Critics, parents question diagnosis of shaken baby syndrome

- A growing number of medical experts believe the diagnosis of shaken baby syndrome is being misdiagnosed in too many cases that often end up breaking up innocent families.

The precise number of cases of shaken baby syndrome cases across the country is unclear because parents or caregivers could face a variety of different charges:  homicide, manslaughter, child abuse or neglect. But according to a study conducted by The Innocence Project, based on post-conviction appeals, more than 1,000 people may be incarcerated for shaken baby syndrome.   

An investigation by The Washington Post and Northwestern University’s Medill School of Journalism found 1,600 convictions since 2001, and 200 other cases where charges were dismissed, dropped or defendants were found not guilty. According to the report, 16 convictions have been overturned on appeal. 

“I KNOW WHAT I KNOW”

DeClara Tripp is accused of abusing her youngest son, Zhakari, about a year ago when he was nine months old. Ramsey County Child Protection Services has removed the child from the home and is attempting to terminate her parental rights. 

"I held him in my hands, called 911, breathed in his mouth and rubbed on his chest. He goes, ‘huhhhh’,” Tripp recalled.

The little boy was taken to Children's Hospital, where doctors said he had bleeding on his brain and behind his eyes.  Doctors removed a portion of the boy's skull to relieve the pressure. He now needs to wear a protective helmet.

Doctor's concluded he was the victim of abusive head trauma (AHT), a new term for shaken baby syndrome (SBS).

Tripp said she had her share of tough times, including homelessness and domestic violence, but she said it has never stopped her from protecting her four children.

"I know what I know,” Tripp said. “My son was not abused. I know he was not left unattended to get abused.  I know that.”

Tripp believes her son's medical issues are a result from complications from his premature birth and a vitamin deficiency.

"I'm confused about how the court system can even go forward without facts," she said.

Unable to afford an attorney or hire medical experts, Tripp said she will not admit to something she did not do.

A spokesperson for Ramsey County told the Fox 9 Investigators they would not comment on individual cases, nor would they do an on-camera interview on the issue of SBS.

COUPLE’S CASE DROPPED AFTER $15,000 IN ATTORNEY FEES

For Shari and Rick Smith's daughter, Mariah, who was also nine months old at the time, it began with a simple accident.

"She had fallen and hit her head on an end table right next to our kitchen," Shari said.

She did not think the girl's bump on the head was a big deal and did not take her to the doctor immediately.

The couple said child protection was trying to terminate their parental rights within three days.

Mariah was diagnosed by the same doctor as Tripp's child at Children's Hospital, part of the Midwest

Children's Resource Center, which diagnoses cases of child abuse. The hospital and MCRC declined to comment for this story.

"The doctor said she had subdural hematoma and there was an eye specialist coming in to look in her eyes [for retinal hemorrhaging]," Shari said.

At first, doctors accused Rick. But after he passed a lie detector test, police accused Shari. 

Finally, after $15,000 in attorney fees and calling on expert witnesses, child protection quietly dropped the case.

"Had we not had that money, we would've lost her," Shari commented. "We would never have been able to prove that we didn't do it."

WHAT IS SBS?

Since researchers first identified the phenomenon with studies on monkeys, there have been three symptoms used to diagnose shaken baby syndrome: a subdural hematoma, when blood fills the space between the brain and skull; cerebral edema which is swelling of the brain; and retinal hemorrhage, bleeding in the back of the eye.

When an infant or toddler, with their larger head and weaker neck muscles, is violently shaken, the theory claims the rapid acceleration creates a whiplash effect, not unlike conditions observed in boxers or football players. The child's undeveloped brain rotates and pitches as it is slammed against the skull. Veins are torn and nerve cells destroyed, leading to bleeding and swelling.  And yet, outwardly, there may be no sign of injury. 

THE CRITICS

Dr. Janice Ophoven is a forensic pathologist, a scientist who determines the cause of death by examining the body. 

"I get these cases, where's the trauma?" Ophoven said. "If you don't need evidence of injury to accuse, how do you defend yourself?"

Ophoven is part of a chorus of expert witnesses now convinced SBS is being misdiagnosed by pediatricians, when there is no other sign of child abuse. Among them is Dr. Jan  Leestma, a neuropathologist in Chicago.

"I've seen so many families ruined by what I consider false accusations," Leestma said.
Another is Dr. John Plunkett, a forensic pathologist in Minnesota, who was featured in a recent documentary debunking SBS called "The Syndrome.”  

"Shaken Baby Syndrome was first developed as a theory 40 years ago that infants who had three symptoms were the victims of violent shaking, and nothing else could cause them." Plunkett said in the documentary.

All three say there are a variety of causes for those same three symptoms, including viral and bacterial infections and even a premature birth or vitamin deficiency. Tripp believes her son’s case was caused by a premature birth and a vitamin D deficiency, but the doctor told a judge that theory is "not commonly accepted in the medical community."

"A lot of kids can get subdural hematoma from trauma and other causes," Leestma said.

Biomechanics is adding to the skepticism.  The Washington Post conducted an experiment with baby dummies, and found a grown man shaking a 22-pound baby generated only six G's of force, while a short fall can generate more than 10 times the force of shaking alone.

Ophoven said she has never seen a case where just shaking a child caused a fatal injury, there has always been an impact in those cases. When asked why there are not neck injuries, she replied: "well, that's the $64,000 question."

MAN ACQUITTED ON MURDER CHARGES

Damien Marsden was home alone with his four-month-old son, Rylin, when suddenly, the toddler went limp.

"[The doctor] flat out said this is shaken baby," Marsden recalled. "At one point the doctor told us he'd seen a fall from two stories that were not worse than what my child had."

Rylan died six days later. Marsden was charged with murder.

"They said this is all fresh and happened within 20 minutes," Marsden said.

But, it was revealed that Rylin had been dropped at daycare the week before. A pathologist testified the injury was old. A jury took only two hours to find Marsden not guilty in 2012.

For nearly three years, Marsden had to live apart from his wife and three other children. Police and social workers almost seemed intent on dividing the family.

"I stuck by him through the whole thing knowing he was innocent,” Marsden’s wife, Megan, said. “After that, we said if we can make it through that we can make it through anything.”
 

RESPONSE TO THE CRITICS

The American Academy of Pediatrics provided this statement to the Fox 9 Investigators in response to a request for comment:

The American Academy of Pediatrics supports pediatricians in their diagnosis of abusive head trauma. These diagnoses are reached only after careful and thoughtful examination and review.” “There is no legitimate medical debate among the majority of practicing physicians as to the existence or validity of AHT/SBS. The only real debate and controversy appear to be in the legal system and the media. Claims that shaking is not dangerous to infants or children are not factual and are not supported by AAP policy, despite being proffered by a few expert witnesses in the courtroom. Alternative hypotheses have been offered by a few physicians and others, but the evidence for these hypotheses is lacking. Several experts who have published and testified regarding alternative theories of AHT causation have conceded in recent medical publications that infants can be damaged or killed by violent shaking or abuse.

But, even the Academy appears to be responding to the critics.  The Academy’s research publication, Pediatrics, published a study last year that looked at expanding the diagnostic criteria for SBS beyond the customary three, to six different symptoms, including head and neck trauma.

The National Center on Shaken Baby Syndrome told the Fox 9 Investigators its official position is: the science behind SBS has been settled, and that SBS can occur with or without an impact injury. Executive Director Ryan Steinbeigle said people should focus on prevention and how to educate parents on caring for a new baby. 
More information can be found at dontshake.org

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