Friday, 26 March, 2004, 00:00 GMT 

http://news.bbc.co.uk/1/hi/health/3564605.stm

 
Doubt over shaken baby diagnosis
 
 
Injuries may not mean abuse

Scientists have cast doubt over the theory that certain eye injuries are a
sign a baby has been violently shaken.

Experts believe that bleeding from the eyes probably indicates that an
infant has been physically abused.

However, a team from the US's Wake Forest University says there is little
hard science to support the view that this alone proves abuse.

Writing in the BMJ, members say assumptions about shaken baby syndrome need
to be challenged.

  False allegations of child abuse could exist

Dr Patrick Lantz 
Other experts said that bleeding from the eyes can suggest a baby has been
shaken violently - but the evidence is only compelling if there are also
signs of brain damage and bleeding in the brain.

The researchers focused on the case of a healthy 14-month-old child who was
brought to hospital with a severe head injury after a television fell on
him at home.

Despite the father's repeated, detailed, and consistent account of the
incident, Child Protective Services removed the child's three-year-old
brother from the home because the baby had injuries to the retina of the eye.

Only after a careful investigation by a paediatrician and a forensic
pathologist was the child's injury deemed to have been an accident.

The Wake Forest team searched the medical literature on the eye injury
observed in this case.

Members found no valid scientific studies to indicate that this particular
eye injury could only result from shaken baby syndrome - echoing the
findings of another recent study into the same topic.

No proof

Lead researcher Dr Patrick Lantz told BBC News Online: "It is important to
remember that this theory has been based on observations but has never been
proven.

"Also, no studies have been done comparing the presence of this eye injury
in shaken baby syndrome and serious accidental head injuries in young
children.

"If some doctors believe that this eye injury can only result from shaking
and haven't critically reviewed the medical literature, false allegations
of child abuse could exist."

In an editorial in the same edition of the BMJ, forensic pathologist Dr
John Plunkett and brain damage expert Dr Jennian Geddes argue the research
suggests that the criteria used to diagnose shaken baby syndrome require
re-assessment.

They say it is not unusual for shaken baby syndrome to be diagnosed on the
basis of signs of bleeding from the eyes alone.

"If the issues are much less certain than we have been taught to believe,
then to admit uncertainty sometimes would be appropriate for experts.

"Doing so may make prosecution more difficult, but a natural desire to
protect children should not lead anyone to proffer opinions unsupported by
good quality science."

In a second editorial, Dr Brian Harding and Dr Anthony Risdon, two experts
at Great Ormond Street Hospital for Children in London, argue that a
conclusion about a baby being violently shaken should only be based on a
careful examination of all the features of an injury.

However, they argue that if all three elements - brain damage and bleeding,
and bleeding from the eyes - are present, this is powerful evidence that
undue force has been applied.

"Damage to the neck or spinal cord is further useful confirmation, and the
presence of gripping injuries, while often absent, can provide further
weight."

Disturbing findings

The Five Percenters, who support parents who say they have been wrongly
accused of shaken baby syndrome, said the findings raised "disturbing
questions" about the opinion of medical experts given in court.

Director Rioch Edwards-Brown, who was wrongly accused of shaking her own
baby son, said their study of parents' accounts of child injuries supported
other reasons for bleeding behind the eyes.

She said: "In approximately a third of cases their child's injuries
followed a minor fall, but both birth trauma and difficulty in breathing
can also cause bleeding under the skin and at the back of the eyes.

"Doctors have been so convinced that these injuries could only be caused by
shaking, they have simply ruled out the possibility that the parents might
be innocent after all."