This article is from the source 'guardian' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.
You can find the current article at its original source at http://www.theguardian.com/law/2016/mar/15/shaken-baby-syndrome-panorama
The article has changed 3 times. There is an RSS feed of changes available.
| Version 1 | Version 2 |
|---|---|
| Battlelines drawn as shaken baby syndrome controversy set to run | Battlelines drawn as shaken baby syndrome controversy set to run |
| (6 months later) | |
| Shaken baby syndrome is back in the news. Monday’s BBC Panorama programme focused on this most contentious of subjects and was itself prompted by the General Medical Council’s prosecution of Dr Waney Squier, a consultant neuropathologist who used to give evidence against those charged with injuring their baby but now provides expert evidence in their defence. On Friday she was found guilty by the GMC of giving “expert opinion evidence outside your field of expertise” in several cases that came before the criminal or family courts, and could be struck off the medical register as a result. | Shaken baby syndrome is back in the news. Monday’s BBC Panorama programme focused on this most contentious of subjects and was itself prompted by the General Medical Council’s prosecution of Dr Waney Squier, a consultant neuropathologist who used to give evidence against those charged with injuring their baby but now provides expert evidence in their defence. On Friday she was found guilty by the GMC of giving “expert opinion evidence outside your field of expertise” in several cases that came before the criminal or family courts, and could be struck off the medical register as a result. |
| The programme and the Squier case have reopened one of the biggest controversies in both medicine and criminal justice: when has a seriously injured baby been shaken violently by one of its parents and when is there a natural, and more innocent, explanation? As retired high court judge Sir Mark Hedley told Panorama: “In cases where children have been harmed allegedly by their parents the stakes are extraordinarily high because in a criminal case a parent is facing a long prison sentence. In family cases they are facing the loss of surviving children [because an abused child is taken away]”. A small group of experts – most believers in the syndrome, others sceptics – often line up against each other in cases that reach the courts. | The programme and the Squier case have reopened one of the biggest controversies in both medicine and criminal justice: when has a seriously injured baby been shaken violently by one of its parents and when is there a natural, and more innocent, explanation? As retired high court judge Sir Mark Hedley told Panorama: “In cases where children have been harmed allegedly by their parents the stakes are extraordinarily high because in a criminal case a parent is facing a long prison sentence. In family cases they are facing the loss of surviving children [because an abused child is taken away]”. A small group of experts – most believers in the syndrome, others sceptics – often line up against each other in cases that reach the courts. |
| Even the terminology surrounding shaken baby syndrome causes dispute, said Dr Geoff Debelle, a consultant paediatrician at Birmingham Children’s hospital and the child protection officer at the Royal College of Paediatrics and Child Health. Some prefer non-accidental injury or non-accidental head injury. Debelle told the Guardian: “We tend to call it something else, as calling it that [shaken baby syndrome] presumes that you know the cause of the problem, that a baby has been shaken. We call it abusive head trauma, though often the courts don’t like that term, because it presumes that you know that [the injury] was abusive.” | Even the terminology surrounding shaken baby syndrome causes dispute, said Dr Geoff Debelle, a consultant paediatrician at Birmingham Children’s hospital and the child protection officer at the Royal College of Paediatrics and Child Health. Some prefer non-accidental injury or non-accidental head injury. Debelle told the Guardian: “We tend to call it something else, as calling it that [shaken baby syndrome] presumes that you know the cause of the problem, that a baby has been shaken. We call it abusive head trauma, though often the courts don’t like that term, because it presumes that you know that [the injury] was abusive.” |
| The result can be permanent brain damage or even death. | The result can be permanent brain damage or even death. |
| Shaken baby syndrome has caused controversy before. In 1997, the British au pair Louise Woodward was released by the trial judge despite her conviction for the involuntary manslaughter of eight-month-old Matthew Eappen in Massachusetts. She had been charged with murdering him. | Shaken baby syndrome has caused controversy before. In 1997, the British au pair Louise Woodward was released by the trial judge despite her conviction for the involuntary manslaughter of eight-month-old Matthew Eappen in Massachusetts. She had been charged with murdering him. |
| In 2003, the court of appeal upheld Angela Cannings’ appeal against her conviction a year earlier for murdering her sons Jason (seven weeks) and Matthew (18 weeks) in 1991 and 1999 respectively. The ex-shop assistant from Salisbury had always maintained that they had died of cot death, which had also claimed the life of her first child, Gemma. | In 2003, the court of appeal upheld Angela Cannings’ appeal against her conviction a year earlier for murdering her sons Jason (seven weeks) and Matthew (18 weeks) in 1991 and 1999 respectively. The ex-shop assistant from Salisbury had always maintained that they had died of cot death, which had also claimed the life of her first child, Gemma. |
| And in 2004, the Cannings case led the attorney general, Lord Goldsmith, to order a review of every case since 1994 in which anyone had been convicted for killing an infant aged under two. | And in 2004, the Cannings case led the attorney general, Lord Goldsmith, to order a review of every case since 1994 in which anyone had been convicted for killing an infant aged under two. |
| Panorama drew the battlelines. Dr Squier, a doctor at the John Radcliffe hospital, told the programme: “There is very little science in shaking baby syndrome. It’s become a label. We’re not there at the time of collapse, we don’t know if these babies have been shaken or not.” Debelle gave what is the mainstream, and he says, settled view among doctors who specialise in treating children. “We are now more confident [of] the so-called ‘triad’ of symptoms, of signs – bleeding behind the eyes and bleeding over the head and this sudden collapse – and we feel more confident about that as being caused by an abusive injury,” he told Panorama. | Panorama drew the battlelines. Dr Squier, a doctor at the John Radcliffe hospital, told the programme: “There is very little science in shaking baby syndrome. It’s become a label. We’re not there at the time of collapse, we don’t know if these babies have been shaken or not.” Debelle gave what is the mainstream, and he says, settled view among doctors who specialise in treating children. “We are now more confident [of] the so-called ‘triad’ of symptoms, of signs – bleeding behind the eyes and bleeding over the head and this sudden collapse – and we feel more confident about that as being caused by an abusive injury,” he told Panorama. |
| “It’s not a common problem. It’s only about 24 cases per 100,000 live births. If you work in a major children’s hospital like this one, where they have a paediatric intensive care unit, you might come across one case every one or two months,” explained Debelle. The babies involved are usually under six months old. Intensive efforts are made to revive them, including resuscitation. | “It’s not a common problem. It’s only about 24 cases per 100,000 live births. If you work in a major children’s hospital like this one, where they have a paediatric intensive care unit, you might come across one case every one or two months,” explained Debelle. The babies involved are usually under six months old. Intensive efforts are made to revive them, including resuscitation. |
| At that stage, doctors hold off diagnosing abusive head trauma until other possible causes have been ruled out. They scan the baby’s head and test to see if its sudden collapse, and bleeding in the brain and in the retina at the back of the eye, have been caused by sepsis, a potentially fatal infection. “We have to investigate other natural causes, for example that a child has an underlying congenital bleeding condition or inherited metabolic condition that affects the brain in a way such that spontaneous haemorrhages could occur. But these things are very, very rare,” said Debelle. | At that stage, doctors hold off diagnosing abusive head trauma until other possible causes have been ruled out. They scan the baby’s head and test to see if its sudden collapse, and bleeding in the brain and in the retina at the back of the eye, have been caused by sepsis, a potentially fatal infection. “We have to investigate other natural causes, for example that a child has an underlying congenital bleeding condition or inherited metabolic condition that affects the brain in a way such that spontaneous haemorrhages could occur. But these things are very, very rare,” said Debelle. |
| Doctors also look for signs that the infant has suffered other trauma, such as broken ribs or bruising. If it has, then, along with the “triad” of classic symptoms of abusive head trauma, it is even more likely that an adult has or adults have inflicted violent injuries. The trouble is, however, that not all such cases are so clearcut. | Doctors also look for signs that the infant has suffered other trauma, such as broken ribs or bruising. If it has, then, along with the “triad” of classic symptoms of abusive head trauma, it is even more likely that an adult has or adults have inflicted violent injuries. The trouble is, however, that not all such cases are so clearcut. |
| In about 15% of cases where babies have sustained these terrible injuries, there is no evidence of other trauma and the parents do not admit having been aggressive. They may recall that their child fell, perhaps more than once. “If they do, we have to estimate if the injuries were likely to have been caused by the force of such falls, and that’s very, very difficult. We can end up relying on estimates from biomechanical engineers to work that out,” added Debelle. | In about 15% of cases where babies have sustained these terrible injuries, there is no evidence of other trauma and the parents do not admit having been aggressive. They may recall that their child fell, perhaps more than once. “If they do, we have to estimate if the injuries were likely to have been caused by the force of such falls, and that’s very, very difficult. We can end up relying on estimates from biomechanical engineers to work that out,” added Debelle. |
| Babies presenting with such injuries usually lead to an investigation by local social services under section 47 of the Children’s Act 1989, whether there is evidence of other trauma or not. | Babies presenting with such injuries usually lead to an investigation by local social services under section 47 of the Children’s Act 1989, whether there is evidence of other trauma or not. |
| For doctors who end up assembling evidence for the courts and social services, not just treating the injured baby, these one in seven cases are the ones that prompt the most unease. Debelle told the Guardian: “In cases where there’s been a sudden collapse and there’s absolutely no evidence of any other trauma, and there’s no admission from the family, that little group causes us a little uncertainty. We do worry about these and look at other possible alternative explanations. But if we don’t find an underlying natural cause, we are left with the distinct possibility that these are inflicted injuries.” | For doctors who end up assembling evidence for the courts and social services, not just treating the injured baby, these one in seven cases are the ones that prompt the most unease. Debelle told the Guardian: “In cases where there’s been a sudden collapse and there’s absolutely no evidence of any other trauma, and there’s no admission from the family, that little group causes us a little uncertainty. We do worry about these and look at other possible alternative explanations. But if we don’t find an underlying natural cause, we are left with the distinct possibility that these are inflicted injuries.” |
| Family courts decide on the basis of probabilities, but criminal courts require a case to be proved beyond reasonable doubt. For some, including lawyer Clive Stafford Smith and other doctors like Squier who challenge established medical thinking on shaken babies, too little weight is given to possible alternative explanations for these terrible injuries. These include particularly the possibility that a subdural hematoma (bleeding in the brain) could have been caused by a lack of oxygen due to the baby suffering a much less severe trauma, or was not caused by trauma at all. | Family courts decide on the basis of probabilities, but criminal courts require a case to be proved beyond reasonable doubt. For some, including lawyer Clive Stafford Smith and other doctors like Squier who challenge established medical thinking on shaken babies, too little weight is given to possible alternative explanations for these terrible injuries. These include particularly the possibility that a subdural hematoma (bleeding in the brain) could have been caused by a lack of oxygen due to the baby suffering a much less severe trauma, or was not caused by trauma at all. |
| Debelle, though, is slightly perplexed by the renewed focus on SBS. “It’s back in the headlines because of the Waney Squier case. But [as an issue] it’s not all that exciting beyond medical circles. We don’t really see it as controversial at all. We feel that the accumulated evidence over a long period of time points to a scenario that these symptoms of collapse make inflicted trauma highly likely. But we would consider any further evidence. We’re not blinkered to the prospect of that.” | Debelle, though, is slightly perplexed by the renewed focus on SBS. “It’s back in the headlines because of the Waney Squier case. But [as an issue] it’s not all that exciting beyond medical circles. We don’t really see it as controversial at all. We feel that the accumulated evidence over a long period of time points to a scenario that these symptoms of collapse make inflicted trauma highly likely. But we would consider any further evidence. We’re not blinkered to the prospect of that.” |