Shaken Baby Syndrome

The inertial loading thresholds for infant head injury are of profound medico-legal and safety-engineering significance. Injurious experimentation with infants is impossible, and physical and computational biomechanical modelling has been frustrated by a paucity of paediatric biomechanical data. This study describes the development of a computational infant model (MD Adams®) by combining radiological, kinematic, mechanical modelling and literature-based data. Previous studies have suggested the neck as critical in determining inertial head loading. The biomechanical effects of varying neck stiffness parameters during simulated shakes were investigated, measuring peak translational and rotational accelerations and rotational velocities at the vertex. A neck quasi-static stiffness of 0.6 Nm/deg and lowest rate-dependent stiffness predisposed the model infant head to the highest accelerations. Plotted against scaled infant injury tolerance curves, simulations produced head acceleration...

Background: Among the causes of non-accidental head injury (NAHI), shaken baby syndrome (SBS) is difficult to diagnose and is associated with retinal hemorrhages (RH). Description: To identify findings and patterns of RH specific to SBS, a PubMed search using the keywords “shaken baby syndrome” or “child abuse” and “retinal hemorrhage” was conducted; 66 articles met the inclusion criteria. The published

The findings of studies on the frequency of violence against children imply that many cases go undetected. Selective literature review based on a search of different databases for publications on all types of violence against children, except sexual abuse. The physical abuse of children can involve blunt trauma, thermal injury, and the so-called shaking trauma syndrome (STS). Physical and psychological child neglect have very serious long-term effects. It can be difficult to draw a clear distinction of child abuse and neglect on the one hand, and acceptable behavior on the other, because of the varying social acceptance of certain child-raising practices. Münchhausen's syndrome by proxy (MSbP) is a rare, special type of child abuse. At the beginning of the 21(st) century, well-established normative structures are in place to protect children against abuse and neglect, and the available help from social organizations can also have a preventive effect. Further improvements will de...

Shaken baby syndrome is the most common cause of deaths caused by abuse of children or serious neurological injuries. Cerebral hemorrhages and intraocular hemorrhages are important determinants in the diagnosis stage of the baby. It was first described by John Caffey, an American radiologist, in 1974 and was named the shaken baby syndrome. Since then, shaken baby syndrome has been recognized as one of the most severe forms of child abuse and has been a common cause of death in abused children. For this reason, a higher awareness is needed to identify the conditions that occur in infants. Shaken baby syndrome is a 100 percent preventable syndrome. Effective cooperation between the various institutions should be ensured for successful management and prevention of the syndrome. In this review, it was aimed to raise awareness in the society by expressing the diagnosis of the syndrome and to reveal the studies conducted to prevent the disease.

Introduction Falls are a common chief complaint among children seeking medical attention in emergency departments and are the leading cause of injuries requiring hospitalisation. Falls are also a frequent excuse to conceal cases of maltreatment in small children. Retinal haemorrhages could be a useful marker for their differential diagnosis. Objective This study aims to determine the prevalence and characteristics of retinal haemorrhages in children with head trauma resulting from a vertical fall. Materials and methods This was a prospective study of children younger than 2 years of age admitted to the hospital with head trauma from a vertical fall. The circumstances of the falls and injuries were analysed. All children were evaluated by an ophthalmologist for retinal haemorrhage. Results One hundred fifty-four patients were included. Eighty-three percent of the falls were from a height equal to or less than 120 cm. The most common mechanism of injury was fall from a stroller followed by rolling off the bed. Sixteen children had evidence of intracranial injuries. Three patients had retinal haemorrhages (prevalence 1.9%; 95%CI, 0.4–5.6%), all unilateral, in association with severe epidural haematoma with a midline shift. The detection of retinal haemorrhages could be related to the presence of intracranial injury but not with the circumstances of the fall. Discussion and conclusions Any cranial injury from a vertical fall that produces severe epidural bleeding can also cause retinal haemorrhages, mainly unilateral. The finding of diffuse and bilateral retinal haemorrhages or their presence in the absence of this type of intracranial haemorrhage must continue to point out another cause different from the fall as origin of the traumatism, being necessary to exclude non-accidental trauma.

An epidemic of accusations against parents and baby sitters of Shaken Baby Syndrome is sweeping the developed world. The United States and the United Kingdom are in the forefront of such questionable practice. Brain (mainly subdural, less often subarachnoid) and retinal haemorrhages, retinal detachments, and rib and other bone ‘fractures’ are considered pathognomic. However, the reality of these injuries is very different and well documented: the vast majority occur after the administration of childhood vaccines and a minority of cases are due to documented birth injuries and pre-eclamptic and eclamptic states of the mothers. Evidence that vaccines cause brain and retinal haemorrhages and increased fragility of bones, has been published in refereed medical journals. That this has been to a great extent due to the depletion of vitamin C reserves resulting in acute scurvy, has also been published. I refer to such articles and demonstrate that there is a viable differential diagnosis a...

Çocuk istismarı ve ihmali tüm dünyada artış gösteren ve her yıl milyonlarca insanı olumsuz bir biçimde etkileyen sosyal bir sorun olmasının yanında aynı zamanda sağlık problemi olarak da kabul edilmektedir. Öyle ki, istismar ve ihmal teşkil eden hareketler çocuğun hastalanmasından ölümüne kadar varan ağır sonuçlara neden olabilmektedir. Çalışma konusunu oluşturan Sarsılmış Bebek Sendromu ise bir tür çocuğun fiziksel istismarı olduğundan bu çalışmada konu ile ilgisi bakımından sadece fiziksel istismar kısa bir biçimde tanımlanacaktır. Daha sonra ise çalışmanın esasını oluşturan Sarsılmış Bebek Sendromu tanımlanarak, söz konusu sendromun tespit edilmesine yarayacak belirtiler, ortaya çıkmasına neden olabilecek potansiyel risk faktörleri ele alınacaktır. Ayrıca Sarsılmış Bebek Sendromuna neden olan şiddetli sarsma hareketinin esasında bir hukuki problem olduğu noktasında farkındalık yaratmak ve bundan sonra konu ile ilgili yapılacak olan çalışmalara bir öngörü oluşturmak maksadıyla çocuğu bizzat sarsan failin sorumluluğu Türk Ceza Kanunu'nda yaptırıma bağlanan "Kötü Muamele", "Aile Hukukundan Kaynaklanan Yükümlülüğün İhlali", "Vücut Dokunulmazlığına Karşı Suçlar" ve "Hayata Karşı Suçlar" kapsamında kısaca değerlendirilecektir. Son olarak, bu sendromdan çocukların korunmasına yönelik olası koruyucu tedbirler ele alınacaktır.

The purpose of this study was to document the hand-held spectral domain optical coherence tomography (HHSD-OCT, Bioptigen, Durham, NC) findings in shaken-baby syndrome (SBS). The nonaccidental trauma in SBS has been associated with retinal findings, including hemorrhages in all layers of the retina and retinoschisis. Three consecutive patients with presumed SBS underwent complete ocular examination, fundus photography with the RetCam (Clarity Medical Systems, Pleasanton, CA), and imaging with the HHSD-OCT. Acquisition of the HHSD-OCT images required an assistant to stabilize the head of the infant. All three patients had clinical findings consistent with SBS, including preretinal and intraretinal hemorrhages. Hand-held spectral domain optical coherence tomography documented focal posterior vitreous separation in four of the five eyes with multilayered retinoschisis in one eye, disruption of the foveal architecture and foveolar detachment in one eye, and disinsertion of the internal ...

My empirical study, which examines neuroscience evidence in 800 criminal cases over the course of two decades, is the first to determine how, when, and why victim brain scan evidence is introduced and used in court. My study reveals that although courts commonly rely on brain scans to show the extent of a victim's injury, the actual application of this neuroscience evidence extends far beyond the purpose for which it is admitted. Indeed, victim brain scans are introduced primarily by prosecutors , and nearly half of these cases are based on medical expert testimony that the victims suffer from shaken baby syndrome, a medical diagnosis with controversial scientific underpinnings and distorted legal ramifications. The diagnosis often successfully serves as the sole foundation for a prosecutor's case, with no proof of the defendant's act or intent beyond the victim's brain scan and the accompanying medical expert testimony. Shaken baby syndrome cases thus portray a troubling phenomenon in which the key element of mens rea is either unclear or overlooked altogether and prosecutors are permitted to concoct intent out of brain scans that were admitted for the sole purpose of presenting the victim's injury. My study further reveals that shaken baby syndrome cases are merely the more transparent examples of the criminal justice system's failure to deal adequately with the surging influx of neuroscience evidence into the courtroom. Shaken baby cases thus represent a microcosm of prosecutorial misuse of victim neuroscience evidence more generally, particularly when the evidence is employed to determine a defendant's mental state.

We estimated the disability-adjusted life-year (DALY) burden of abusive head trauma (AHT) at ages 0 to 4 years in the United States. DALYs are computed by summing years of productive life that survivors lost to disability plus life-years lost to premature death. Surveying a convenience sample of 170 caregivers and pediatricians yielded health-related disability over time according to severity of AHT (measured with the Health Utilities Index, Mark 2). Incidence estimates for 2009 came from Vital Statistics for Mortality, Healthcare Cost and Utilization Program Kids' Inpatient Database for hospitalized survivors, and published ratios of 0.894 case treated and released and 0.340 case not diagnosed/treated while in the acute phase per survivor admitted. Survival probability over time after discharge came from published sources. An estimated 4824 AHT cases in 2009 included 334 fatalities within 30 days. DALYs per surviving child averaged 0.555 annually for severe AHT (95% confidence ...

Shaken baby syndrome is evaluated in the context of its historical evolution and its veracity in referring to causal injury mechanisms. A rational assessment of the injury causation and consequent pathological states associated with the syndrome is presented. It is now evident that shaken baby syndrome evolved as a result of a faulty application of scientific reasoning and a lack of appreciation of mechanisms of injury. A brief explanation of the commonly understood usage and interface of scientific methodology and reasoning as applied to clinical medicine is given.