The Real Consensus On Shaken Baby Syndrome?

Nanny Louise Woodward after her 1998 conviction

Note: Please check out our latest post on this topic here: Queens prosecutors appalled by op-ed.

Last week, CommonHealth linked to a provocative Op-Ed piece in The New York Times on the abusive shaking of babies. Written by law professor Deborah Tuerkheimer, it said that “experts are questioning the scientific basis for shaken baby syndrome. Increasingly, it appears that a good number of the people charged with and convicted of homicide may be innocent.”

In fact, according to one child-abuse expert, Dr. Daniel Lindberg of Brigham and Women’s Hospital, Tuerkheimer “systematically distorts the scientific consensus.” She “relies exclusively on the opinions and work of ‘experts’ who derive substantial income from lucrative court testimony on behalf of the accused perpetrators of child abuse,” he wrote in a response to our link. And “her sources rarely, if ever, provide medical care for children. “

“As an emergency physician and child abuse specialist, I have seen many cases where abusive head trauma is a real and deadly entity.” he wrote. “Further, I have seen several cases where the diagnosis of abuse was carefully considered and then put aside. I have never seen a case where physicians simply found the elements of the ‘triad’– bleeding around the brain, retinal hemorrhages, and brain swelling — and concluded that a child was murdered without a careful and thorough examination of all other possibilities. Beyond my personal experience, many threads of science continue to support the dangers of shaking.”

The overwhelming consensus among child-abuse experts, Lindberg says, is that shaking is dangerous and that the “triad” of injuries cited by Tuerkheimer raise concerns of abuse and need to be carefully investigated. (One particularly famous case of abusive head trauma became a public obsession in 1998: the “nanny trial” of Louise Woodward, who was convicted of killing the Newton baby in her charge, Matthew Eappen, but then released.)

“As with anything,” Lindberg said, “doctors are not judges, juries or executioners, but as with any patient who comes in with signs of violence, we have a role to protect our patients, especially those who can’t speak for themselves.”

Readers, if you treat possible abuse victims, what is your sense of the consensus on abusive head trauma? Did Tuerkheimer misrepresent it?

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  • myloridarlin

    Apple, you didn’t witness any shaking, because not one single case of what these people are calling SBS has ever been witnessed by another human being. NOT. ONE. EVER. It is a travesty of justice that these “doctors” hold on so tightly to a paper written by a man based on theory only, with no medical evidence to back his theory. And he says so. Publicly. These old believers need to be put out to pasture. I am sorry about your friends. I hope it has been resolved by now.

  • myloridarlin

    First, it is absolutely untrue that the physicians you speak of with such disrespect make exclusive income from being defense experts. ALL of them have either testified or examined evidence and given affidavits pro bono in order to prevent miscarriages of justice. Your post is so egregious, it is not worth reading. Secondly, even Guthkeltch himself says he is appalled that people sit in prison today, based on a paper he wrote as a theory with no scientific evidence to back it up, yet you accuse these fine doctors of hiding the flaws in theories that have been proven. Tell me, how do you account for the fact that not ONE case of Shaking has ever been witnessed by another human being? Not one. EVER.

  • myloridarlin

    You and Squier are insane. I knew there was something wrong with your reasoning and the comment following yours proved I was right,


    Yiur theory has been DEBUNKED. WELCOME OUT OF THE DARK AGES.

  • myloridarlin

    The forensic medical community testifies in many cases pro-bono, because they feel that it is their duty to help correct the injustices that have occurred due to the erroneous nature of SBS convictions. Your comment about the burden of proof being shifted to the defendant is exactly right. And then consider the defendant is poor and has the luck to get a lying prosecutor, a defense that didn’t actually defend their client and a judge who denied the accused an independant expert at trial. The defendant is on death row in MS. His name is Jeffrey Havard and he has been on death row 12 years. We have multiple (pro bono) experts opining that the poor child’s death was due to a short fall (with a pre existing condition called Cephalohematoma). And we have MS, who says it is too late to prove his innocence, so he should die.

  • myloridarlin

    Again, you know not of what you speak and you are a monster.

  • myloridarlin

    And I called the women from Boston irresponsible! Her project doen’t exist in her own mind.

    Have you not heard of Drs. Baden, Ophoven, Plunkett, Nichols, Laposata and Van Ee to name a few?

    Tuerkheimers beliefs are absolutely medically sound and the legal community have, for the most part, come around. It’s the old timers, dinosaurs, that are hanging on by a thread. And even that thread you are holding on to does not believe in SBS alone anymore. That was always nothing but a theory with no science to back it up medically. No,now the dinosaurs call it shaken baby with impact.

    Your comment is typical of those in the judicial system who THINK they know what happened and even if it didn’t, the guy is guilty of SOMETHING. So lock them up and throwaway the key. Rightfully or not.

    I think, Charles D. Gill, that you are the stuff of nightmarws.

  • myloridarlin

    Well, you two came on like gangbusters. I wonder if, now, 3 years later, you are of the same opinion? We now know that it is impossible for a human to create the G Force necessary to kill an infant by shaking without other, serious presenting trauma. Neck and rib injuries, to name two.

    I think your comments are way farther outside the scope of the truth than Professor Tuerkheimers.

    You ladies are the irresponsible ones and I pity the parent that brings their child to you for treatment.

    Wonder how many people the two of you have wrongfully accused and convicted by your inability to make a common sense diagnosis.

    Knowing what we know now, the thought makes me shudder.

  • Thoughtful Apple

    Dear George, I am so very sorry for the sudden loss of your 11-month old son.  I cannot even begin to imagine how painful that must be.  I am truly sorry.  Nevertheless, because you have used your own personal experience as an example, I feel the need to make a comment concerning it. 

    Proximity in time and location does not NECESSARILY prove cause.  Without daring to presume knowledge of the specifics of your case, I can see where in a similar circumstance a child may have stopped breathing and was shaken by a caretaker in response to the child’s suddenly not being able to breathe.  I can also see a case where symptoms seen in the hospital, attributed to some event, may have actually had their start at a different place and time and only began to manifest themselves while in the care of a particular caretaker.

    I am sure that some people shake babies violently in abusive ways, but I am also sure that some people accused of violently shaking a baby were only shaking a baby AFTER some medical symptom presented itself and the poor caretaker was frantically trying to help the situation the best way he/she knew how.

    It is also possible that the act of shaking may have nothing at all to do with a manifesting symptom.

    Here is MY story:  At present, I am the close friend of a family currently being accused of shaking their baby.  The baby’s medical symptoms are classic for SDS as promoted in the medical literature, so the doctors have made that diagnosis.  The only problem with their conclusion is that they are mistaken.  What they believe happened did not happen.  There has to be some other explanation for the SDS symptoms, because the baby was not shaken, dropped or in any way subjected to anything which outwardly CAUSED the symptoms.

    How do I know this?  I know the family extremely well and have the privilege of living with the grandparents.  The parents, baby and extended family are at our house almost daily.  In all my observations of this family over several years, there is not the slightest indication that anything even remotely like shaking their baby would occur.  There is no history of drugs, alcohol, arguing, uncleanliness, unfaithfulness, or anything like that.  They are completely straight forward, honest and upright.  The baby is not at all fussy and is either being held or at arms length at all times.  A diagnosis of SBS simply does not fit.  It is completely out of character.

    On the day the baby stopped breathing, I had the intimate privilege of accompanying the family to the hospital on the emergency run.  The baby was not at our house when he stopped breathing, so I did not see with my eyes exactly what happened, but given my experience with the family, I can say with unwavering confidence that what the doctors think happened did not happen.  Mind you, they did not “see” it either.

    What I am currently witnessing is a very swift case of accusation brought against the family.  I have read the court report and am currently reading the medical records.  I notice little inaccuracies and flaws and “twisted words” which have crept in, perhaps because of language barriers, but nevertheless, inaccuracies are there.  I also notice an immediate assumption of guilt on the part of Social Services, so that when a parent says something, it is written down as “parent DENIES such and such,” or “parent APPEARS concerned about the baby.”  It is clearly written with skepticism as to the parents’ innocence in this matter.

    Based on the doctors’ diagnosis, Social Services intends to take this baby away from his parents permanently, even though the parents have said that “nothing happened.”  Social Services takes this as a cover up for guilt or proof of negligence on the part of the parents. 

    But from what I know about the family, I am sure that what the parents say is true.  Nothing happened.  But this truth is discounted.  The parents are being prosecuted and their baby is being taken away from them faster than I would ever have imagined.

    This is an absolute injustice!  So, while abuse cases may exist which are legitimate, to assume that ALL medical SDS diagnoses are true is, in my personal experience, obviously false.  And innocent people CAN be charged with and locked up for something they did not do. 

    And I can see how one parent might agree to confess to something he/she knows did not happen and accept an unjust restraining order just so that at least one parent can get the baby back from the claws of Social Services.

    How SAD it is when the truth someone tells is taken as an evidence for guilt instead of as an assistance to the medical community in searching for a more accurate diagnosis.

    Confession does not equal proof of guilt.

    There are many problems with this SDS medico-legal freight train which cannot, or ought not to  be, dismissed by thinking people.

  • johnAljohn

    It’s not clear that the defenders of SBS diagnosis understand the core criticism. It is merely this: the existence of the SBS-triad, absent additional evidence of abuse, is clearly insufficient to justify damning expert opinion that the baby was shaken to death and insufficient to support a conviction for murder beyond a reasonable doubt.
    No one is saying that babies aren’t abused, and that abuse doesn’t sometimes result in death, and that such murders aren’t reprehensible. Rather, what people are saying is that SBS-triad, alone, does not justify a conclusive finding of abuse.
    Everyone seems to agree that SBS-triad, plus additional reliable evidence of abuse, may just justify a medical finding of death resulting from physical abuse.
    We all have a cognitive bias for explanations, and SBS neatly and simply explains previously inexplicable deaths. We need to recognize this bias and fall back upon scientific method in such an emotionally charged subject. Convicting a caregiver – a parent – of murdering an infant is far far too damning an act to do on anything less than medical and scientific certainty.

  • Penny Mellor

    A confessed 30 days of abuse from the day she came out of the PICU, including persistent shaking, dropping the baby on it’s head, throwing her onto the sofa – this baby was born prematurely with RDS and a congenital heart disorder – admitted to hospital several times, the final time she was checked for retinal haemorrhaging – there were none detected, her eyes however were twitching so they gave her anti convulsants.

    This is a confession, just like the ones you all rely on – so answer me this, given the confessed amount of times this baby was subjected to the most horrendous abuse, including abuse that would result in serious trauma to the head and given that this baby was medically vulnerable, just where does it leave all the theories about one shaking/impact event killing a baby? How is that this baby survived so many assualts on it’s brain yet did NOT have retinal haemorrhaging and did not die straight away – there is a gap between the diagnosed “twitching” (probably caused by brain injury query SDH due to the abuse) of 21 days (always assuming they sought medical attention immediately”. Is this the evidence of a three week lucid interval? Certainly the medical background would back that up.

    “The appellant also described abuse of the child prior to the day on which the child died. He said that he had “tortured” (a word he used) and physically abused her by flicking her nose and ears, squeezing her nostrils together while holding his hand over her mouth, causing her to suffocate for brief periods. He said that he would pull her ears away from her head and that he had on occasions slapped her to the face. He had held her under her arms and shaken her on occasions when she was crying. He also described putting his fingers deep into the child’s throat on a number of occasions, again apparently to stop the child crying. He accepted full responsibility for his actions which had resulted in the child’s death. He said that his abuse had started about two weeks after the child had come home from hospital. When she was about two to three weeks old he had begun to shake her. He sometimes lost control if she started to cry. He would then try to suffocate her or would drop her on the floor from the settee. He estimated that he carried out the action of dropping the child from a height on about a dozen occasions. He said that he would also on occasions throw her against the back of an armchair or sofa when he felt angry that she would not settle. He knew that what he was doing was wrong, but continued to do it.

    The appellant admitted to the police further instances of abuse. Those included kicking or propelling the child across the carpet using his bare feet. He described it as “nudging” her. He also admitted stamping on the child’s chest with his bare feet and having heard on at least one occasion something snap. He told the police that, in addition to that, he had on occasion held the child upside down by her feet and that he had forcibly straightened her arms and legs.

    He acknowledged that the skull fracture found during post mortem was likely to have been caused by his holding the child’s head against the sofa and pushing it whilst applying pressure. He said that he had made two or three hard pushes with his hand. He acknowledged that her head may have hit the wood of the sofa, although he stated that he had not intended that to happen. In dealing with the evening of the fatal injuries, he acknowledged that on that evening he had placed his hand over the child’s mouth and brought her to the point of suffocation; that he had violently shaken her; that he had, as on other occasions, put his fingers down her throat in order to shut her up; and that he had slapped her.

    Despite those admissions, which were consistent with the pathologist’s findings, the appellant repeatedly said that he had not intended to kill the baby. However, he referred to what he had done as “torturing” her.”

  • Penny Mellor

    I keep seeing the phrase “advocacy service” applied directly to the abuse of children in many of the responses from doctors and the legal profession alike. It seems to me that what is going on here is no so much a discussion about “closed head injury” but the application of closed minds!

    I see no advocacy at all, just outrage because the abuse of any child in any manner evokes such strong feelings in most people as to make rational debate almost impossible. In any case it is NOT the role of any doctor or any Judge, to “advocate” – their role is one that should be based soley on medical FACTS nothing else. If the doctors on this forum want to advocate, then I suggest they look for another job.

    I am not a doctor, nor a lawyer, I am, however, a very well informed member of the public who spends her life researching medical data, not just what’s on PUBMED either, there are many other resources. To be frank, I am shocked at the behaviour of some of the people on this forum, in particular Judge Gill, who, in the UK would be prevented from sitting on any case ever again and bought to book by his superiors, impartiality being an absolute must for our judiciary.

    Any wonder the criminal justice system in both the USA and the UK is in such a mess when it comes to these types of alleged child abuse, there is an all out war going on between the “experts” – this isn’t advocacy, this is about personal feelings and personal pride getting in the way of the truth; posturing and then hiding behind “child protection” – smoke and mirrors.

    It seems to be a convenient truth that the “majority” claim the “minority” do not believe that shaking a baby can kill it, when that is not what is being said at all, what the “minority” are saying is that in some cases, there is medical evidence that the baby was predisposed to bleed or rebleed, that in other cases the medical and forensic evidence does not add up to a shaking injury and that there are other causes and that neuropathology, like any other part of medicine is ever evolving. Rule of thumb “never say never”. Thing is, when everyone is so adamant that they “know” what killed the baby (not that any of them were there and witnessed the event”) they lose the ability to be proper scientists.

    You can all repeat mantra over and over again until you believe it’s true, however you can’t fool all of the people all of the time, no matter how many letters you have after your names or how much you stamp your feet and bully those in the scientific community who have an alternative opinion, Superior Court Judge or not.

    Some babies are abused and killed by their carers or parents, some babies just die and we don’t know why, the doctors on this forum need to understand, that sometimes you just don’t have the answers, you just think you do.

    For the sake of all children, back off, sit back and question whether or not you really know everything there is to know about the workings of the infant human brain and then start to absorb the evidence that in some cases do not fit your theories, you may surprise yourselves and actually save lives!
    Does shaking harm babies – probably

    How – we just don’t know because we can’t shake live babies to see what would happen and even if we could, which babies? The babies of mothers who smoke? The babies of parents with genetic problems? The babies whose mothers didn’t eat properly in pregnancy? The “healthy baby” that was never, at any time, exposed to smoke, pollution or alcohol? (Is there such a baby?)

    So you see, you can use animal models as much as you like to “prove” your points, it’s scientifically invalid, because those animals would not have been exposed to the same things as a human and have an entirely different genetic makeup.

  • Celeste Wilson

    As a child abuse pediatrician, I was disappointed by Professor Tuerkheimer’s op-ed article in the New York Times, Anatomy of Misdiagnosis. Her interpretation of the medical research regarding “Shaken Baby Syndrome” is apparently dated, clearly demonstrating a lack of awareness of the current literature on the topic. Of the many troubling statements contained in the piece, she highlights the recent change in terminology from “Shaken Baby Syndrome” to “Abusive Head Trauma” as support that confusion exists with the diagnosis. But, in fact, pediatric clinicians fully appreciate that children can be abused in many different ways, including, but not limited to a shaking event. When children present with concerning medical findings, it is incumbent on pediatric clinicians to be thorough in their approach to the evaluation, considering all possibilities. In many hospitals, a multidisciplinary team consisting of child abuse pediatricians, radiologists, neurosurgeons, nurses, and attorneys come together to make decisions regarding the best course of action and decisions of this magnitude are not taken lightly. Health care professionals are fully aware of the stigma attached to such a diagnosis and for that, as well as many other factors, are very cognizant of the range of mechanisms which could result in such injuries. Indeed, there is no debate about the extensive damage that can be inflicted upon a child at the hands of an adult perpetrator. It is most unfortunate that Professor Tuerkheimer feels there is a basis to suggest otherwise.

    Celeste R. Wilson, MD
    Associate Medical Director
    Child Protection Program
    Children’s Hospital Boston

  • Allison Scobie-Carroll

    As the Program Director for the Child Protection Program at Children’s Hospital Boston I wanted to offer these brief comments in response to the discourse unfolding here. Each year our team consults on approximately 1800 cases of child maltreatment. And each year we are directly involved in the care of dozens of cases of abusive head trauma. It has been my experience that despite our wishes to the contrary, some caregivers, (even those with no known documented history of violence toward others, and even those who closely resemble the very lawyers and physicians enlisted to defend them) do, in fact, inflict devastating and irrevocable harm on children. Like many serious acts of maltreatment of children, the severe shaking of an infant is rarely witnessed. This may be, in part, due to the “guardian” effect that was noted in an earlier post. That is, that people, when in the presence of others, may exercise restraint in their response to the frustrations of care giving. It may also be due to the fact that individuals who lack the internal or external resources (maturity, stability, judgment, sobriety, social supports etc) necessary to manage the stresses of a crying infant are sometimes left alone to do so. In just a few frustrated seconds of rigorous shaking, whether intended to stop a child’s crying or simply to relieve the caregiver’s frustration, the child’s life, and the lives of those that love that child, are forever changed. Denying that this occurs does little to prevent future incidents of such abuse, and it is a profound invalidation of the maltreatment that these children have endured.

    Allison Scobie-Carroll, LICSW, MBA
    Program Director
    Child Protection Program
    Children’s Hospital Boston

  • Lori Frasier MD

    Here is real life example:
    Two month old without any history of trauma comes to the hospital. She just collapsed.
    She has massive brain trauma, retinal detachments, many, many fractures in various stages of healing, bruises and burns.
    She dies two days later. The medical examiner finds a vetebrae “burst” (spinal bone) that we could not see on xray.
    An expert comes: This is mystery, a rush to judgement. Perhaps she has two rare diseases, which include brittle bone, and possible vitamin D deficieny (rickets).
    Oh, and this expert refuses to comment on the burns, only to say this baby’s death is mystery.
    This is not the “triad” or the “tetrad” or the “quintet”.
    This trauma on mutliple occasions, unexplained.
    Those who doubt, should have attended the autopsy it was heartbreaking.
    She did have many tests looking for other conditions. Maybe not every single one. But..there is not one disease that I know of that could explain everything.
    I have diagnosed everything from brittle bones, to metabolic conditions, to infections, to ruptured aneurysms, to real accidental injuries, that NO OTHER MEDICAL provider thought could happen, but a careful investigation proved it. Even when the child was alone with the caregiver. This is not an “industry”, we don’t get paid a bounty for finding abuse. We get paid the same no matter what our findings are. Our best days are when there is no abuse.

  • Charles Gill

    Law Professor Deborah Tuerkheimer’s Op-Ed 9/20/10 in the New York Times on The Shaken Baby Syndrome is a criminal defense lawyers dream, but a reality nightmare.

    I have lectured at dozens of law and medical schools on child abuse. Her real inexperience in this area shows.

    It is disconcerting, if not frightening, when a law professor professes factual, technical, and legal misleading statements in public and professional publications.

    Her over-extension of the highly questionable medical minority view on the subject into the legal
    world makes me wince. Her beliefs are not medically, scientifically or legally correct. They suggest a legal tilting at her new “innocence project”. We liberals love such pursuits. But her project is guilty of existing pretty much in her own mind. Her sources are scant and wrong.

    Let us hope that her efforts do not result in the freeing of people who murder our infants in the most despicable way.

    Connecticut Superior Court Judge Charles D. Gill

    • BR

      May be you should check the science before passing judgement Your Honor. It is very frightening to see a Judge who understands so little abut scientific matters yet passing judgment based in an unproven theory that has been going on for 40 years without a stronger proof than confesions

      • Charles Gill

        I know the science well. My son has written papers on it. The only place that SBS/AHT is a “Theory” is in the minds of those who think that confessions alone have made the science.

        • BR

          Do I see a conflict of interests here?

  • Anonymous

    As a pediatrician with 30yrs experience in evaluating child abuse, I’d say Dr. Lindberg got it right. For us, the happiest days are those where our evaluation reveals a benign cause of injury. Fortunately, this happens a lot, and then nobody goes to court or foster care.

    On others, however, the explanation for the injury doesn’t match what we know about injuries, based on years of research. In those cases, the next step is to look for conditions that might render the child more fragile than others (bone or blood diseases, genetic conditions, infections, etc.). We work hard at this – there’s a lot riding on the outcome, for the accused, for the doc who has to defend her opinion in court, and for the child. To assert otherwise shows little experience with clinical practice, but then very few – if any – of those denying that abuse exists do clinical work with, or for that matter, research on, children, and they are generously rewarded for voicing their contrary opinions. I’ll get my information from those who actually treat the children, thanks.

    Tuerkheimer goes one step farther and asserts that there’s no such thing as abusive head trauma, which is rather like denying the existence of cancer because someone misdiagnosed a case. She marshals a handful of largely discredited or outdated studies, and quotes a number of professional expert witnesses to support her claims. Now, I can understand a lawyer, even a law professor, distorting facts to support a client. I can’t understand how members of the medical profession can.

    • BR

      I haven’t met anybody who says that child abuse doesn’t exist, only that shaken baby syndrome is an unproven myth. Now if you are talking about a proven impact, that is another matter. Then is a question of deciding if it is accident or inflicted. Unfortunately very often both look the same and it all depends on whether the doctor decides to believe or not the carer’s story. There have been witnessed short falls producing SDH but not a single witnessed shaking.
      Pretending that the people who doubt shaking as a cause of the triad do not believe that child abuse exist is pathetic

      • Anonymous

        Please forgive any hyperbole. We shouldn’t conflate “Shaken Baby Syndrome” with all abusive head trauma, and let scientific uncertainty about exact mechanisms keep us from recognizing when a child is in danger.
        In fact, many of my colleagues would agree that shaking by itself hasn’t been conclusively proven to cause life-threatening CNS damage, bleeding and retinal hemorrhage (not quite the same thing as saying it’s been disproven, of course). The ultimate question, however, isn’t how many shakes or whether there was an impact. The question is whether the history given is consistent with the clinical findings, and whether the child was somehow fragile. If the child is healthy, and there are no other acceptable, evidence-based explanations, we’re left with inflicted injury.

        • BR

          Hyperbole forgiven. The problem is that most of those babies in which only thew triad is present are not healthy babies once you start doing a thorough investigation and many have unkcommon problems (remember the vitamin C deficiency case in England some years ago?). I still think that the role of the doctor is not to be judge and jury and if there is not enough evidence of abuse just say so, even if you still have abuse in your differential.

  • Salam

    I am puzzled by the emphasis on the great amounts of money supposedly being made by people who testify for the defense. The defendants in these cases are not corporations. They are for the most part young parents and babysitters. In truth, many (not all) defense experts work for what people can afford to pay. Many of them previously testified mainly for the prosecution but became convinced that the scientific underpinnings of the triad used to diagnose the syndrome (subdural and retinal bleeding, brain swelling) are not secure enough to say with certainty that abuse has occurred (in the absence of other symptoms) or who did it (because even the research by prosecution experts continues to show that the injuries cannot be timed with certainty). Recently in Rhode Island, a woman who was convicted was released because her boyfriend admitted to his lawyer that he had inflicted the injuries and the attorney broke confidentiality to reveal that. There are other cases where parents have been accused only to later find (if the child survived) that the baby had a congenital disease with the same symptoms. Circumspection is warranted in these cases because it is not difficult to convict an innocent person when the burden of guilt shifts to the defendant to prove what DID happen without his/her having any means to do that. Depriving innocent children of an innocent parent (caretaker or breadwinner) is child abuse perpetrated by authorities who say they sincerely want to protect children!

  • Michael Innis

    This is a copy of part of my response to the call for Abstracts to the Amersterdam International Forum 2011

    Innis’ Syndrome,

    Nutritional deficiencies of essential Vitamins and minerals can cause all the signs and symptoms they are currently attributing to Non-accidental Injury, Shaken Baby Syndrome, Inflicted Brain Injury or Abusive Head Injury. The appropriate tests for Haemostasis and Osteogenesis must be done and correctly interpreted before any accusations of child abuse are made.

    4) Intervention: Describe the intervention used in sufficient detail so that others could reproduce it.

    Essential Laboratory Investigations:

    1. Full Blood Count and Differential

    2. Prothrombin Time

    3.Partial Thromboplatin Time

    4. Protein Induced by Vitamin K Absence/ Abnormality (PIVKA).

    5. Under carboxylated Osteocalcin.

    6. Serum Albumin

    7. Total Serum Protein.

    8. Serum Alkaline Phosphatse

    9. Serum Vitamin C

    10. Serum Vitamin D.

    These Laboratory Investigations will disclose deficiencies in the Coagulation System and defects in the Calcification of Bone which could be responsible for all the “injuries” found on the child.


    The Shaken Baby Syndrome and its synonyms are, as I have said many times before, a fabrication of doctors and others ignorant of the pathophysiology of Haemostasis and Osteogenesis. Every new concept must be nailed with a name and I make no apology for calling it Innis’ Syndrome. If the SBS afficionadoes or the Professionals Against Child Abuse care to question the validity of Innis’ Syndrome I am happy to debate them.

    My children and grandchildren, like thousands of others, could be victims of these so-called Professionals. For those who have already fallen victim to SBS accsations the Law should intervene.

    Michael Innis MBBS; DTM&H; FRCPA; FRCPath.
    Retiree Consultant Haematologist
    Princess Alexandra Hospital

  • Mark Dias, MD

    I am saddened and frustrated at the tenor of the Tuerkheimer article as well as many others that have been published in the past several years by some of the ‘expert witnesses’ to which she refers. Virtually all of these articles are published by physicians who have in common four things: 1) virtually all of them have no history of actually diagnosing or treating children as medical providers; 2) most them are deriving significant (and in some cases virtually exclusive) income from testifying in court on behalf of defendants; and 3) all of them have in common the fact that, as expert medical witnesses, they are advocates for a particular point of view to the exclusion of other points of view – in particular the overwhelming point of view of clinicians, pathologists, scientists, and others that shaking, with or without impact, can cause serious brain injury, intracranial hemorrhage, and even death. They distort the medical literature, presenting their own alternative hypotheses and op ed ‘journal articles’ as legitimate scientific fact, hiding overwhelming significant methodological flaws in their own ‘literature’ (criticizing for the sliver in the opposing and voluminous literature while ignoring the log in their own), and out and out lie on the stand in some cases. For example, one neurosurgeon, who virtually always testifies to a theory that subdural hemorrhages could occur during the birth process or some trivial trauma and then rebleed months later with catastrophic consequences without a SHRED of evidence that such rebleeding can cause acute neurological deterioration from the small volume of rebleeding that typically occurs in these cases, testifies that subdural hematoma could rebleed as a result of burping!

    There is a vigorous, robust, and methodologically sound literature concerning the ‘triad’ as the experts call it and its relationship to the types of injuries and even the mechanisms involved in AHT. There is even now an animal model, published just this year, in which 7-10 day old anesthetized lambs were vigorously shaken by humans with subdural hemorrhage, retinal hemorrhage, and axonal injury – if shaking is so innocuous, how do we explain these injuries? There are multiple clinical studies that document the types of injuries in AHT, comparative studies that contrast the pattern, severity and distribution of injuries in AHT versus accidental injuries, and multiple (and increasing) perpetrator confession studies that demonstrate that the injury pattern, severity and distribution are identical 1) whether there is a history of trauma or not, and 2) whether the admission is to impact, shaking, or both. Are there methodological flaws? Absolutely. Do these rise to the level of seriously questioning the validity of the diagnosis? ABSOLUTELY NOT.

    I host a scientific conference every other year (we will have our third conference in San Francisco next summer) that brings together scientists and clinicians from ALL points of view to discuss controversies and expand and improve our understanding in this area. These conferences have been attended by clinicians on BOTH sides of the issue – at our last conference I debated one prominent critic of abusive head trauma on the outcomes from short falls (I reviewed a tremendous literature plus my own 19 year experience in coming to the conclusion that short falls that cause serious injury are EXCEPTIONALLY rare, the critic replied that he agreed with everything I had said but essentially opined that it was still possible to get similar injuries from short falls while providing virtually no evidence that the pattern of fatal injuries from short falls are remotely similar to those incurred during AHT. I allowed these critics to lambaste other presentations on their scientific merit and even accepted their submitted abstracts for presentation – in brief, their ‘scientific presentations’ amounted to incredibly poorly documented case histories and ‘studies’ having scientifically laughable merit. For example, on critic (who has already provided an opinion on this issue above) presented his ‘study’ of a cow’s eyeball that he placed into a plexiglass ‘cone’ representing an orbit, and shook it, slammed it, and in his words, finally stuck a fork in it which was the only way he could produce retinal injury. Another presented three audiotapes of 911 calls in which the child could be heard moaning in the background, and suggested that this ”proved’ that they didn’t have brain injury induced breathing problems because they wouldn’t have been able to vocalize at all (anyone every hear somebody waking up from anesthesia? I have! they make the same noises!). These ‘presentations’ would have been laughable if they weren’t used to generate ‘evidence’ against AHT that obfuscates the issues, elevates these folks as ‘experts’ when in fact they are nothing of the sort, and promulgates a conspiracy theory that has no basis in fact and yet is gaining traction in the media .

    I and many others are doing legitimate science, and are testifying in a responsible, reasonable manner after considering all of the facts of each case carefully. I have an extremely high threshold for reasonable medical certainty when I testify in court, and all of us are very aware of the gravity of our testimony and do not take this lightly. The evidence is clear and unambiguous; shaking with or without impact can cause brain injury, subdural hemorrhages, and even death. To ingore the wealth of scientific evidence in support of abusive head trauma, and to pass off the types of ‘science’ practiced and promulgated by these ‘experts’, is a gross injustice and simply unfair.

    Mark Dias, MD
    Professor and Vice Chair of Neurosurgery
    Director of Pediatric Neurosurgery
    Penn State University College of Medicine
    Penn State Milton S. Hershey Medical Center

    • dayoub md

      I would like to point out some flaws of Dr. Dias’ insulting mischaracterization of expert witnesses who defend victims of false allegation of child abuse. First, an expert radiologist does not treat patients but provides a diagnosis chiefly based upon radiological interpretation. I can assure you virtually no radiologist examines an infant with a fracture or brain injury. This does not lesson his role in appropriate diagnosis. Therefore, a radiologist witness for the defense or prosecution relies on the same information and it is irrelevant that neither has directly diagnosed (via examination) or treated the patient. It is unclear how he can characterize “virtually all” of defense witnesses into any collective stereotype and doing so only shows the deep degree of bias of most prosecution “experts” who disregard alternative medical explanations for infantile “injuries”.

      Likewise, how could he possibly know that “most” defense experts derive “significant” income from their legal work. As an expert witness for the defense at least a dozen occasions I rarely am asked to disclose that in the courtroom. Did Dias bribe my accountant?  In fact, less than 1% of my annual income is derived from such work. In fact, to my knowledge, my charges have never exceeded those of the prosecution witnesses. I have billed fewer than 50% of my cases and in many instances my invoices are unpaid.

      What about the financial conflicts of interest that drive the child abuse engine? For example, a recent candidate for County Supervisor (San Diego) revealed that one county received over $4,000 in excess revenue for each child in foster care each month! (
      It is unlikely such money is spent on defense experts. 

      How can Dr. Dias possibly know that “all” defense witnesses are in “fact” advocates of a particular point of view? How can he differentiate a motive based upon the belief of truth rather than a blind advocacy for a cause? Is he omnipotent? Perhaps he really objects to anyone having a contradictory opinion to his own. His arrogance in this matter undermines his credibility and exposes an insecurity that many child abuse “experts” demonstrate in court, an insecurity, in my opinion, rooted in faulty science and the fear that good science is now challenging the status quo of the child abuse community.

      As an invited speaker to Dias’ Third annual conference in San Francisco, I look forward to  having the chance to show just who is actually distorting the scientific literature in the area of infantile fractures, another tragic chapter in the ongoing saga of over-prosecution of innocent caregivers. The failure of America’s healthcare system in this regard should come as no surprise to those who know that the USA possess the highest infant mortality rates among all industrial nations and whose pediatric population suffers not only from an epidemic of illnesses that mimic child maltreatment, but whose rising plague of such diverse illnesses as autism, asthma, obesity, learning disabilities, allergies etc., continue unabated and without explanation or prevention strategy.

      Kudos to Tuerkheimer for arousing the zealots. Such narrative exaggerations like that by Dias demonstrate the emotional insecurity and fragile mindset of those who embrace the SBS mantra.

    • BR

      One has to wonder why such vitriol against colleagues who disagree with the “robust” evidence in favor of shaken baby syndrome (if it si so robust why the vitriol?). Biomehanical evidence failed to demonstrate that shaking alone can cause the triad without major neck injury (ample evidence that the threshold for neck injury is much less than that for head injury) as (sort of) acknowledged in the SBS conference in Atlanta. The once traumatic diffuse axonal injury is now accepted as hypoxic brain damage. Retinal and subdural hemorrhages are recognized in neonates, etc. The most robust proof of SBS is confesions (do we need to get into the reliability of confesions?). What about Dr Dias’s and colleagues bias in deciding which children belong to the category of abuse? Of course short distance falls “EXCEPTIONALLY cause injury” if you first decide that since there is an injury it can’t be a short distance fall and has to be abuse.
      Not only defense witnesses get paid for their testimony, there is a huge SBS industry in the USA with a lot of money in grants which in 40 yeatrs failed to demnstrate that the triad of brain edema, subdural hemorrhage and retinal hemorrhage means abuse almost by default. Every day there is a new cause described of one or all of these symptoms. Are these people so arrogant that they can’t say that the default diagnosis is “I don’t know” when no clear evidence of trauma is found?

    • Waney Squier

      The tone of the responses to Prof Tuerckheimer’s article is deeply regrettable.
      Dr Dias does himself a disservice by ridiculing selected presentations from his meeting last year and engaging in meaningless ad hominem attacks. Instead he should be taking the credit, not only for entertaining short presentations, but indeed for programming keynote lectures from those whose views are not always in accord with his own. This is surely the way forward; to meet, hear and debate the scientific evidence.

      • Mark Dias

        Thank you Dr. Squire for your reply. I will say publicly that your presentation (which I didn’t mention in my original post) was a well thought out and meaningful contribution to our conference. The other presentations, those of Gardner and Galaznik in particular, I suspect you would honestly agree, were baseless and horribly unscientific (not being vitriolic, just providing my interpretation of the scientific merit of their presentations, a view that was shared by many many people in attendance in their reviews of the conference), and contributed nothing to our understanding of the issues. Although apparently Dr. Ayoub, whom I’ve never met (but look forward to hearing his talk next summer) and who wasn’t actually present last year to hear the presentations, thinks that I’m demonstrating some sort of closed minded zealotry, I actually maintain a very open mind, which explains why I started this conference 4 years ago with the express purpose of encouraging people with disparate points of view to share scientific evidence with their medical and scientific colleagues. I have invited people with widely disparate opinions (including Dr. Ayoub) to speak at this conference so that we can get the science out in the open.

        As for the ‘vitriol’ that others speak about, I and many, many others have kept silent for so long, watching and reading a truly tiny number of people (look them up in the media – they are the same 12 or so names, he same names also found repeately in the court dockets) mount what we have considered to be a ‘conspiracy theory’ about the non-existence of shaking as a mechanism of brain injury in children advanced both in court and the press. I have seen these folks continue to argue the non-existence of shaking in court even in cases where there is blatant evidence of signficant impact injury! To listen continually to the same people make such public statements about this issue without providing some balance to these arguments gets pretty frustrating.

        As for where the medical community actually stands on this subject, I recently queried child abuse, pediatric neurosurgery, forensic pathology, and pediatric ophthlalmology listserves to which a variety of medical professionals belong about their opinions regarding whether shaking WITHOUT IMPACT can cause 1) retinal hemorrhages, 2) subdural hemorrhages, 3) brain injury, and 4) death. the results – 95% said YES. And YES, I will acknowledge that this is not a scientific survery and I know there are those who will reply that I have queried only those who drank the Kool-Aid. However, I think this says volumes about where the balance lies in who believes what.

    • JMP

      Since this page is still being referenced in the SBS “debate”, I feel it is fair to provide more up-to-date information on Dr. Dias.

      Dr. Mark Dias believes so blindly in SBS, that according to court records, he sees it where it does not exist (misdiagnosis), and is currently a defendant in a lawsuit in the case of Jamel Billups*.  How many innocents were actually convicted based on his flawed testimony, and the testimonies of others in Penn State’s “Child Safety Team”?  Could he be the American version of Charles Smith?  The fact that his research into SBS has allowed him to receive a $2,800,000 grant should strongly question his ethics in these matters, as he certainly could be said to have a motive for making an SBS misdiagnosis.  Meanwhile, he derides the experts who testify on behalf of the wrongly accused who are “deriving significant (and in some cases virtually exclusive) income from testifying in court.”

      Aside from Dr. Dias’ questionable methods and ethics, while a small few medical doctors are arguing that SBS does not exist, most reasonable people are simply upset at the fact that the “triad”, as they say, is pathognomonic of abuse.  Even Dr. Guthkelch has now come forward to state that his theory of SBS is now being used in a way that he never intended by doctors and law enforcement.  To use the Global Warming analogy, even though there is a consensus on Global Warming, it cannot be used to explain why it was so hot last Tuesday.  A differential diagnosis should always be performed, and I believe that perhaps most pathologists are doing that, but many are not. How can we expect a jury to determine the truth in matters where hospital staff have not adequately performed their duties?  That is the essence of the problem we are facing in the legal system.  


    • Judgement Day

      Dude…Diaz…are you for real?

      I was at your conference.  You got ur butt handed to you on a platter.  Your arguments are invalid, pointless and you have no answer to questions posed by your opponent.

      It’s a joke you’re still a Doctor.  You actually treat patients?

      Looky here…your judgement day will come.  The pseudo shaken science is dispproven as the pillars fall…so it will crush all your life long work.


  • Horace Gardner

    Vinchon has recently shown that subdural and retinal hemorrhage can occur spontaneously, thus making history of no value. Many cases of presumed SBS have had more than one person present when the child became symptomatic. Since there was nothing to observe, they cannot be expected to observe the same thing.

  • Steven Gabaeff, MD, FAAEM

    Dr. Rorke-Adams says this “One aspect of the medical history which these naysayers typically ignore is the fact that the victim is ALWAYS alone with the perpetrator”

    When I began to study SBS, one of the first things I wondered was why it only happens when the are supposedly murderous caregiver, previously loving would do this at all and why no one ever saw any bad behaviors prior to the unwitnessed alleged shake. Why isn’t shaking commonly witnessed? Where are all the shaken babies not shaken sufficiently to cause damage but taken for an eval by a concerned parent aware of the shaken baby precautions that virtually all parents are exposed too at birth. How many child abusers have that much control to ALWAYS do the alleged dirty deed when no one is there? To George, my condolences, but I would say that it is virtually certain that the once beloved and trusted caregiver who you trusted with your child for good reason I am sure, who you now conceptualize as a murderer was the second victim of tragedy.

    Infectious disease (ID), most often bacterial or viral meningitis, often obscured by early antibiotics in an ED, invalidate post antibiotic cultures and ID is commonly missed and leads to findings that fall within the loose criteria that child abuse MD used to be CERTAIN that the case is abuse and abuse only. DIC (coagulation disorders that lead to widespread bleeding) complicating infection, impact trauma, central venous thrombosis, apnea, regurgitation, activation of the laryngochemoreflex in premies with dysphagia and abnormal cough reflexes unable to clear that pharynx, suffer fatal apneic arrest and this is a likely cause of SIDS according to the New England Joural of Medicine (Kinney 2009). The oxygen deprivation that results leads to SDH and RH as proven by Cohen and Scheimberg (2009).

    The objective mind sees many causes for these findings. The invested physician seems blinded to the mountain of evidence that disputes the theory and reluctant to acknowledge that ANY studies that disprove a theory, disprove that theory and in this case invalidate the shaken baby syndrome (SBS).

    Donhoe (2003) in the Amer J of Forensic Med Pathology analyzed all the SBS literature from 1968 to 1998 (the years where this notion was cultivated) not for content but for methodology. His conclusion

    There was no evidence on the subject of SBS that
    exceeded QER III-2 by the end of 1998, which means that
    there was inadequate scientific evidence to come to a firm
    conclusion on most aspects of causation, diagnosis, treatment,
    or any other matters pertaining to SBS.
    The majority of evidence achieved only a level of QER
    IV, opinions that shed no new light upon SBS and did not add
    to knowledge about SBS. [III-3: Evidence obtained from a single case study or a
    selected cohort study. III-4: Conflicting evidence obtained from 2 or more
    well-designed and controlled studies] .Many of the authors repeated the
    logical flaw that if RH and SDH are nearly always seen in
    SBS, the presence of RH and SDH “prove” that a baby was
    shaken intentionally. Many other studies assumed that the
    presence of RH and SDH was sufficient to make the diagnosis
    of SBS in terms of case selection.
    The remainder of articles are QER III-3, and as noted
    above, the inclusion of case series without controls would
    normally not occur. Thus, the data available in the medical
    literature by the end of 1998 were inadequate to support any
    standard case definitions, or any standards for diagnostic
    Before 1999, there existed serious data gaps, flaws of
    logic, inconsistency of case definition, and a serious lack of
    tests capable of discriminating NAI cases from natural injuries.
    By 1999, there was an urgent need for properly controlled,
    prospective trials into SBS, using a variety of controls.
    Without published and replicated studies of that type,
    the commonly held opinion that the finding of SDH and RH
    in an infant was strong evidence of SBS was unsustainable, at
    least from the medical literature.

    If it has never been seen to happen and it is offered up as the most likely event, how likely is it??

    There are 70K cases of viral meningitis in the US each year, serious injuries from falls occur every day, 3% of all acute life threatening events (ALTE) are meningitis. There are many lists of mimics of SBS and they are long. These alternative diagnoses are in the open, they are common and produce the same symptoms of SBS. The infrequency argument to dismiss low frequency events fails since only the low freqency events go to the hospital. While a million kids can fall in a day, only the seriously injured with go to the hospital. Of those that go, according to Greenes (Ann of EM 1997 and 1998) about 20% of children after accidental short fall will have a serious head injuries. If every fall, not witnessed by an independent witness is diagnosed as abuse regardless of the integrity of the caregiver or the biomechanical plausibility of the fall to cause injury, you can be sure that some of these will be false accusations because every unwitnessed fall is not abuse and the probability of acciental fall causing head injury is being disregarded because abuse is subjectively determined to be more likely. If something can occur 1% of the time and all of those are seen by an MD then he will only see the 1%. If they are all diagnosed as abuse because 1% is a low probability they will all be misdiagnosed and legally prosecuted.

    Kempe back in 1977 found that low risk mothers, defined by his own criteria , did not commit a single act of abuse while being followed for 2 years after birth. Non violent people do not turn violent and kill their child over wet diapers and crying yet this snapping theory is at the heart of the majority of SBS cases. The loving caregiver today, who has never been violent, will not kill your baby tomorrow over common child care problems. I have seen quite a few of those caregiver cases and there babies generally are sick with a medical problem and then left with a previously loving caregiver who witnesses their ALTE, calls 911 and if there is blood in the head of any etiology, and RH, or sometimes only one and not the other, it is nonaccidental trauma before the baby walks through the door of the ED. Differential diagnosis is feigned while prosecution and the taking of children from the accused is a fait accompli within hours.

    • George

      Sorry, but as Daniel Patrick Moyhihan famously said, everyone is entitled to their opinion, but not to their own facts. Perhaps because the focus of medical training is the diagnosis and treatment of medical conditions, doctors do not seem to acquire much specialized education about the social factors that influence human behavior. The medical literature has been slow to realize it, but people do behave differently in “private” than they do in public. People also behave differently when they are sleep-deprived and/or placed in positions of high stress or power.

      For example, incidents of abuse are far more often reported in family care settings, with one caregiver, than day care centers when two or more caregivers are present. Julia Wrigley, the sociologist who did the study, attributes the difference to the sociological concept known as the “guardian” effect.

      You’re entitled to believe a “loving caregiver” can’t behave in a way that will inflict injury. That obviously is a belief many people do hold, because it’s apparently pretty easy to find someone who can quoted to that effect in most news accounts of abuse – even cases of undisputed abuse.

      However, I do not recommend relying on those beliefs when leaving a child with a caregiver…

      By the way, having read some trial transcripts, it is certainly apparent that there are “invested physicians” that steadfastly refuse to admit any possibility of an inflicted injury.

  • Rorke-Adams, MD

    Turkheimer did indeed misrepresent the state of knowledge in the medical community regarding the reality of child abuse, and, in particular, shaken baby syndrome/abusive head trauma. There has been a growing body of welldone scientific work confirming the various aspects of this syndrome, specifically, the pathogenesis of subdural hematomas, the nature of the retinal hemorrhages and more serious retinal injury, the pathophysiology of the concussion which results from shaking, the reality of the severe spinal cord injury etc. It is well-recognized that there may be mimics of SBS and physicians dealing with the clinical and pathological diagnosis of babies presenting with signs of abuse meticulously explore all other possibilities before concluding that the illness or death is not a consequence of natural causes.

    The small number of ‘experts’ who challenge this enormous body of evidence are , for the most part, not involved in the day-to-day practice of pediatrics, neurosurgery or pediatric forensic pathology/neuropathology. Alternative explanations which they offer to explain the constellation of findings of traumatic injury include lack of oxygen, excessive coughing or vomiting or short falls such as rolling off a bed or couch. One aspect of the medical history which these naysayers typically ignore is the fact that the victim is ALWAYS alone with the perpetrator. The acute collapse of the infant never seems to occur during Thanksgiving dinner.

    Efforts should be directed toward prevention not denial.

    Lucy B. Rorke-Adams, M. D.
    Senior Neuropathologist, The Children’s Hospital of Philadelphia
    Consultant Neuropathologist, Office of the Medical Examiner of Philadelphia

  • Steven Gabaeff, MD, FAAM

    How likely is the shaken baby syndrome when there has never been a single case of witnessed or videotaped shaking in which a child subsequently has been immediately examined and found to have either sudural hematoma (SDH) or retinal hemmorhage (RH)? That is never. Not once! Ask any child abuse expert if they have ever had that case I describe and not one will say they had one.

    The physics of shaking demonstrate that forces of a shaking are 1/10 of there known threshold for brain injury and are insufficient to damage a previoulsly healthy brain without damage to the neck and damage to the neck in the hundreds of cases of alleged SBS that I have seen, is absent.

    There are many etiologies of SDH. RH does not occur from shaking an eye. It is the result of increased intracranial pressure after SDH or neuropathic catastrophe of any type that causes increased intracranial pressure sufficent to lead to metabolic compromise (low oxygen or hypoprofusion) in capillaries in the eye and the dural plexus which then fail for lack of either. Niether finding is diagnositic or reliable to identify abuse.

    The relationship between increased ICP and RH has been known for more than 100 years and this relationship, proven time and again, is persistently ignored for the proponents of SBS as an inconvienent truth. The syndrome was born in the imagination of Caffey and Guthkelch in the 70′s (without any independent experimentation) and all the biomechanical experiments and neuropathologic research that has been done since, undermine every aspect of this supposed form of abuse. SBS appeals to the accusatory mind that remains comfortable accusing caregivers of abuse, based not on witnesses events of shaking but an inference that a finding that occurs for many reasons proves abuse. It is a reliance on a belief that an event that is never witnessed must have occurred because two nonspecific findings are classified in their minds as diagnostic; an apparent unshakable belief. They possess an ease with assuming that every person accused, to the last man or women, is lying. They are never wrong.

    To them SBS is based on two nonspecific findings found by accident really 40 years ago in three cases in which an alleged perpetrator wqho killed three babies and mentioned that she had shook them. When shaking has been witnessed or taped it is known to cause no damage at all the previously healthy child.

    It is not the critics of SBS that need to reexamine the literature that proves SBS does not exist, it is the defenders. Their zealotry is the defense against being caught in the nightmare of their own failure to seek the truth, the many previous accusations the have made and a trail of pain they have left behind. It is they who must come to grips with the flaws in thier thinking and damage of their actions as they perpetrate their own abuse on families and children through their false accusations. It is a burden so heavy that even the slightest acknowledgement of the weakness of SBS opens a trap door to the vast and frightening reservoir of sorrow filled with the tears of thousands of damaged families.

    Ms. Turkheimer is no fool and those who think she is, are fools themselves. They carry the SBS flag without the evidence to validate it as a syndrome or even a means of inflicting its three supposed diagnostic findings without failure of the neck. There are thousands of people in jail falsely convicted of an act that no one saw and no one can prove causes damage to the brain or the eye.

    If shaking was as common as it proponents claim it is then why haven’t I, an emergency medicine MD who has seen over 175,000 patient never once had a parent come in to ask me to check a child who they saw being shaken?

    Read Professor Turkhiemer paper and the flaws and tragedy of the false accusations of SBS will be clear as day.

    Any illusions that the child abuse expert at your children’s hospital is not the judge and jury of those they accuse is naive, uninformed, and ignorant of what happens when the inflammatory fusion of true believer MD and DA meet in court to win thier cases.

    • Amorehead88

      I’m not a doctor or anything close to it, but I was wondering do you think it is possible for a child to be diagnosed with SBS but have no complications following the incident?

  • george

    As a lawyer, I read the Tuerkheimer op-ed piece with interest and recognize the tools of my trade, employed in the service of advocacy. As the father of an eleven month old boy who died when he was shaken by his child care worker, I read it with a mix of outrage and dismay.

    Outrage at the facile progression from the facts of the Edmunds case, which simply recognized that Edmunds was entitled to a new trial under Wisconsin law to present “new’ medical opinion to a jury, to the premise that the Edmunds case reflected a substantial, evidenced-based shift in the medical consensus on the causes and consequences of the diagnosis named shaken baby syndrome.

    Rather than a sea-change in judicial thinking, Edmunds is more aptly characterized as an aberration – outside of Wisconsin, only 4 of 281 reported state court cases that use the terms “shaken baby” or “abusive head”, cite Edmunds. There may be fierce “debate” about the Syndrome, but it takes place in courts, not medical centers, and the debate is created by a small coterie of experts, who seem to almost always be in the employ of the defense, and whose purpose is not to find facts, but to create reasonable doubt.

    One should not confuse that process with the search for truth. Which is not to say that the defense is not entitled to challenge the state’s evidence. Everyone has an interest in ensuring that the state meets its burden of proof, for injustice is done not just when an innocent person is convicted, but when a guilty person is set free.

    Increasingly, however, the role of a defense expert is not just to evaluate the adequacy of the prosecution’s evidence or to present alternative theories or causes for the injuries, but to deny the existence of the Syndrome. Biomechanical investigation, they say, proves it impossible.

    Well, for 60 years biomechanical engineers were unable to prove that bumblebees or butterflies flew, and even today, they debate how water gets to the highest leaves in a Sequoia tree. The absence of proof is not evidence of the absence of the event, but simply a failure of explanation. The results may not always be to our liking, but the law does a decent job, overall, of allocating responsibility and liability for events whose cause cannot be adequately explained.

    The dismay is that this op-ed piece focuses energy and effort on the consequences of inflicted injury, not on the opportunity for preventing it. As Doctor Runyan points out, since the Upstate New York SBS Prevention Project began in Buffalo in 1998, the incidence of inflicted head injuries has been reduced by 50%. Educating new parents about the vulnerability of young children to inflicted head injury, and what they can do to help protect their child from injury, works.

    A simple intervention, not speculation and conjecture, has reduced the number of inflicted injuries, and effectively reduced the number of trials and incarcerated caregivers. It not only saves young children and families from tragedy, but saves money.

    Many of us in the advocacy community work with hospitals, child care organizations and government agencies to encourage prevention efforts. Moving past the issue of child abuse to injury prevention helps, but the effort takes time and energy. Approximately two-thirds of births in the US now occur in states that offer some form of education, but one-third don’t.

    An op-ed piece that asked why the opportunity to learn how to keep their child safe isn’t available to every parent would have been a much better use of everyone’s time.

    George Lithco
    SKIPPER Initiative
    Poughkeepsie, NY

    • scott


      Well said sir. Well said.

    • Salam

      I don’t think anyone is arguing that shaking or hitting a baby is safe or good, or that education to help parents become better parents is without value. Rather, the discussion has to do with what constitutes proof beyond a reasonable doubt, enough proof to convict a person of murder.

      You wrote: “The absence of proof is not evidence of the absence of the event, but simply a failure of explanation.” I might add that nor is it evidence of the PRESENCE of the event.

  • Harry Bonnell, M.D.

    The ststement by Dr. Boos says it all “questioning what I and my colleagues believe to be true.”
    Not what they know to be true but what they believe.

    Dr. Block shows his prejudice when he says “the cause of the so-called innocence project;” This project is so-called because it has proven the innocence of those wrongfully convicted and has done so with scientific evidence, not personal beliefs. I have proudly participated in such exonerations.

    Dr. Frasier states “The “experts” who question these concepts are frequent itinerant witnesses for defendants and generate large incomes”. But it is also true that some of the physicians making comments also do the same thing, whether salaried by their home institution or funded by research grants; many of those who testify that there is no scientific evidence to support the diagnosis, aside from confessions which have been repeatedly shown to be unreliable and and can be elicited by interrogators releasing information to the suspect, do so for free.

    There are numerous articles demonstrating how interrogators, armed with the statements by physicians that the child must have been shaken, convince the person being interrogated that s/he must have done it; thereby unscientifically confirming the diagnosis.

    “Who should be believed?” The answer is obvious. What scientific evidence allows us to know, not believe. Faith is a belief but it is not enough to destroy a family and sentence someone to prison.

    Abusive head trauma is a diagnosis where the pediatrician not only makes a diagnosis but interprets the intent of how it was inflicted, based on their bias. Police, judge and jury all in one. Perhaps we should change diagnostic codes to “Abusive stab wounds”; Abusive head trauma in adults”; Abusive gunshot wound” After all, none of these could possibly occur accidentally!!!

    • Stephen Boosmd

      This is really a word game. When I chose to use the word believe it is with the understanding that EVERYTHING in science is a theory. Everything is subject to revision. We move from Newton, to Einstein, and perhaps to string theory. Unfortunately, that sort of honesty about “knowledge” is seldom displayed in court. Ultimately medicine is a game of likelihoods, not certainty. If that is not good enough for you, stop going to the doctor, taking your medicine, having your imaging studies and undergoing your procedures and live with what life deals you. This is why family court rules on the preponderance of the evidence, and criminal court rules when reasonable doubt is ruled out, not all doubt. People who lack self doubt are scary, and people who cannot act in the face of doubt are paralyzed. Word games will not help anyone. I think we can have a reasonable discussion of the science, but conflating knowledge, belief and faith will get us nowhere.

  • Robert Block, MD

    Professor Tuerkheimer has been duped by a strident group of defense witnesses who for inexplicable reasons refuse to consider the foundational science and the increasing new scientific reports underscoring the great harm and death that can occur when an adult violently shakes an infant. One must question her motives for not only writing a biased, totally unprofessional paper for a Law Review Journal, but also for the audacity of making her claims in an op-ed piece in the NY Times. As a pediatrician and child abuse doctor, I have been involved in so many cases of injured children that I feel Ms. Tuerkheimer is either furthering the cause of the so-called innocence project; or has been beguiled by a group of physicians who are using the courtroom to distort science, facts, and reality. It is a pity that the press ignores the plight of children, but comes alive when offered totally unsupported opinions that generate emotions. We can, and must, do better.

    • MinorityView

      Dr. Block, who are the group of physicians who have duped Ms Tuerkheimer? It would much strengthen your argument if you could provide some evidence that these people exist and that they are presenting invalid science for financial gain. As a curious observer of this debate, I find accusations addressed against an unnamed group of people less than overwhelmingly convincing.

  • Stephen Boos MD

    I spoke extensively with Ms. Tuerkheimer when she was preparing her original law review article. I gave her what I felt was a nuanced, complete, and balanced view of the state of the art and its limitations. In return, she allowed me to see and discuss her manuscript, before it’s final publication. Then as now I see the outcome two ways. I believe that she was influenced by “experts” who have made a career of questioning what I and my colleagues believe to be true. I suspect, but cannot verify, that they presented a strident view with no suggestion of self doubt or balance. In the end, Ms. Tuerkheimer appears to have regarded us equally, rather than attempting to sort us out. I feel that she could have, and should have done just that. I feel that her view of the science would be more valid, had she thought about the informant more, when considering the information. As such, I agree with other posts that her view of the state of the science is skewed.

    I said that I see these things two ways. If Ms. Tuerkheimer (who can take her time, find her own sources, and study the issues unbridled by the rules of evidence) cannot sort this out, how do we expect a judge or jury locked in an adversarial process to do so. In her original paper Ms. Tuerkheimer also focused on these questions, and their impact on “justice.” Because I saw this point, I declined to ask for my name to be removed from the law review paper, when others chose to do so. It is a shame that the editorial chose to focus on the weaker portion of her original paper, and not the more interesting part.

    Since I spoke with Ms. Tuerkheimer in 2008, the science in support of shaking injury has only grown stronger. As a physician who has long advocated moving away from the term “shaken baby syndrome” I am only more convinced that some baby’s are clearly injured by violent, and often repeated shaking. Unfortunately, I am no more convinced that the court system is capable of dealing with the difficult job of sorting out science, as presented by opposing experts. Ultimately justice will be served case by case, court by court, based on who shows up to testify until weaknesses in the rules of evidence are addressed, no matter how clear or contentious the science.

  • Lori Frasier MD

    Deborah Tuerkheimer’s Op-Ed piece in Sept 20, 2010 New York Times is a new low in journalistic integrity. The American Academy of Pediatrics suggests the term “abusive head trauma”, because children are injured through a variety of mechanisms that damage their brain. This includes violent shaking. Her position that any infant with “triad” of bleeding on the brain, behind the eyes, and brain damage is unthinkingly diagnosed with shaken baby syndrome is a legal argument. It is a tactic to convince juries that physicians blindly rush to judgment in diagnosing abuse. The “experts” who question these concepts are frequent itinerant witnesses for defendants and generate large incomes. They are rarely involved in the day to day care of injured children. These few, but vocal individuals contrast sharply with majority medical opinions of the nation’s pediatricians, neurosurgeons, radiologists, ophthalmologists, and other specialties. Who should be believed?

    Lori D. Frasier MD, FAAP
    Professor of Pediatrics
    University of Utah School of Medicine

    • Joe Burns

      “Who should be believed?” Science. Ad hominem attacks on Experts who defend Science does nothing for your credibility. The “day-to-day care” argument, that these Experts are not in current practice weakens your argument further.

      Laboratories are not directly involved in day-to-day care but few physicians would make a diagnosis without first consulting the Scientists in the lab.

      SBS is not a scientific theory, it could not be said that there is consensus. It has merely become a religion that either you have faith or you are a heretic. Science is supposed to be based on questions, good science cannot exist without it.

      The entire theory is based on 50 rhesus monkeys that were not even shaken to death. Gutkelch testifies for the defense in most cases now and “wouldn’t hang a cat” based on the evidence. Where babies have been observed being shaken on covert “Nannycams”, NONE of the babies exhibited ANY of the Triad. Bio-mechanical studies prove that the forces exerted by shaking are less than babies can generate themselves in “Jolly Jumpers”.

      The fact that nobody is allowed to ask questions reduces Medical Science to no more than a religious belief. It’s a wonder that science progresses at all as the Research Scientists are heretics because they are not involved in day-to-day care or ask questions.

      The wonderful thing about science is that it exists without requiring the theorist having to exist. It doesn’t need to be defended or supported. If there is no consensus there is no science.

      The sad fact is, that if the theory of SBS never existed, we probably would have solved the mystery of SIDS by now. The Religion of Medicine prevents any scientific study. Nobody from the religion is even willing to study why so many babies around 5 months old exhibit the Triad about 10 days after vaccination. If it happens to a baby in hospital care it’s SIDS, if a persons was ever alone with the baby it’s SBS and that person is a murderer.

      Prosecutors just love SBS, you can get a parent sentenced to death and you don’t need a smoking gun, you don’t need a witness, a bruise, a neck injury, marks on the torso from grabbing the baby, no fractures, no history of child abuse, no studies to prove conclusively that it is even possible, all you need is for a doctor to state that the Triad is present and the jury will convict. It is shameful that educated people believe this nonsense. It’s very disturbing that Medicine has become a religion of faith.

  • Desmond Runyan

    I was shocked and dismayed that the New York Times chose to publish Professor Turkheimer’s piece about shaken baby syndrome when she had so many factual an conceptual errors and that it was disseminated further by WBUR. Where Professor Turkheimer states that there are more than 1000 babies labeled with the diagnosis of shaken baby, she used an estimate derived from a study that I helped design and conduct. In North Carolina we had 80 cases of children less than 2 years of age who were diagnosed as having suffered and inflicted traumatic brain injury in 2000 and 2001. This yielded a rate of 17/100,000 children in the first 2 years of life. In that study we undertook a careful blinded secondary review of the case circumstances and found that the diagnoses were accurate and well done and the only two cases that we found mis-identified. In one case we determined it was most likely an accident and in another we concluded he case was likely abusive- In both cases the physician involved called it “undetermined.” From the 80 North Carolina cases that constituted our sample over two years, only 54 cases proceeded to the courts. In 80% of those cases there was a guilty plea by the perpetrator. Thus, there were six trials each year and five convictions. The information the juries used went far beyond Prof. Turkheimer’s “triad” and included careful histories, other injuries, and diagnostic testing to rule-out other diagnoses. Her premise that there are many hundreds of people languishing in jails with false convictions is, as the courts would say, “not in evidence.” The cases are real. I have cared for many shaken babies and talked with many parents. One of the mothers of a patient said: “I would never hit my baby but he had to stop crying, so I shook him.” That child survived but was devastated. Dr. Mark Dias published a study in in 2005 in which informing parents of new babies not to shake infants resulted in a 47% decline in cases in western New York State. If shaken baby syndrome doesn’t exist, how can it be reduced by warning mothers not to shake. The New York Times did its readers and the public’s health a major harm by publishing Professor Turkheimer’s misinformed opinion and creating a class of aggrieved parents that does not exist.

    Des Runyan, MD, DrPH
    Professor of Social Medicine and Pediatrics, The University of North Carolina School of Medicine

    • Sca

      For context, 95% of all criminal cases are resolved by plea bargains, often very generous ones. While your University hospital may regularly do diagnostic testing to rule out other diagnoses, that is frequently not the case. In one case I know of, the Medical Examiner said he reported DAI because the child had been shaken and that’s part of the syndrome. He saw no need to do any tests. Even the judge observed that the ME started with a conclusion and set out to prove it. I urge the AAP to publish an investigation checklist to discourage doctors and investigators from starting with the answer and setting out to prove it. If a child has been abused and the wrong person is charged, there are two injustices!