Doctors Question Medical Diagnosis Used in Thousands of Criminal Cases

George Lavender

For decades Shaken Baby Syndrome, or SBS, has been an accepted medical diagnosis, and one that was involved in 3,000 criminal cases last year alone. Evidence of SBS was first described by Dr. A. Norman Guthkelch in the British Medical Journal in 1971. Now doctors, including Dr Guthkelch himself, are raising concerns that in some cases SBS is diagnosed, and used to convict people, when other explanations should be considered. 

Matt Stroud covered the case of Joshua Miller, who was accused of shaking his seven week old son Rhys, and received a maximum 10 year sentence. He has an article on the ongoing debate about SBS on The Verge .

As many as 1,400 children each year are harmed as a result of violent shaking, according to numbers compiled by the National Center on Shaken Baby Syndrome. More than 300 of those kids die. So whenever there’s seemingly clear evidence that someone like Josh Miller became frustrated and shook a child — as a stupid, last-ditch attempt to stop the child from crying — prosecutors are often inclined to file child abuse charges. And these charges have become a relative commonplace. At least nine separate pretrial shaken baby syndrome cases have made news across the country since the beginning of April.

For many years, the seemingly clear evidence in SBS cases came from brain scans.

In 1971, Dr. Norman Guthkelch published an influential paper called Infantile Subdural Hematoma and its Relationship to Whiplash Injuries.” Doctors at the UK hospital where Guthkelch worked had seen a growing number of children arrive with subdural hematomas — blood on the brain’s surface — but no visible physical injuries. The paper was written to attempt an explanation: according to Guthkelch’s theory, the babies had been shaken. As he explained to NPR in 2011, there wasn’t stigma against it at the time, so the parents told me the truth,” he told NPR. They’d say, “‘Yes, I shook him.’”

That theory grew far beyond Guthkelch’s grasp. In time, mainstream medicine came to understand that SBS could be identified by a triad of symptoms: subdural hematomas, bleeding behind the eyes, and a swollen brain. If a child shows up in an emergency room with those injuries, doctors are going to ask some very serious questions.

There’s no indication that Guthkelch — or doctors more broadly — intended SBS to inspire prosecutorial charges en masse against parents and caregivers who’d allegedly shaken their children into unconsciousness. But that’s what prosecutors have done. Enlisting doctors as expert witnesses, SBS criminal cases are not uncommon. Students at the Medill School of Journalism at Northwestern University found last year that there’ve been as many as 3,000 criminal cases in the United States related to shaken baby syndrome.

In 2011, ProPublica, PBS Frontline and NPR, carried out a joint investigation into several cases in which people were accused of killing children and later cleared. As part of the investigation, reporters spoke with Patrick Barnes, a pediatric radiologist at Stanford University who said we started realizing there were a number of medical conditions that can affect a baby’s brain and look like the findings that we used to attribute to shaken baby syndrome or child abuse.”

2001 postmortem study of children allegedly killed by violent shaking, for example, pointed to alternative causes of death beyond SBS. Studies of biomechanics have suggested that it’s impossible for an adult to shake a child violently enough to cause brain bleeding. And a 2004 study showed that a child can fall, sustain fatal injuries, have a lucid interval” where they seem fine, and then die later on from brain injuries that look like the SBS triad.

2012 paper published in the Houston Journal of Health Law & Policy summarizes these points and others. It concludes: For decades, the SBS hypothesis provided a clear and simple explanation for the collapse or death of children who presented with subdural hemorrhage, retinal hemorrhage, and brain swelling,” it states. We now know, however, that its premises were wrong.”

The National Center on Shaken Baby Syndrome has previously responded to reports questioning SBS by acknowledging wrongful convictions take place,but that these are very rare.” The center has rejected the notion that SBS is a flawed diagnosis

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George Lavender is an award-winning radio and print journalist based in Los Angeles. Follow him on Twitter @GeorgeLavender.
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