Michigan Shaken Baby Investigations

 

In many ways, the idea that there will actually be an investigation is a misnomer.  To understand this, some brief history of SBS theory is helpful.  In the early days of the Shaken Baby Syndrome phenomenon, an SBS diagnosis required three elements, known as the triad:

• subdural hematoma
• brain injury
• retinal hemorrhage

It was generally believed that this "constellation" of symptoms was "diagnostic" of SBS absent an explanation of some high intensity trauma such as a high speed motor vehicle accident or fall from a third story window.

 

Although medical doctors, the American Academy of Pediatricians and prosecutors have retreated in some ways from this position, the retreat has not been helpful to parents who are falsely accused.  This is mostly because of the changing theories (substantially unsupported by scientific evidence) of the mechanism of injury.

 

In order to bolster their testimony, doctors have shied away from the notion that they can provide the specific etiology of shaking as a mechanism of injury.  Instead the current list of possible causes typically includes the following:

• High speed motor vehicle accident
• Fall to a hard surface from a high window
• Repetitive shaking
• Shaking plus impact on a hard surface
• Repetitive slamming into a soft surface (bed or pillow)

As you might quickly understand, most parents in a hospital setting will quickly rule out the first two.  In the absence of those explanations, Abusive Head Trauma is likely to be the diagnosis. Doctors have become very comfortable at offering an opinion that they don't really know what happened, it must be shaking or impact on a hard or soft surface.  The somewhat recent addition of the soft surface impact was really speculation by doctors trying to explain why children present with "triad" medical problems but have no swelling or bruising.

 

Every ATH or SBS "diagnosis" must be built around a patient history provided by parents or caretakers.  However, the "investigation" often starts with a conclusion.  The conclusion is that the only explanations from the history that will explain the medical findings are those mentioned above.  The purpose, then, of obtaining a history is to rule out the motor vehicle accident and the hard surface impact after a fall from a three story window.  Once the parents acknowledge that these events did not occur, every thing else they say is categorized as a parental explanation which does not explain the injury and must be a lie.