nyt: Shaken-Baby Syndrome Faces New Questions in Court

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Shaken-Baby Syndrome Faces New Questions in Court

<http://www.nytimes.com/2011/02/06/magazine/06baby-t.html?ref=magazine>

By EMILY BAZELON

Some doctors are taking issue with the diagnosis of the syndrome,

raising the possibility that innocent people have been sent to jail...

Medical experts, however, have begun to point out that clinical

observations show that it's possible for a child to have a brain injury

and still remain conscious. The child may be lethargic or fussy or may

not eat or sleep normally for hours or days, while the subdural

hemorrhage and other injuries become more serious, ending in acute

crisis. This has made some doctors wary of pinpointing the timing of a

child's injury --- even when they are sure that abuse occurred --- lest

the wrong adult take the blame. " The police want us to time it within

one to three hours, " says Leventhal, a Yale pediatrics professor

and medical director of the child-abuse programs at Yale-New Haven

Children's Hospital. " But sometimes we can only time it to within days. " ...

The defense relied primarily on Uscinski, a neurosurgeon on the

faculty of the medical schools of Washington University and

town. When he took the stand, Uscinski refuted all the prosecution

experts who said that Noah's hemorrhaging was acute --- the sudden

result of a new injury. Uscinski testified that he saw chronic subdural

bleeding on the scans, which he said was the result of trauma at birth.

" Rebleeds " like Noah's, he testified, " can occur with minimal or no

trauma. They can occur spontaneously. " ...

A dozen years ago, the medical profession held that if the triad of

subdural and retinal bleeding and brain swelling was present without a

fracture or bruise that would indicate, for example, that a baby had

accidently fallen, abuse must have occurred through shaking. In the past

decade, that consensus has begun to come undone. In 2008, the Wisconsin

Court of Appeals, after reviewing a shaken-baby case, wrote that there

is " fierce disagreement " among doctors about the shaken-baby diagnosis,

signaling " a shift in mainstream medical opinion. " ...

A small but growing number of doctors warn that there can be alternate

explanations --- infections or bleeding disorders, for example --- for

the triad of symptoms associated with shaken-baby syndrome...