External Hydrocephalus. Pediatr Neurosurg 2003;39:57-59.

23) Ravin S, Maytal J. External Hydrocephalus: A Cause for Subdural Hematoma in Infancy. Pediatr Neurol 2003;28:139-141.

24) Ludwig S, Warman M, Shaken Baby Syndrome: A Review of 20 Cases. Annals of Emergency Medicine Feb. 1984; 104-7.

25) Hymel K, Jenny C, Block R., Intracranial Hemorrhage and Rebleeding in Suspected Victims of Abusive Head Trauma: Addressing the Forensic Controversies. Child Maltreament, Vol. 7, No. 4, November 2002: 329-48.

26) People v Martinez, 51 P3d 1046 ( 2001) (R'hrg den. 2002) (cert. granted, 2002).

27) The Queen v Stuart Lee Supreme Court of the Australian Capital Territory 2002 WL 14350

28) People v. Marsh San Diego Superior Court Case No. CR 64376.

29) People v. Phinney, Superior Court of San Diego County, No. CRN 10112.

30) Robert H. Kirschner, The Pathology of Child Abuse, in THE BATTERED CHILD 248, 275 (Mary Edna Helfer et al. eds., 5th ed. 1997).

31) Chadwick, D.L. Child Abuse. Chapter in Pediatrics. Rudolph, A. Appleton-Lange, New York, 1986

32) Williams, R.A. Injuries in infants and small children resulting from witnessed and corroborated falls. J Trauma 1991;13:1350-52.

33) Chadwick DL, Chin S, Salerno CS, et al. Deaths from falls in children: How far is fatal? - J Trauma 1991;13:1353-55.

34) Uscinski R Shaken Baby Syndrome: fundamental questions. British Journal of Neurosurgery 2002; 16(3): 217-219.

35)Parent A.D. Pediatric chronic subdural hematoma: a retrospective comparative analysis. Pediatric Neurosurgery 1992; 18:266-71.

36)Sherwood D. Chronic subdural hematoma in infants. Am J Dis Child 1930; 39:980.

37)Swift, Dale M. Chronic Subdural Hematomas in Children. Journal of Chronic Subdural Hematomas 2000; July 11(3).

38) Simon B, Letourneau P, Vitorino E, McCall J. Pediatric minor head trauma:indications for computed tomographic scanning revisited. J Trauma. 2001 Aug;51(2):231-7; discussion 237-8.

39) Mandera M, Wencel T, Bazowski P, Krauze J. How should we manage children after mild head injury? Childs Nerv Syst. 2000 Mar;16(3):156-60.

40) Stein SC, Young GS, Talucci RC, Greenbaum BH, Ross SE. Delayed brain injury after head trauma: significance of coagulopathy. Neurosurgery. 1992 Feb;30(2):16.

41) Ros SP, Cetta. Are skull radiographs useful in the evaluation of asymptomatic infants following minor head injury? Pediatr Emerg Care. 1992 Dec;8(6):328-30.

42) Hahn YS, McLone DG. Risk factors in the outcome of children with minor head injury. Pediatr Neurosurg. 1993 May-Jun;19(3):135-42.

43) Whitby E. et al. Frequency and natural history of subdural haemorrhages in babies and relation to obstetric factors. Lancet 2004 363: 846-51.

44) Neonatology—Perinatal Medicine Diseases of the Fetus and Infant 5th Edition 1992. Edited by Fanaroff A., Martin R. Mosby-year book.

45) Helfer RE, Slovis RL, and Black M, Injuries resulting when small children fall out of bed. Pediatrics 1977 60: 533-535.

46) Chadwick DL. Falls and Childhood Deaths: Sorting Real Falls From Inflicted Injuries. The APSAC Advisor 1994 Vol, 7 No, 4:24-25.

47) Dacey R.G, Alves W, Rimel R, Winn R, and Jane J. Neurosurgical complications after apparently minor head injury. Neurosurgery 1986; 65:203-10.

48) Nahelsky M, and Dix J. The time interval between lethal infant shaking and onset of symptoms: A review of the Shaken Baby Syndrome Literature. The American Journal of Forensic Medicine and Pathology 1995; 16(2):154-157.

49) Barnes Patrick D. Ethical Issues in Imaging Nonaccidental Injury: Child Abuse Topics in Magnetic Resonance Imaging 2002. 13(2): 85-94.

50) Tongue Andrea. The Opthalmologists Role in Diagnosing Child Abuse. Ophthalmology 1991; 98(7): 1009-10.

51) Rosenberg N with discussants Singer J, Bolte R, Cristian C, and Selbst S.M. Retinal Hemorrhage. Pediatric Emergency Care 1994; 10(5) 303- 5.

52) Kaur B, & Taylor D. Current Topic: Retinal Hemorrhages. Arch. Dis. Child 1990; 65:1369-72.

53) Gutman, F. Evaluation of a Patient with Central Vein Occlusion. American Academy of Ophthalmology 1983; 90(5) 481-3.

54) Levin S, Janive J, Mintz M, et al. Diagnostic and prognostic value of retinal hemorrhages in the neonate. Obstetrics and Gynecology 1980;55:309-314.

55) Kwok Ak, So AK, Lam SW, Ng JS, Fok TF, Lam DS. Can Vitreous Haemorrhage Indicate Non-accidental Injury if Mild Retinopathy of Prematurity is Present? Eye. 2000;14:812-813.

56) Termote JU, Schalij-Delfos NE, Wittebol-Post D, Brouwers HA, Hoogervorst BR, Cats BP. Surfactant replacement therapy: a new risk factor in developing retinopathy of Prematurity? Eur J Pediatr. 1994 Feb;153(2):113-6.

57) Liao PM, Thompson JT. Opthalmic Manifestations of Virus- Associated Hemophagocytic Syndrome. Arch Opthalmol. 1991;109:777.

58) Shults WT, Swan KC. High Altitude Retinopathy in Mountain Climbers. Arch Ophthalmology;93:404-408.

59) Innis MD Proposed Name Change of Shaken Baby Syndrome. 17 Apr 2004 http://bmj.com/cgi/eletters/328/7442/766#56915

60) Scheibner V. Patterns of presentation of the "shaken baby" syndrome may not be caused by trauma at all. April 2004. http://bmj.bmjjournals.com/cgi/eletters/328/7442/766#55368

61) Kalokerinos A. Every Second Child. Thomas Nelson (Australia) Ltd 1974.

62) Clemetson, C.A.B. Barlow's disease. Medical Hypotheses 2002;59:52 -56.

63) Gunkel JH, Banks PL. Surfactant therapy and intracranial hemorrhage: review of the literature and results of new analyses. Pediatrics 1993;92:775-786.

64) Baric I, Zschocke J, Christensen E, Duran M, Goodman SI, Leanard JV et al. Diagnosis and management of glutaric aciduria type I. Journal of Inherited Metabolic Disease 1998 21(4), 326-40.

65) Nassogne MC, Sharrard M, Hertz-Pannier L, Armengaud D, Touati G, Delonlay-Debeney P, Zerah M, Brunelle F, Saudubray JM. Massive subdural haematomas in Menkes disease mimicking shaken baby syndrome. Childs Nerv Syst. 2002 Dec;18(12):729-31.

66) Chaou WT, Chou ML, Eitzman DV. Intracranial hemorrhage and vitamin K deficiency in early infancy. J Pediatr. 1984 Dec;105(6):880-4.

67) Suzuki K, Fukushima T, Meguro K, Aoki T, Kamezaki T, Saitoh H, Enomoto T, Nose T. Intracranial hemorrhage in an infant owing to vitamin K deficiency despite prophylaxis. Childs Nerv Syst. 1999 Jul;15(6-7):292-4.

68) de Tezanos PM, Fernandez J Perez Bianco PR. Update of 156 episodes of central nervous system bleeding in hemophiliacs. Haemostasis 1992 22(5). 259-267.

69) Furui T, Yamada A, Iwata K. Subdural Hematoma as a complication of hemostatic deficiency secondary to liver cirrhosis—a report of two cases. Neurolgia Medico-Chirurgica (Tokyo), 29(7):588-91.

70) Kolluri VR, Reddy DR, Reddy PK, Naidu MR, Kumari C. thrombocytopenia purpura: Case report. Neurosurgery 1986 19(4):635-36.

71) Nicholls J, Chan LC, Koo YM, Kwong YL, Tsoi NS. Subdural haematoma and factor XII deficiency in a Chinese infant. Injury 1993 24(3):202-203.

72) Salooja N, Martin P, Khair K, Liesner R, Hann I. Severe factor V deficiency and neonatal intracranial haemorrhage: A case report. Haemophilia 2000 6(1):44-46.

73) Levin M, Kay JDS, Gould JD, Hjelm M, Pincott JR, Dinwiddie R, Matthew DJ, Haemorrhagic shock and encephalopathy: A new syndrome with a high mortality in young children. The Lancet July 9, 1983: 64-67.

74) Carvalho KS, Bodensteiner JB, Connolly PJ, Garg BP. Cerebral venous thrombosis in children. J Child Neurol. 2001 Aug;16(8):574-80.

75) Barron TF, Gusnard DA, Zimmerman RA, Clancy RR. Cerebral venous thrombosis in neonates and children. Pediatr Neurol. 1992 mar-Apr;8(2):112 -6.

76) Liao PM, Thompson JT. Opthalmic Manifestations of Virus- Associated Hemophagocytic Syndrome. Arch Opthalmol. 1991;109:777

77) Rooms L, Fitzgerald N, McClain KL. Hemophagocytic lymphohistiocytosis masquerading as child abuse: presentation of three cases and review of central nervous system findings in hemophagocytic lymphohistiocytosis. Pediatrics 2003;111:e636-40.

78) Hallahan AR, Carpenter Pa, O’Gorman–Hughes DW, Vowels MR, Marshall GM. Haemophagocytic lymphohistiocytosis in children J. Paediatr Child Health 1999; 35: 55-9.

79) Fitzgerald NE, McClain KL. Imaging characteristics of hemophagocytic lymphohistiocytosis. Pediatr Radiol 2003(33):392-401.

80) Reik L Jr. ‘Hypothesis’ Disseminated Vasculomyelinopathy: An Immune Complex Disease. Annals of Neurology 1980 Vol 7, No 4:291-96.

81) Amir J, Katz K, Grunebaum M, Yosipovich Z, Wielunsky E, Reisner SH. Fractures in Premature Infants. Journal of Pediatric Orthopedics 1988 Vol 8, No. 1: 41-44.

82) Baker AB, Noran HH. Changes in the central nervous system associated with encephalitis complicating pneumonia. Archives Internal Medicine. 1945;76:146-153.

83) Ogilvy CS, Chapman PH McGrail K. Suburban empyema complicating bacterial meningitis in a child: Enhancement of membranes with gadolinium on magnetic resonance imaging in a patient without enhancement on computed tomography. Surgical Neurology 1992 37(2);138-41.

84) Syrogiannopoulos GA, Nelson JD, McCracken GH Jr. Suburban collections of fluid in acute bacterial meningitis: A review of 136 cases. The Pediatric Infectious Disease Journal 1986 5(3):343-52.

85) Oikawa A, Aoki N, Sakai T. Ateriovenous malformations presenting as acute subdural hematoma. Neurological Research 1993 15(5):353-55.

86) O’Leary PM, Sweeny PJ. Ruptured intracerebral aneurysm resulting in a subdural hematoma. Annals of Emergency Medicine 1986 15(8):944-46.

87) Koc RK, Pasaoglu A, Kurtsoy A, Oktem IS, Kavuncu I. Acute spontaneous subdural hematoma of arterial origin: A report of five cases. Surgical Neurology 1997 Vol 47 No 1:9-11.

88) Fenton S. Massive retinal Hemorrhages in a 6-month-old infants. Arch Opthalmology 1999 Vol. 117:1432-1434.

89) Eldow JA, Caplan LR. Avoiding Pitfalls in the diagnosis of Subarachnoid Hemorrhage. Primary Care Vol. 342 No. 1:29-36.

90) American Academy of Pediatrics Committee on Child Abuse and Neglect: Shaken Baby Syndrome: Rotational Cranial Injuries—Technical Report. Pediatrics 2001 Vol. 108 No. 1:206-10.

91) Harding B, Risdon RA, Krous HF. Shaken baby syndrome. BMJ 2004 328: 720-721.

92) Geddes JF, Hackshaw AK, Vowles GH, Nickols CD, Whitwell HL. Neuropathology of inflicted head injury in children. I. Patterns of brain damage. Brain 2001;124: 1290-8.

93) Geddes JF, Vowles GH, Hackshaw AK, Nickols CD, Scott IS, Whitwell HL. Neuropathology of inflicted head injury in children. II. Microscopic brain injury in infants. Brain 2001;124: 1299-306

94) Ommaya AK, Goldsmith W, Thibault L. Biomechanics and neurophathology of adult and paediatric head injury. British Journal of Neurosurgery 2002 16(3):220-42.

95) Adams GGW, Clark BJ, Fang S, Hill M. Retinal Hemorrhages in an infant following RetCam screening for retinopathy of prematurity. Eye 2004 18; 652-53.

CO-SIGNATORS:

Heather J. Lohr, Huntingdon, PA USA (Falsely accused)

Robert E. Lohr, Huntingdon, PA USA (Falsely accused)

Susan Kreider, RN, CPC susan.kreider@uphs.upenn.edu Philadelphia, PA, , USA (hepatitis B vax-injured adult, friend of the falsely-accused)

Debbie Grater Pottstown, Pa USA (Falsely accused)

Ken Grater Pottstown, Pa USA (Spouse of falsely accused)

VRAN - Vaccination Risk Awareness Network Inc. (Canada). A not-for- profit educational society with members across Canada, which informs the public about vaccine risks. (Some members have children who have suffered vaccine reactions, injuries and death.)

Richard J. Thomas, DC, Life Chiropractic Center, USA

Robert "Bob" Flint, director, Great Falls Professional Services, ( VacLib Chapter of Maine ), Lewiston, Maine, USA www.greatfallspro.net

John Brooks, Mesa, AZ, USA (Concerned grandparent)

Joan Mootry, Spokane, WA, USA

Ingri Cassel, Spirit Lake, Idaho, USA (director of Vaccination Liberation - www.vaclib.org)

Don Harkins, Spirit Lake, Idaho, USA (editor and publisher of The Idaho Observer - www.idaho-observer.com)

Lisa Jillani, president, PAVE Charlotte, NC, USA www.vaccineeducation.com

Jason Behrens, Orlando, Florida 32817, USA, (Falsely Accused)

Onnie Kahlenberg, eggallery@mfire.com

Thomas Grazier Jr. Huntingdon, PA USA

Karen Grazier, Huntingdon, PA USA, Registered Nurse

Karen Mayne Salt Lake City, Utah, USA (parent of falsely accused)

William Mayne Salt Lake City, Utah, USA (parent of falsely accused)

Jean M. Bernstein

Arnold Wadle, Colorado Springs, CO, USA

Tara Benton, Sacramento, CA, USA (Falsely accused of SBS)

Bob Benton, Sacramento, CA, USA (Falsely accused of SBS)

Karen Lyke

Martin Hewitt, London, N22 7FX (parent of an autistic child)

Gary Krasner, Director, Coalition For Informed Choice, Hollis, NY, USA

Lois Herlihy, Pembrooke Pines, FL, USA (mother of wrongfully convicted son)

Wendy Callahan Hawthorne, FL, USA vaccinetruth.org

Christine Anderson

Tracy Anderson, Burnie, TAS 7320, Australia, (family of falsely accused)

Holly Bender, Thorndale, PA, U.S.A. (family of falsely accused)

Shawn Bender, Thorndale, PA, U.S.A., (falsely accused)

Brenda Warter, San Diego, CA, USA

Melissa Archibald, West Jordan, Utah, USA (none)

Doug Archibald, West Jordan, Utah, USA (none)

Carolyn Burke, Hillsboro, Missouri, USA

Christy A. Shutz, Boise, Idaho, USA (Mother of wrongfully convicted son)

Chris Huffman, Harrisonburg VA, USA

Shannon Huffman, Harrisonburg VA, USA

Angela Grazier, Huntingdon, PA, USA

Hiram Reynolds, Huntingdon, PA, USA

Belinda Moran, Apopka FL, USA

Kevin Moran, Apopka FL, USA

Ryan Moran, Apopka FL, USA

Kieran Moran, Apopka FL, USA

Rudy Torres, San Diego, TX, USA

Mary Broderick, Chicago, IL, USA (Falsely accused of SBS)

Tom Broderick, Chicago, IL, USA (Falsely accused of SBS)

Thomas Grazier III, Huntingdon, PA, USA

Christina Grazier, Huntingdon, PA, USA

Pat Kelly, Chicago, IL, USA

Lisa Blakemore-Brown Psychologist UK

Christopher Grazier, Charlotte, NC, USA

Kim Grazier, Charlotte, NC, USA

Competing interests: We are the accused, friends of the accused and people who are just plain fed up with the all too easy dismantling and imprisonment of families, without exhaustive investigation of the infant’s/child’s condition and family background/character, by an all too powerful “system.”

Competing interests: None declared

L. Travis Haws, Dentist

Co-signators listed below references

Lakewood CO 80228

Click to like:

Editor,

“If there is any greater crime or sin that we as members of the Human Race and citizens of this great country can commit beyond that of harming a child, it is to wrongfully accuse and/or persecute an innocent parent that has already suffered the loss or harm of one of their offspring" Lee E Woodard, Sr.--Human rights USA @ MSN Groups

Yet this is exactly what is happening, not only in the USA, but in Britain and Australia. False allegations against already devastated parents is the shameful action of a Justice System ignorant of, and unwilling to properly investigate, unfamiliar disorders of childhood which are then labelled “Shaken Baby Syndrome” or “Munchausen Syndrome By Proxy.”

Constant reminders from the more senior members of the Royal Colleges that younger members are difficult to recruit into the Child Protection Service illustrate a change may be occurring. No longer are the myths and fabrications of SBS and MSBP accepted as Gospel Truth because the Professors say so. Unfortunately the change is too late and too slow for some and several are still awaiting a review of their fate – which incidentally is mainly in the hands of those that originally charged them.

There is evidence that some Paediatricians have mistaken the cutaneous lesions of Atypical Kawasaki disease for “cigarette burns.” [1]

The Rachitic Rosary of Vitamin D deficiency is frequently mistaken for malicious blows or even kicks to the front of the infant’s chest by some Radiologists.

Rib fractures, which can be shown to be due the absence of an essential amino acid, have been attributed to Non-accidental Injury by Radiologists, Paediatricians and Pathologists alike.(Innis MD Unpublished)

The cerebral hypoxia which follows an Apparent Life Threatening Event, frequently brought on by a Seizure, is ignored by those who condemn an innocent parent when Cerebral and Retinal haemorrhages form part of the infant’s problems.

It is time to dispense with the flawed and fabricated diagnoses of Shaken Baby Syndrome and Munchausen Syndrome By Proxy and adopt a more rational approach to the investigation of children.

Results of Haematological and Biochemical investigations should be interpreted by the appropriate specialist – misinterpretation by a generalist is not uncommon in my experience.

Judges and Juries must be made aware that the myth of the Shaken Baby Syndrome had its origins in unsubstantiated claims made before a more enlightened approach to the investigation of Bleeding, Nutritional and Congenital Disorders was demanded.

The Attorney General, Lord Goldsmith … stated “ if there are alternative explanations, we need to know. If the Expert only owns up to possible alternatives under cross examination, he risks showing himself as careless, inexpert or worse – a charlatan” London November 27th 2004 [2].

Perhaps those “non-specific feelings” that paediatricians are advised to ponder[3] should be the first casualties in restoring some semblance of scientific rigor into the Judicial Systems of England, Australia and the USA.

Let us have some action …before mothers run out of tears.

Michael D Innis MBBS; DTM&H; FRCPA; FRCPath

Reference: 1.Innis MD Conference on SBS and MSBP held in Sydney Australia 2004

2.Blakemore-Brown L. MSBP - A PSEUDO-SCIENTIFIC TRAP. A Paper presented at Portcullis House on 2nd December 2004 as part of Conference Proceedings entitled `ABUSE ALLEGATIONS –SYSTEMIC FAILURE’ and organised by the All Party Group for Abuse Investigations (APGAI)

3.FABRICATED OR INDUCED ILLNESS BY CARERS Report of the Working Party of the Royal College of Paediatrics and Child Health November 2001

Competing interests: As previously declared

Competing interests: None declared

Michael Innis, Director Medisets International

Home 4575 email micinnis@ozemail.com.au

Click to like:

24 September 2004

The final paragraph with the conclusion of Professor Reece's letter contains sentiments most of which few might disagree with, but one sentence leaves me puzzled: "Unfortunately, there remains considerable difficulty for some doctors to accept that children are abused."

It would be helpful if the source of this statement were identified and what study or survey had led to it?

It's a claim I find hard to credit, that anyone, a doctor even, refuses to believe some children are abused, or has difficulty accepting this.

There is a debate about the extent of child abuse and whether sometimes experts are correct in their opinions as to whether abuse has taken place in a particular case, and whether their opinions are based on secure research, but surely not a debate as to whether any children are abused at all?

Competing interests: I am currently working on a television documentary reporting a pending appeal application against conviction for murder of an infant.

Competing interests: None declared

Brian Morgan, Freelance Journalist

Cardiff CF11 6LF

Click to like:

As a mother who went through the agony of temporarily loosing custody of my infant son, and nearly loosing custody of him forever, because it was wrongly claimed, he had been shaken, I understand how other similarly charged parents’ feel and suffer. I am therefore morally obliged to do whatever is possible to prevent this happening to other parents and carers unnecessarily.

In Australia, health workers, and others, are legally compelled to notify authorities, such as The Department of Youth and Community Services and the police, when there is evidence or suspicion of abuse – and this includes what has become known as ‘shaking’.

Unfortunately, few individuals understand the complexity of the issues involved. Often, from the beginning, a decision is made that the ‘cause’ of the problem is ‘shaking’, and there is no need to proceed through what should be the routine of what is known as a ‘differential diagnosis’. This involves a consideration of all possible causes, the collection of evidence and the performance of an array of special medical investigations.

Unfortunately this procedure is rarely followed. Worse still, as recent cases demonstrate, prosecuting witnesses sometimes deliberately withhold information, invent information, become extremely careless, break many of the rules relating to the collection and interpretation of evidence – and escape relatively unharmed when one compares their fate with the sufferings of those falsely, or wrongly, accused and charged.

In medical journals throughout the world the vastness of information that is pertinent to the pathologies found in so-called ‘shaken babies’ is impressive. This should be collected, carefully considered, and made ‘compulsory reading’ for all those involved in the investigation of cases. I have no doubt that, if this is done, justice will be served, and we will emerge from one of the darkest pages in the history of medicine into a better understanding of the nature of infant illnesses.

To begin, I suggest that the following investigations be considered:

Case history - including family history, pregnancy, labour, birth, and continue to the time of collapse, recovery or death.

The number of medical consultations, including those with nurses and specialists.

Reasons for these consultations.

Feeding, and gastrointestinal problems, including diarrhea

Antibiotics administered and reasons for why

All medications administered, Reasons why. Were there side effects or potential side effects? Were parents properly counselled about this?

All medications administered and reasons why. Was counselling about side effects provided to the parents?

Vaccine history including batch numbers in case some were known to be ‘hot’ batches. That is known to have produced excessive side effects.

Eardrums. Inspect on admission, and daily. If an infant dies both middle ears should be inspected during the autopsy and swabs taken to enable tests for bacteria and viruses. At the same time, if excessive fluid is present some should be collected and tested for endotoxin levels

Perform and record electroencephalogram, electrocardiogram, CT scan, MRI, brain ultrasound, Ophthalmic investigations, including retina, Retcam (retinal photographs), head circumference (repeat daily”, pupil size, record and repeat as necessary.

Neurological observations.

Skeletal survey – if possible.

Endotoxin levels in blood, and, if prudent, in the CSF.

Look for 'toxic' strains of gut bacteria. These produce excessive amounts of endotoxin. If an autopsy is performed light and electron microscope studied may reveal the presence of toxic strains and the damage done to the gut.

Look for abnormal gut viruses

Genetic testing of patient, parents, and siblings.

When ‘fractures’ exist, light and electron microscope studies of bones, including epiphyseal and fracture areas. This is recommended because, sometimes, fractures can be due to bone disorders related to the effects of endotoxin and an increased utilization of Vitamin C.

Extensive coagulation/bleeding profiles, including (despite some difficulties) platelet functions, capillary fragility, and bleeding time.

Blood levels of Vitamin C and histamine

Von Willebrand factor

Factor x111

Vitamin K levels.

D-dimer levels – to the end-point.

Liver and kidney functions

Bruise should be carefully examined, during life and autopsies – despite known difficulties. This includes (during autopsies, cutting into the areas, and light and electron microscope examinations.

Glutaric acid levels.

Some of these tests are expensive and laboratories will need to establish the necessary facilities. The alternative is to jail some innocent individuals for long periods and destroy their families.

If the doctors involved in the investigation of cases do not agree to do these tests, and satisfactory reasons for such actions are not produced, charges of negligence should be set in motion.

Parents claiming to be innocent should be entitled to know why these tests are not being done. During the 2001 International Conference on the Shaken Baby Syndrome, in Sydney, I asked Dr Ryan, who often gave evidence as an expert for the prosecution, why extensive tests were not done and he answered, in a packed lecture theatre, ‘Its too expensive’. My response was, ‘Then why are the parents and family not offered the opportunity to have these tests performed at their own costs?’ There was no answer.

Clearly, if parents and carers are innocent, and doctors and authorities claim that the cause of the pathologies is ‘shaking’, the only option available is to demand that tests be done. Furthermore, if tests are not done quickly, at the time of admission, as time goes by the presence of some causes may be absent or masked.

Despite the fact that retinal haemorrhages alone are not necessarily diagnostic of ‘shaking’, experts have been allowed to offer the opposite opinion without demonstrating that all other possible causes have been eliminated. This is medical and legal lunacy. The claim that certain ‘types’ of retinal haemorrhages are diagnostic is also a falsehood.

A PERSONAL NIGHTMARE

I was 5 months pregnant with my son, Codey, when our daughter developed diabetes.

At the 6 months stage I was found to have borderline gestational diabetes, and iron deficiency.

Codey’s birth-date, after an induction, was on February 28, 2000. He was artificially fed, and then quickly developed gut problems. His paediatrician found it necessary to change the formula 3 times in the first 2 months.

Progress was not normal. May 5, 2000, developed cold/flu

May 8, 2000, vaccinations – DPT, Polio, and HIB

Mid May 2000, Nasal congestion, trouble breathing – chest checked.

Early June 2000, Bronchiolitis and productive cough.

Mid June 2000, Bronchiolitis, fever, productive cough.

Antibiotics administered

June 21, 2000, Back to GP, a level of distress, concern about cry –query pneumonia, inflamed eardrums.

June 21, 2000, attends paediatrician. No improvement on antibiotics. Chest X-ray, otitis media. For check with GP in 6 days.

Deteriorates, extremely high temperature, crying, and severe coughing.

June 26,2000, Grand mal seizure. Admitted to hospital.

1st admission High temperature on arrival of ambulance.

Blood taken for tests on day of admission. These showed a leucocytosis, reactive thrombocytosis, high platelet count, high white cell count, and high glucose level. Intravenous drip. Antibiotics administered intravenously. Panadol and painstop administered frequently, alternatively.

Discharged June 30, 2000 – on augmentum for 8 days. Panadol and painstop continued.

Between June 30 and July 11, continues to have fevers, crying, back arching, little improvement. Antibiotics, panadol and painstop continued.

June 11, 2000, taken to GP. Given the ‘4 month’ DPT/polio and HIB, DPT/polio and HIB boosters

High temperature followed, arched back, crying. Panadol and painstop prescribed by paediatrician.

July 12, second admission. Another seizure. Hospital records show ‘Post vaccination febrile convulsion’.

Managed with pulmonary resuscitation, and high flow oxygen. Likely cause for seizure was said to be fever - post vaccination.

At this point Codey was not weighed. An overdose of antibiotics was administered intravenously. Next morning the consulting physician stopped this medication.

24 hours after admission Codey was diagnosed as a ‘shaken baby’.

Immediately, all tests were stopped. The authorities were called in, and we began a roller coaster ride that threatened to destroy our family.

Codey was removed to unknown foster care. – A day we will never forget!

August 4, similar presentation to that of July 12. Foster carer could not be located. Codey was hungry, and no formulae was available. Codey had a rash on his back, was unsettled, crying, and had loose, green and offensive stools.. A list of what was not done is as follows:

No blood tests

No liver tests

No ECG

No EEG

No MRI No CT scan

No brain ultrasound

No eye examination

No measurement of head circumference

No neurological monitoring

No pupil scale record

No skeletal survey

No intensive coagulation/bleeding studies.

13 months of court battles followed. Legal fees were $150,000. The effort involved was huge. It was as if we spent 25 hours a day and 8 days every week researching the literature so that we would at least understand what was going on in Codey’s little body. What we found was certainly not pretty. It was, in reality, a nightmare of unbelievable proportions.

The cause of what happpened? It was not something that we had done. It was not something that that was unknown. It was ‘the system’ that indoctrinated doctors, and others, in a way that closed all the doors to understanding and fed poison into the minds of those who were supposed, because of their special skills and training, to know better.

We know that Codey was never shaken.

We know that statements like, ‘Codey was a previously well baby’, were ludicrous to the extreme.

We know that only standard coagulation/bleeding profiles were done at admission, and never repeated.

We have reasons to believe that medical negligence contributed to the pathologies.

We know that the diagnosing paediatrician (who provided the evidence that was relied on for the diagnosis of ‘shaking’) later admitted that he should have carried out extensive coagulation tests, inclusive of testing for Factor X111 abnormalities.

The Department of Youth and Community blamed the hospital for errors. The hospital blamed that department.

Codey is now home and reunited with our family unit. He is safe, well, and has never been vaccinated again or prescribed antibiotics.

Our family believes in, and praises, the immunization schedule. However, we also believe that, for some children, immunizations can cause a number of side effects, (as stated in the TGA records), specifically when combined with other toxins and illnesses.

We also know that, today, as I write, sadly, there are innocent Australian families currently caught in the system and while in the system (ie, the Children’s Court) no-one can, and will, assist or intervene – even though those charged are innocent. The cry of HELP falls on deaf ears. There is no support, nowhere to turn! Hundreds of thousands of tax payer’s dollars, could be saved if SBS diagnosing physicians took greater care. I know. I have been there!

A few weeks ago in England, news-papers headlined, ‘Scotland Yard changes tact over suspicious baby deaths’ (Sandra Laville, Wednesday July 14, 2004, The Guardian). I was delighted to read this, and learn that UK authorities are progressing towards the reversal of unlawful convictions for what was stated to be the ultimate crime – shaking a baby to death.

Wrongly accused mother's like Angela Canning’s, Sally Clark and Trupti Patel, have, at last, through the efforts of a handful of dedicated individuals, been freed, physically and mentally, from terrible accusations.

The English authorities have stated, in response to criticism, that they now intend to ‘get it absolutely right, and that these investigations are something which need expertise and particular skills’. I quite agree!

I believe that it is possible to shake a baby to death. I also know that, often, there are causes for the pathologies that have nothing to do with inflicted trauma.

BOTTOM LINE

We NEED a DIAGNOSTIC PROTOCOL - WE NEED to get it RIGHT!

If authorities do not agree with what I have stated, particularly because there is a huge amount of supporting literature, they could be, and should be, regarded as being negligent. If they refuse to perform adequate tests, not pay adequate attention to case histories, and simply farm out the problem to individuals or organizations that are not properly qualified to handle the issues, they should be compelled to provide reasons for such actions – or face legal actions. They should not be allowed to wash their hands and walk away.

References:

1. Greenwald MJ, Weiss A, Oesterle CS, Friendly DS Traumatic retinoschisis in battered babies. Ophthalmology 93(5):618-625, May 1986

2. Vanderlinden RG, Chisholm LD Vitreous hemorrhages and sudden increased intracranial pressure. J Neurosurg. 1974 Aug;41(2):167-76

3. Tomasi LG, Rosman NP Purtscher retinopathy in the battered child syndrome Am J Dis Child. 1975 Nov;129(11):1335-7

4. Pollack JS, Tychsen L Prevalence of retinal hemorrhages in infants after extracorporeal membrane oxygenation. Am J Ophthalmol. 1996 Mar;121(3):297-303

5. Goetting MG, Sowa B Retinal hemorrhage after cardiopulmonary resuscitation in children: an etiologic reevaluation. Pediatrics 85(4):585 -588, April 1990

6. Weedn VW, Mansour AM, Nichols MM Retinal hemorrhage in an infant after cardiopulmonary resuscitation. Am J Forensic Med Pathol. 1990 Mar;11(1):79-82

7. Adetona N, Kramarenko W, McGavin CR. Retinal changes in scurvy. Eye. 1994;8 ( Pt 6):709-10

8. Bloxham CA, Clough C, Beevers DG. Retinal infarcts and haemorrhages due to scurvy. Postgrad Med J. 1990 Aug;66(778):687

9. Biousse V, Mendicino ME, Simon DJ, Newman NJ The ophthalmology of intracranial vascular abnormalities. Am J Ophthalmol. 1998 Apr;125(4):527- 44.

10. Biousse V, Newman NJ. Intracranial vascular abnormalities. Ophthalmol Clin North Am. 2001 Mar;14(1):243-64

11. Beratis NG, Varvarigou A, Katsibris J, Gartaganis SP Vascular retinal abnormalities in neonates of mothers who smoked during pregnancy. J Pediatr. 2000 Jun;136(6):760-6

12. Budenz DL, Farber MG, Mirchandani HG, Park H, Rorke LB Ocular and optic nerve hemorrhages in abused infants with intracranial injuries. Ophthalmology. 1994 Mar;101(3):559-65

13. Weissgold DJ, Budenz DL, Hood I, Rorke LB Ruptured vascular malformation masquerading as battered/shaken baby syndrome: a nearly tragic mistake. Survey of Ophthalmology 39(6):509-512, May-June 1995

14. Gutman FA Evaluation of a patient with central retinal vein occlusion Ophthalmology. 1983 May;90(5):481-3

15. Iijima H Gohdo T Imai M Tsukahara S. Thrombin-antithrombin III complex in acute retinal vein occlusion. Am J Ophthalmol. 1998 Nov;126(5):677-82

16. Granel B Disdier P Devin F Swiader L Riss JM Coupier L Harle JR Jouglard J Weiller PJ. Occlusion of the central retinal vein after vaccination against viral hepatitis B with recombinant vaccines. 4 cases Presse Med. 1997 Feb 1;26(2):62-5

17. Fledelius HC. Unilateral papilloedema after hepatitis B vaccination in a migraine patient. A case report including forensic aspects. Acta Ophthalmol Scand. 1999 Dec;77(6):722-4

18. Miller E Waight P Farrington CP Andrews N Stowe J Taylor B. Idiopathic thrombocytopenic purpura and MMR vaccine. Arch Dis Child. 2001 Mar;84(3):227-9

19. Kumagai K Nishiwaki K Sato K Kitamura H Yano K Komatsu T Shimada Y. Perioperative management of a patient with purpura fulminans syndrome due to protein C deficiency. Can J Anaesth. 2001 Dec;48(11):1070-4

20. Russell-Eggitt IM Thompson DA Khair K Liesner R Hann IM Hermansky -Pudlak syndrome presenting with subdural haematoma and retinal haemorrhages in infancy. J R Soc Med. 2000 Nov;93(11):591-2

21. Marshman WE Adams GG Ohri R. Bilateral vitreous hemorrhages in an infant with low fibrinogen levels. J AAPOS. 1999 Aug;3(4):255-6

22. Hattenbach LO Beeg T Kreuz W Zubcov A Ophthalmic manifestation of congenital protein C deficiency. J AAPOS. 1999 Jun;3(3):188-90

23. Kaur B, Taylor D Fundus hemorrhages in infancy. Survey of Ophthalmology 37(1):1-17, July-August 1992

24. Mei-Zahav M, Uziel Y, Raz J, Ginot N, Wolach B, Fainmesser P Convulsions and retinal haemorrhage: should we look further? Arch Dis Child. 2002 May;86(5):334-5

25. J. F. Geddes, R. C. Tasker, A. K. Hackshaw, C. D. Nickols, G. G. W. Adams, H. L. Whitwell and I. Scheimberg (2003) Neuropathology and Applied Neurobiology 29, 14-22 Dural haemorrhage in non-traumatic infant deaths: does it explain the bleeding in 'shaken baby syndrome'?

26. J. F. Geddes, J Plunkett. The evidence base for shaken baby syndrome. We need to question the diagnostic criteria BMJ 2004;328:719- 720 (27 March), doi:10.1136/bmj.328.7442.719

27. NH Thomas, JE Collins, SA Robb and RO Robinson Mycoplasma pneumoniae infection and neurological disease Archives of Disease in Childhood, Vol 69, 573-576

28. Caffey J. On The Theory and Practice of Shaking Infants. Its Potential Residual Effects of Permanent Brain Damage and Mental Retardation. Am J Dis Child 1972; 124:161-69.

29. Ganesh A, Jenny C, Geyer J, Shouldice M, Levin AV. Retinal hemorrhages in type I osteogenesis imperfecta after minor trauma. Ophthalmology. 2004 Jul;111(7):1428-31.

30. Berrocal AM Scott IU Flynn HW Jr Walker-Warburg syndrome: congenital neurodysplasia and bilateral retinal folds. Ophthalmic Surg Lasers Imaging. 2004 May-Jun;35(3):256-8.

31. Divizia MT, Priolo M, Priolo E, Ottonello G, Baban A, Rossi A, Silengo MC, Lerone M. How wide is the ocular spectrum of Delleman syndrome? Clin Dysmorphol. 2004 Jan;13(1):33-4.

32. Mosin IM Vasil'eva OIu Skripets PP Iaroslavtseva EV Avuchenkova TN Iziumova EB, Shakarova EA Shuleshko OV Neuro-ophthalmological and radiological signs of Aicardi syndrome Vestn Oftalmol. 2004 Mar- Apr;120(2):15-20.

33. Lee WB O'Halloran HS Grossfeld PD Scher C, Jockin YM Jones C. Ocular findings in Jacobsen syndrome. J AAPOS. 2004 Apr;8(2):141-5

34. Gardner HB. Hypoxia leading to intracranial problems may be a retinal haemorrhage. Neuropathol Appl Neurobiol. 2004 Apr;30(2):192

35. Ahmad OF Hirose T. Severe retinopathy in a child with hypoplastic left heart syndrome. Am J Ophthalmol. 2004 Mar;137(3):566-7

36. Pierre-Kahn V Roche O Dureau P Uteza Y Renier D Pierre-Kahn A Dufier JL. Ophthalmologic findings in suspected child abuse victims with subdural hematomas. Ophthalmology. 2003 Sep;110(9):1718-23

37. Gable EM Brandonisio TM Ocular manifestations of Donohue's syndrome. Optom Vis Sci. 2003 May;80(5):339-43 38. Donohoe M Evidence-based medicine and shaken baby syndrome: part I: literature review, 1966-1998 - Am J Forensic Med Pathol. 2003 Sep;24(3):239-42

39. Clemetson CA. Child abuse or Barlow's disease? Pediatr Int. 2003 Dec;45(6):758

40. Geier MR, Geier DA Neurodevelopmental disorders after thimerosal- containing vaccines: a brief communication. Exp Biol Med (Maywood). 2003 Jun;228(6):660-4

41. Vahedi K, Massin P, Guichard JP, Miocque S, Polivka M, Goutieres F, Dress D, Chapon F, Ruchoux MM, Riant F, Joutel A, Gaudric A, Bousser MG, Tournier-Lasserve E Hereditary infantile hemiparesis retinal arteriolar tortuosity, and leukoencephalopathy Neurology. 2003 Jan 14;60(1):57-63

42. Gaetz M. The neurophysiology of brain injury Clinical Neurophysiology, January 2004, vol. 115, iss. 1, pp. 4-18(15)

Competing interests: None declared

Competing interests: None declared

Donna L Meads-Barlow, Mother and Company Director

Sydney, NSW 2113

Click to like:

Editor,

I wish to offer my apologies to Professors Reece and Clemetson for spelling their names incorrectly.

Michael Innis

Competing interests: None declared

Competing interests: None declared

Michael D Innis, Director Medisets International

Home 4575w

Click to like:

Editor,

“When Truth and Error clash the perception of both is made clearer”[1]

Alan Yurko draws attention to the worrisome and persistent bias of Reece et al.

If Reeece et al,[2] believe SBS and NAI are not fabricated diagnoses let them produce a single case in which Vaccination, Haemostasis, Nutrition, Liver disease and Infection played no part.

If the RCPCH required proof of the absurdity of their advice “Frank bleeding from the nose or mouth is significant of physical intervention, and to be distinguished from blood tinged secretions”[3] they have it in the findings of the GMC in the Southall case.

Bleeding from any site - mouth, brain, retina or skin can occur, as Professor Clements points out, in Barlow’s disease precipitated by vaccination of a susceptible child.[4]

The conditions Shaken Baby Syndrome and Non-accidental Injury (as it applies to infants) are, for the most part, fabrications.

Some Paediatricians are planning to “peer review” the credentials of those giving evidence in cases of alleged child abuse. The “peer review” is a subterfuge by these individuals to set up Kangaroo Courts in England, America and Australia. They fear their mistaken diagnoses may be exposed.

Professors Reece, Craft, Mann and 105 others asserting the authenticity of SBS are now silent in spite of the diagnosis they espouse being claimed to be fabricated. Have they no answer for Professor Clement and Alan Yurko?

Why?

Michael Innis

Reference:

1.I have mislaid the name of the author. Perhaps one of your readers can remind me.

2.Reece RM The evidence base for shaken baby syndrome: Response to editorial from 106 doctors BMJ, May 2004; 328: 1316 - 1317.

3.The Fabricated and Induced Illness Report Report of the Working Party of the Royal College of Paediatrics and Child Health November 2001 p 22

4.Clemetson CAB. Barlow’s Disease Medical Hypotheses (2002) 59(1) 52- 56

Competing interests: I agree with Alan Yurko

Competing interests: None declared

Michael D Innis, Director Medisets International

Home 4575

Click to like:

Reece et al display a worrisome and persistent bias against the diagnosis of child abuse which can lead to malpractice (inter alia). Certainly, parents and others abuse children, and certainly, the violent shaking of infants can have injurious sequelae. Drs. Plunkett and Geddes do not appear to dispute this in any of their publications or testimonies. What is worrisome is that Reece et al appear to endorse and embrace a zealous position on myriad presentations of potential child abuse especially surrounding pediatric head injury and the so-called shaken baby syndrome (SBS). Rather than seek and perpetuate stringent and critically objective conclusions from medical literature and their clinicianship, it seems they’ve taken a persistent bias that excludes any margin of error in their theories and hypotheses. This inability to be objective, and consequent disregard for scientific method, should be a grave concern to the medical and legal communities. True objectivity would attempt to disprove one’s own hypotheses. Reece et al seem more intent on defending unproven theories of causation and etiology. Perhaps Reece et al have forgotten the tenets of scientific method? Perhaps they fear, with good reason, that the fate of Meadows et al will befall them?

Statistically, one must wonder how many cases of child abuse have been misdiagnosed by Reece et al. Even objectivity of the purest nature will have a margin of misdiagnoses. That margin multiplies when bias and zealousy are factors. How many innocent people are in prison? How many families have been destroyed? How many children died because a proper diagnosis wasn’t made, thus preventing proper therapeutic intervention? How many diagnoses of child abuse are really malpractice?

I have been intimately involved in this field for seven years. I was wrongly convicted of murder due to SBS. Over the years, we (myself and medical experts) discovered that our Chief Medical Examiner, Shashi Gore, MD, cross-contaminated my son’s autopsy with tissue samples and data that were not my son’s. Dr. Gore has met a similar fate as Meadows et al. The Florida Department of Law Enforcement and The Florida Medical Examiners Commission ruled in our favor and has barred Shashi Gore from ever doing autopsies again. The courts have scheduled a hearing and my exoneration is imminent. Other evidence of malpractice and misdiagnosis has been uncovered as well. My son is dead. My daughter was taken from my wife and molested in foster care. We were treated as pariahs and the malpractice destroyed our family, utterly.

Interestingly, I have personally contacted 88 of the 106 doctors, including Reece. I asked each one to look at the case objectively. Not one would do so. Several (n=11) "offered" to review the records but "needed" an average of $5,000 to $8,000 (USD) as a "retainer" (non-refundable) and then "work" at an average hourly cost of $400 to $600 per hour. The price of objectivity is certainly outrageous with Reece and a majority of his colleagues. Some of Reece’s colleagues have even tried to stifle the new evidence and malpractice involved in my case.

I pray that Reece et al take pause. Their worrisome and persistent bias will have dire consequences for children, families, and possibly the cost of 106 doctors’ malpractice insurance.

(This response was transcribed by Susan E. Kreider, RN, CPC for Mr. Yurko.)

Competing interests: Alan Yurko is co-founder of The Yurko Project which advocates for wrongly accused parents, persons, and families in child abuse cases concerning pediatric head injury and the so-called shaken baby syndrome. The Yurko Project has assisted over 100 families and has aided both prosecution and defense, as well as courts.

Competing interests: None declared

Alan R. Yurko, X13917 - CCI

400 Tedder Road, Century, FL 32535

Click to like:

17 June 2004

Today a leading proponent of parent blame theories was charged with abusing his professional position. David Southall claimed that his own small study on nose bleeds led him to the solid conclusion that a man he saw on a TV programme talking about his child having a nose bleed had killed his children, this man's wife already locked up for this. There was absolutely no basis to his deeply held beliefs.

The astonishing conclusions are echoed in so many cases in which parents are blamed in a cavalier manner for causing their childrens' illnesses, often iatrogenically induced. I informed the Government before they were even the current Government about this shocking state of affairs in another case.

The obvious has been ignored, the enigmas embraced. This must stop.

Competing interests: Specialist in ASD and ADHD disorders

Competing interests: None declared

Lisa C Blakemore-Brown, Psychologist

UK

Click to like:

Editor,

Brian Morgan notes that findings of fact in the family courts and convictions in the criminal courts have been cited in biomedical literature in support of suggestions for assessment of child abuse. Both categories are subject to review and asks “how should the literature be amended?”

Based on my analysis of the records of 22 such cases I suggest the following amendments be made to ensure Justice in both the family and criminal courts:

1.The publication entitled “The Fabricated or Induced Illness Report” put out by the Royal College of Paediatrics and Child Health contains such statements as “Frank bleeding from the nose or mouth is significant of physical intervention, and to be distinguished from blood tinged secretions.” This and several other statements are likely to mislead the inexperienced with limited knowledge of haemostasis and should not be admitted as evidence of child abuse in the law courts.

2.The diagnosis of Shaken Baby Syndrome (SBS) is a fabrication and should no longer be considered a valid diagnosis. From evidence I have all the alleged cases of Shaken Baby Syndrome can be accounted for by the following:

a.Adverse reaction to a vaccine administered within 21 days of the onset of symptoms. (Check the history, Vitamin C and Histamine in the blood)

b.Haemorrhagic Disease of the Newborn or, more correctly, Vitamin K Deficiency Bleeding.(Check PT, APPT and PIVKA)

c.Malabsorption or Malnutrition which is often associated with low birth weight and prematurity (Check Serum ALBUMIN, UREA, ALKALINE PHOSPHATASE and ESSENTIAL AMINOACIDS)

d.Infections – both viral and bacterial (Check for EB Virus and perform test for C-Reactive Protein and FBC. CSF, Blood and Urine cultures)

e.Liver disease causing deficiency of clotting factors.(Check AST, ALT, GAMMA GT, PT, APTT, PIVKA)

f.Vasculitis including Kawasaki Disease and Microscopic Polyangiitis (Check AST/ALT, p-ANCA, c-ANCA and AECA)

While I do not have any cases of Alloimmune Thrombocytopenia, Bernard -Soulier Syndrome, Prekallikrein deficiency and other exotic bleeding or congenital disorders among the cases sent to me it is imperative that they be considered before making the erroneous diagnosis of Shaken Baby Syndrome.

I can produce documented evidence to support each of the categories, a – f, and I invite Professors Reece, Craft and Hall and the other 105 doctors [1,2] who believe SBS is not fabricated to produce a SINGLE case which cannot be accounted for by the conditions listed above.

If they cannot do so they should admit the diagnosis ‘Shaken Baby Syndrome’ has no legitimacy and should be abandoned forthwith. But judging from the huge financial considerations recorded by Tracy Emblem [3] it is unlikely they will do so and the only alternative is for the Law Courts in England, America and Australia to ignore a diagnosis of SBS as a Brisbane Court ignored MSBP as a diagnosis.[4].

Because it is necessary to restrict the word count one can look up 'Laboratory Medicine' The Selection and Interpretation of Clinical Laboratory Studies Edited by Noe DA and Rock RC. for the abbreviations.

Michael D Innis MBBS; DTM&H; FRCPA; FRCPath. Honorary Consultant Haematologist, Princess Alexandra Hospital Brisbane Australia.

References

1.Reece RM The evidence base for shaken baby syndrome: Response to editorial from 106 doctors BMJ, May 2004; 328: 1316 - 1317.

2.Craft AW, Hall DMB Munchausen syndrome by proxy and sudden infant death BMJ, May 2004; 328: 1309 - 1312

3.Emblem TL SBS Proponents Should Disclose Funding http://bmj.com/cgi/eletters/328/7451/1316#62462,

4.R v LM ttp://www.courts.qld.gov.au/qjudgment/ca04_151.htm (192)

Competing interests: As previously declared

Competing interests: None declared

Michael D Innis, Honorary Consultant Haematologist

Home 4575

Click to like:

It has also been my personal experience that many defense witnesses do not charge or ask only that their expenses be reimbursed.

This would remove financial incentives from any motivation to testify. What is left then? OH, maybe just that they believe in justice and want to see it prevail.

Thank you to the doctors who believe so strongly that they will travel across the country to help people they do not have to. Thanks for not turning your backs on the falsely accused.

Competing interests: MOTHER OF CHILD FALSELY ACCUSED OF BEING ABUSED

Competing interests: None declared

HEATHER LOHR, parent

Huntingdon, PA 16652 USA

Click to like:

THIS WEEK'S POLL