Andrew H. Stevenson
The History of SBS and How It Relates to Defending False Allegations of Abuse - Part 1
Understanding the development of Shaken Baby Syndrome can lead to a better understanding of the medical allegations levied against parents falsely accused of abuse. In a two-part post, I review the history of the development of SBS in an effort to reveal some of the shortcomings of the theory as well as give insight into defending false allegations of abuse.
In the 1970's the idea was advanced by two doctors (Caffey and Guthkelch) that shaking/whiplash could be the cause of the unexplained and sudden collapse or death of infants who were found to have a subdural hemorrhage with no outward signs of abuse or other obvious cause. It was argued that the shaking of infants, who have large heads and weak neck muscles, could cause the infant's head to strike its chest. Originally, benign examples of why shaking would occur were put forth, such as attempted revival or helping a child who is choking. No deliberate malicious intent on the part of the parents was presumed. Rather, the advancement of the idea was intended to be more of a public awareness campaign directed at warning parents so that they did not unintentionally cause harm to their child through shaking.
Overtime this public awareness campaign evolved into a medicolegal hypothesis which became known as "shaken baby syndrome." The hypothesis held that if three medical findings (the "triad") simultaneously present in an infant (subdural hemorrhage, retinal hemorrhage, and encephalopathy), then shaking can reliably be inferred to have been the cause. As most of the infants who presented were otherwise asymptomatic (no other apparent injuries) the diagnosis of SBS was believed to be the only explanation for the underlying traumatic findings.
The next step in the development of the SBS was to provide an explanation of how shaking actually caused the injuries. Proponents of SBS theorized that violent shaking results in the triad due to the rupture of veins and brain axons. Subdural hemorrhages (brain bleeds) were believed to be the result of a rupture in the bridging veins that convey blood from the brain to the large veins or sinuses. The back and forth motion would cause the vein to rupture and pour blood into the dural area of the brain. Likewise, the same rapid acceleration / deceleration would cause the retinal blood vessels to rupture leading to the observed hemorrhages in the eyes. The force of shaking was also assumed to be sufficient to cause the axons or nerves that connect the cells of the brain to tear or separate.
The problem with the explanation provided is that it was not born out of research based on the scientific method, but rather, was purely hypothetical in nature. For obvious reasons, the causal connection between the observance of the three findings (commonly called the "triad") could not be scientifically tested. Meaning, no one would ever take a health baby and intentionally and violently shake it to see if the triad presented in the infant. Instead, the causal connection was developed in an entirely hypothetical manner. The problem with purely hypothetical ideas, which cannot be proved or disproved though the scientific method, is that they can sustain a position of high ground for extended periods of time causing them to be generally accepted even though they lack significant factual proof.
Once a causal explanation was provided, SBS grew from a hypothesis into a medical diagnosis. SBS continued to gain popularity and seemed to develop firm standing in the medical field. It was not until the trial of Louise Woodward (the English nanny in Boston) and the work of Dr. Geddes in 2001 that the flaws of SBS began to fully come to light. Continued in Part 2.