Anatomy of Misdiagnosis: Shaken baby

"Shaken Baby" cases are difficult cases for a number of reasons: chief among them that no matter how the injury happened, a baby is injured or dies. However, in recent years, more evidence has accumulated that shaken baby syndrome is often misdiagnosed by doctors and law enforcement alike. If you find yourself investigating a shaken baby case, it is important to look for an expert that can assist in preparation and examination of the medical records of the baby. Look for a pediatric expert that is familiar with current research on the topic. An article written in the New York Times last fall (available here) contained a good roadmap of things to be looking for with a shaken baby case. The New York Times article points out that the American Academy of Pediatrics recommended that the diagnosis of shaken baby syndrome be discarded and replaced with abusive head trauma which takes the presumption of a "shaker" out of the equation. As as been discovered, many things can be responsible for head trauma in infants including falls, unintentional dropping, and mishandling by young siblings. One recent important discovery deals with the fact that the baby may lose consciousness hours or even days after the trauma which means that the last caregiver is not necessarily the culprit.

For the past 30 years, doctors have diagnosed the syndrome on the basis of three key symptoms known as the “triad”: retinal hemorrhages, bleeding around the brain and brain swelling. The presence of these three signs (and sometimes just one or two of them) has long been assumed to establish beyond a reasonable doubt that the person who was last taking care of the baby shook him so forcefully as to fatally injure his brain.

But closer scrutiny of the body of research that is said to support the diagnosis of shaken baby syndrome has revealed methodological shortcomings. Scientists are now willing to accept that the symptoms once equated with shaking can be caused in other ways. Indeed, studies of infants’ brains using magnetic resonance imaging have revealed that triad symptoms sometimes exist in infants who have not suffered injuries caused by abuse. Bleeding in the brain can have many causes, including a fall, an infection, an illness like sickle-cell anemia or birth trauma.

What’s more, doctors have learned that in many cases in which infants have triad symptoms, there can be a lag of hours or even days between the time of the injury and the point when the baby loses consciousness. This contradicts the idea that it’s possible to identify the person responsible by looking to the baby’s most recent caregiver.

Last year, the American Academy of Pediatrics recommended that the diagnosis of shaken baby syndrome be discarded and replaced with “abusive head trauma,” which does not imply that only shaking could have caused the injury.