Shaken Baby Research Articles

Prevention of Shaken Baby Syndrome and Promotion of Safe Sleep

Prevention of Shaken Baby Syndrome and Promotion of Safe Sleep

Effect of an Educational Guideline Program on Mothers’ Performance regarding Shaken Baby Syndrome Prevention

Effect of an Educational Guideline Program on Mothers’ Performance regarding Shaken Baby Syndrome Prevention

Forensic Psychology Consultation in Shaken Baby Syndrome/Abusive Head Trauma: A Response to Commentary

ABSTRACT Critical commentary and exchange are vital to advancing forensic psychology consultation in Shaken Baby Syndrome/Abusive Head Trauma. The interests of children and families warrant such attention. Multiple sources, such as psychological research identifying processes in wrongful conviction, peer-reviewed medical research, the National Registry of Exonerations, and documentary film illustrations, all contribute to recognizing and reducing risks of wrongful conviction.

Fractures and skin lesions in pediatric abusive head trauma: a forensic multi-center study

Abusive head trauma (AHT) and its most common variant, the shaken baby syndrome (SBS), are predominantly characterized by central nervous system-associated lesions. Relatively little data are available on the value of skeletal and skin injuries for the diagnosis of SBS or AHT. Thus, the present study retrospectively investigated 72 cases of living children diagnosed with the explicit diagnosis of SBS during medico-legal examinations at three German university institutes of legal medicine. The risk of circular reasoning was reduced by the presence of 15 cases with confession by perpetrators. Accordingly, the comparison with the 57 non-confession cases yielded no significant differences. Skeletal survey by conventional projection radiography, often incomplete, was found to be performed in 78% of the cases only. Fractures were found in 32% of the cases. The skull (43%) and ribs (48%) were affected most frequently; only 8% of the cases showed classic metaphyseal lesions. In 48% of the cases, healing fractures were present. Skin lesions (hematomas and abrasions) were found in 53% of the cases with the face (76%), scalp (26%), and trunk (50%) being the major sites. In 48% of the cases, healing skin lesions were observed. Nearly 80% of the cases with fractures also showed skin lesions. The data prove that SBS is frequently accompanied by other forms of physical abuse. Therefore, skeletal survey is indispensable and should always be done completely and according to existing imaging guidelines if child abuse is suspected.

Trends in shaken baby syndrome diagnosis codes among young children hospitalized for abuse

ObjectiveTo investigate national trends of SBS diagnosis codes and how trends varied among patient and hospital characteristics.MethodsWe examined possible SBS, confirmed SBS, and non-SBS abuse diagnosis codes among children age three and younger who were hospitalized for abuse between 1998 and 2014 using a secondary analysis of the National Inpatient Sample, the largest US all-payer inpatient care database (N = 66,854). A baseline category logit model was used based on a quasi-likelihood approach (QIC) with an independent working correlation structure.ResultsThe rate (per 100,000 census population of children age 3 and younger) of confirmed and possible SBS diagnosis codes was 5.4 (± 0.3) between 1998 and 2014, whereas the rate of non-SBS abuse was 19.6 (± 1.0). The rate of confirmed SBS diagnosis codes increased from 3.8 (± 0.3) in 1998 to 5.1 (± 0.9) in 2005, and decreased to 1.3 (± 0.2) in 2014. Possible SBS diagnosis codes were 0.6 (± 0.2) in 1998, increasing to 2.4 (± 0.4) in 2014. Confirmed SBS diagnosis codes have declined since 2002, while possible SBS diagnosis codes have increased. All abuse types were more frequent among infants, males, children from low-income homes, and urban teaching hospitals.ConclusionsWe investigated seventeen-year trends of SBS diagnosis codes among young children hospitalized for abuse. The discrepancy between trends in possible and confirmed SBS diagnosis codes suggests differences in norms for utilizing SBS diagnosis codes, which has implications for which hospital admissions are coded as AHT. Future research should investigate processes for using SBS diagnosis codes and whether all codes associated with abusive head injuries in young children are classified as AHT. Our findings also highlight the relativity defining and applying SBS diagnosis codes to children admitted to the hospital for shaking injuries. Medical professionals find utility in using SBS diagnosis codes, though may be more apt to apply codes related to possible SBS diagnosis codes in children presenting with abusive head injuries. Clarifying norms for SBS diagnosis codes and refining definitions for AHT diagnosis will ensure that young children presenting with, and coded for, abusive head injuries are included in overall counts of AHT based on secondary data of diagnosis codes. This baseline data, an essential component of child abuse surveillance, will enable ongoing efforts to track, prevent, and reduce child abuse.

The silence of innocence

The mysterious and suspicious death of the young Henry Borel on March 8, 2021 in Brazil brought up again the subject of child violence to the media. The child had multiple injuries in the abdominal cavity, pulmonary contusion, head trauma and other injuries incompatible with a domestic accident or fall in his room as reported by parents. Brazilian media has closely followed the case, offering continuous updates.
 In Brazil, violence is a public health issue that hits population in a large scale, including children.
 Violence against children takes many forms. It can be physical, emotional or sexual. It happens in all countries and any settings – in a child's home, community, school and online. In some parts of the world, violent discipline is socially accepted and common. And for many girls and boys, violence comes from the hands of the people they trust – their parents or caregivers, teachers, peers and neighbours [1].
 A perpetrator is a person who is responsible for the abuse or neglect of a child [3].
 The National Child Abuse and Neglect Data System (NCANDS) showed that in 2019, about 252,324 children in the U.S. were abused by their mother [4]
 Unfortunately, one or more parent is involved in 78% of child maltreatment fatalities.
 Child maltreatment is a global problem with serious life-long consequences. In spite of the recent national surveys in several low- and middle-income countries, data from many countries are still lacking [3].
 Shaken Baby Syndrome / Abusive Head Trauma (SBS / AHT) is a term used to describe the constellation of signs and symptoms resulting from violent shaking and impacting of the head of an infant or small child [5]. 
 According to the WHO nearly 3 in 4 children - or 300 million children - aged 2–4 years regularly suffer physical punishment and/or psychological violence at the hands of parents and caregivers [3].
 The Brazilian Society of Pediatrics (SBP) entered into a partnership with the Federal Council of Medicine (CFM) and the Ministry of Human Rights, to seek solutions against aggressions against children and adolescents.
 On average, 233 assaults of different types (physical and psychological torture) against children and adolescents aged up to 19 years are notified in Brazil [6].
 In 2020, this pandemic has brought with it additional challenges in protecting young people from abuse and revealed gaps in our existing approach [7].
 The stress in families and children will not end when the stay-at-home orders are lifted. Let's be prepared to help all our children emerge healthy and strong, and ready to learn.
 Everyone knows violence is bad for children and adolescents, and sometimes fatal. It is harmful for them to be mistreated or abused by an adult, to be victimized by bullies, to witness serious domestic violence, or to be criminally assaulted. Many, though not all, young people who are exposed to violence react to this adverse experience by developing behavioral, emotional, or learning problems. What is less well known is that adverse experiences such as violence exposure can also lead to hidden physical alterations inside a child’s body.
 Some children exposed to violence learn to resolve their own conflicts in a violent manner. Others seem to become desensitized to violence and the pain and distress of others. Some retreat into a shell, avoiding people and the world around them. These children with long-term exposure are at an increased risk for:
 
 Behavioral, psychological, and physical problems
 Academic failure
 Alcohol and substance use
 Delinquent acts
 Adult criminality
 
 
 Despite these grave physical and mental health consequences, the vast majority of child victims never seek or receive help to recover. What’s more, children who grow up with violence are more likely to re-enact it as young adults and caregivers themselves, creating a new generation of victims.
 Violence against children can be prevented. Preventing and responding to violence against children require that efforts systematically address risk and protective factors at all four interrelated levels of risk (individual, relationship, community, society). Do not underestimate child violence. Report it.

Abusive head trauma: Canadian and global perspectives.

Canada has come a long way since Dr. C. Henry Kempe first described battered-child syndrome in 1962. The year 1999 was crucial in Canada's battle against shaken baby syndrome/abusive head trauma (SBS/AHT), when the first national conference on the topic was held in Saskatoon. This was followed by the issuance of a national statement and multidisciplinary guidelines, recently updated in 2020. Incidence of AHT in Canada is similar to that found in population-based studies from Switzerland and New Zealand. The mainstay of prevention of AHT in Canada is education of parents and caregivers with respect to their response to infant crying. Population-based data for global incidence of AHT are lacking, largely because of social and cultural differences contributing to poor understanding of AHT as a medico-legal entity. India faces a distinct challenge in the battle against female feticide and infanticide.

A commentary on Johnson et al.’s “Shaken baby syndrome/abusive head trauma: Wrongful conviction risks, mis-information effects, and psychological consultation”

ABSTRACT Abusive Head Trauma (AHT) is a medical diagnosis which indicates that accidents, diseases, or other medical conditions do not plausibly explain a child’s injuries. While psychologists may be involved in AHT cases, they do not generally evaluate children at the time injuries caused by AHT occur and they do not diagnose those injuries. This article is a commentary on Johnson et al, which advises that psychologists would benefit from understanding the medical aspects of an AHT case. This is a laudable goal. However, in an effort to discuss medical issues regarding AHT and legal exonerations, the article presents flawed data and speculative theories which are unsupported by medical evidence or the extensive range of generally accepted medical literature. We discuss some of these flaws and present a more in-depth medical analysis in the hope that interested psychologists gain more understanding of this very complex area of medical specialty.

Does ‘Shaken baby syndrome’ occur in South Africa? A review of emergency room and inquest records in Cape Town

ABSTRACT Abusive head trauma (AHT, formerly known as Shaken Baby Syndrome) is a serious form of maltreatment of young children. It appears to be virtually absent in South Africa, which is puzzling in a country where maltreatment rates are several times higher than the global average. Children under age 3 are most vulnerable to injury or death from shaking. We examined two sources of data to establish whether AHT occurs in South Africa and what the incidence rate is: records of injuries of children under age 3 from a tertiary hospital trauma unit (the ChildSafe database 1996–2015), and autopsy records of deaths of children under age 3 from three Magistrates’ Courts in greater Cape Town, South Africa (2006–2016). Of the 52,165 injuries in this age-group in the ChildSafe database, there were only three accounts of shaking, of which only one caused injury. However, the structure of the database made it impossible to identify clusters of injuries that may have resulted from AHT, nor were doctors constrained to indicate whether shaking had occurred. There were no reports of shaking in autopsy findings, although several cases had indications that shaking may have occurred. It therefore remains unclear as to whether AHT is occurring in South Africa. In order to detect shaking in future, we recommend that: (1) the form which doctors in trauma units are required to complete explicitly enquires about this; (2) doctors performing autopsies are provided with a standard protocol that requires them to investigate the possibility of AHT; (3) a prospective study of infants and caregivers be conducted, to establish the incidence of shaking and whether it causes injury.

How to Prevent Shaken Baby Syndrome and Other Forms of Abusive Head Trauma

How to Prevent Shaken Baby Syndrome and Other Forms of Abusive Head Trauma

Swept-source OCT findings in shaken baby syndrome: case report

BackgroundOur purpose was to document the swept source optical coherence tomography (SSOCT) findings in a patient with Shaken baby syndrome (SBS).Case presentationSSOCT was obtained without sedation in a six-month-old girl with bilateral multilayered retinal hemorrhages due to SBS. It documented vitreoretinal interface abnormalities, including internal limiting membrane (ILM) detachment with retinal traction, in association with other specific changes in the inner and outer retinal layers. Six weeks later, retinal hemorrhages had substantially resolved, and there was optic disc pallor. OCT showed ILM reattachment with release of retinal traction and the development of severe diffuse retinal atrophy involving the fovea.ConclusionsSS OCT can provide useful information in SBS, revealing a wide variety of vitreoretinal interface, inner, and outer retinal changes not detected by clinical examination. It also may have a prognostic value over follow-up.

The Unspoken Shaken Baby Lie Detector Algorithm—An Analysis of Diagnostic Procedures in Cases of Allegedly Abusive Head Trauma without External Signs of Trauma

Various algorithms have been developed for diagnosis of Abusive Head Trauma (AHT); however, there is no explicit algorithm for the 1/3 of alleged AHT cases which present with findings restricted to subdural and retinal hemorrhages, with or without encephalopathy—i.e., isolated triad cases. Moreover, such cases have been lumped together with AHT cases with external sign of trauma and all diagnosed as AHT despite those we are focusing on lack signs of trauma. It is therefore relevant to analyze how this diagnosis can be reached in the absence of unequivocal trauma. Our analysis indicates that with respect to isolated triad cases, a two-step algorithm seems to be in use—but unspoken. The first step concerns a ruling out diagnostic process and the second step addresses the veracity of the caregivers’ narrative. Both steps are based on the traditional AHT mechanism theories and ten tacitly applied auxiliary hypotheses which are, however, questionable or incorrect. If the traditional AHT mechanism theories and necessary auxiliary hypotheses are not valid, then neither is the two-step algorithm. Accordingly, we propose that in alleged AHT cases with no external signs of trauma, the two-step algorithm—here referred to as the unspoken shaken baby lie detector algorithm—should be abandoned.

Shaken Baby Syndrome: literature review in the last 5 years

Background: The aim of this study was to perform a narrative review on what the literature about shaken baby syndrome brought us in the last five years. Methods: A search on PubMed and Scielo using the keywords ´´Shaken Baby Syndrome´´, ´´Abusive Head Trauma´´ and ´´Síndrome do Bebê Sacudido´´ found 842 articles. After apply the inclusion and exclusion criteria we defined the sample corpus in 54 articles. Results: In the last five years several medico-legal debates have taken place discussing the controversies in the pathophysiology and diagnosis of abusive head trauma. Despite this, it is still the most common cause of brain damage in child. Prevention methods were created and tested. Although some have been successful they need some adaptations to improve the effectiveness. Conclusion: The Shaken Baby Syndrome is a high incidence disease that involves several neurological, cognitive and motor impairments. Because of that new research needs to be done to improve our knowledge about this type of trauma and the effectiveness of the prevention methods.

Shedding light on excessive crying in babies.

Excessive and inconsolable crying behavior in otherwise healthy infants (a condition called infant colic (IC)) is very distressing to parents, may lead to maternal depression, and in extreme cases, may result in shaken baby syndrome. Despite the high prevalence of this condition (20% of healthy infants), the underlying neural mechanisms of IC are still unknown. By employing the latest magnetic resonance imaging (MRI) techniques in newborns, we prospectively investigated whether newborns' early brain responses to a sensory stimulus (smell) is associated with a subsequent crying behavior. In our sample population of 21 healthy breastfed newborns, those who developed IC at 6 weeks exhibited brain activation and functional connectivity in primary and secondary olfactory brain areas that were distinct from those in babies that did not develop IC. Different activation in brain regions known to be involved in sensory integration was also observed in colicky babies. These responses measured shortly after birth were highly correlated with the mean crying time at 6 weeks of age. Our results offer novel insights into IC pathophysiology by demonstrating that, shortly after birth, the central nervous system of babies developing IC has already greater reactivity to sensory stimuli than that of their noncolicky peers. Shortly after birth, the central nervous system of colicky infants has a greater sensitivity to olfactory stimuli than that of their noncolicky peers. This early sensitivity explains as much as 48% of their subsequent crying behavior at 6 weeks of life. Brain activation patterns to olfactory stimuli in colicky infants include not only primary olfactory areas but also brain regions involved in pain processing, emotional valence attribution, and self-regulation. This study links earlier findings in fields as diverse as gastroenterology and behavioral psychology and has the potential of helping healthcare professionals to define strategies to advise families.

Ambiguous loss after shaken baby syndrome/abusive head trauma: parental management of dialectical contradictions of grief

ABSTRACT Shaken baby syndrome/abusive head trauma (SBS/AHT) is the number one cause of child abuse related deaths in the United States. This study, based on qualitative interviews with 35 birth parents of SBS/AHT survivors, employs grief management and dialectical theory to explore the ambiguous loss experienced by parents. This study finds parents experience dialectics of acknowledgment-denial, control-helplessness, certainty-uncertainty, guilt-innocence, and openness-closedness, which prevent them from fully experiencing grief due to the ambiguity of the loss. Because their child is still alive, and the loss is the experience of raising a formerly healthy child, the ambiguous loss experienced, complicated by dialectics of grief, prevent their fully dealing with the grief. Grief management tactics that impact family communication are explored.

Vitreous body hemorrhage-How long can one wait?

In the case of acute vitreous body hemorrhage, the ophthalmologist is faced with the question of whether spontaneous absorption can be awaited or whether avitrectomy is necessary. In addition to the intensity of the bleeding, the underlying cause also plays an important role. Athorough medical history is therefore important. The most common causes in adults include posterior vitreous detachment, diabetic retinopathy, and retinal vascular occlusion. In children, retinal vasculitis, systemic diseases, and trauma (e.g. shaken baby syndrome) must be excluded. If there is no evidence of a retinal tear or detachment using ultrasound, it is usually possible to wait afew weeks under sonographic control to assess the spontaneous tendency to resorb. Overall, the trend is towards earlier surgical interventions due to improved vitrectomy techniques and the desire for early rehabilitation of vision.

Infantile Acute Subdural Hematoma with Retinal Hemorrhage Caused by Minor Occipital Impact Witnessed by an ICU Nurse: A Case Report

An acute subdural hematoma (ASDH) in infants without external signs of trauma is differently recognized as shaken baby syndrome (SBS) or abusive head trauma (AHT) in the United States or as infantile acute subdural hematoma (i-ASDH) due to minor head trauma in Japan. The aim of the present case report is to document the existence of i-ASDH as a discrete clinical entity differing from SBS and AHT.

Perception of male and female infant cry aversiveness by adult men

ABSTRACT Objective: The study aimed to determine why male infants are abused more frequently than female infants. Background: Infant crying is a well-known trigger for Shaken Baby Syndrome or Abusive Head Trauma (SBS/AHT). For unknown reasons, male infants are more often victims of SBS/AHT than female infants. We hypothesised that this sex difference in victimisation was attributable to either acoustic or movement differences between male and female infants when crying, or to gender stereotypes about infant crying (e.g. ‘boys don’t cry’). Methods: Adult male participants rated auditory and video cry stimuli from male and female infants for aversiveness. Each infant was rated while wearing both blue and pink clothing to denote male or female gender. Results: In two experiments, male infants spent more time producing expiratory phonations than did female infants, and this variable was positively correlated with aversiveness ratings. Including visual stimuli increased male but not female infant cry aversiveness compared with audio stimuli alone. Finally, dressing infants in blue did not increase cry aversiveness. Conclusions: These findings suggest that both the tendency of male infants to produce more expiratory phonations when crying, as well as their visual appearance when crying, may contribute to their increased vulnerability to abuse.

Shaken Baby Syndrome/Abusive Head Trauma: Wrongful Conviction Risks, Mis-information Effects, and Psychological Consultation

ABSTRACTPsychologists as experts may be engaged in criminal or family court cases involving Shaken Baby Syndrome/Abusive Head Trauma (SBS/AHT). There are unsettled questions within medical specialties regarding the diagnosis of SBS/AHT, as well as the mechanisms and timing of injuries. Psychologists need to be cautious about providing testimony based on findings from disciplines other than psychology. Forensic psychological consultation in SBS/AHT can be informed by the record of exoneration in these cases. Also, psychological research on processes in wrongful conviction such as the “mis-information effect” and forensic “confirmation bias” can inform such consultation and testimony.

Beyond circular reasoning: Fishing the uncertainty behind shaken baby syndrome – Conceptual case report

Beyond circular reasoning: Fishing the uncertainty behind shaken baby syndrome – Conceptual case report