PEOPLE who have been convicted of shaking infants to death may have new support for appealing their convictions. An extensive review has concluded that there is evidence on its own of child abuse.
Formerly known as shaken baby syndrome, abusive head trauma is a combination of symptoms believed to result from violently shaking an infant 鈥� an action that usually has long-term health consequences and can be fatal. Three symptoms in particular 鈥� swelling of the brain, bleeding on the brain鈥檚 surface and bleeding behind the retinas 鈥� have together been used as crucial evidence in court. In many countries, including the UK and US, this triad of symptoms, sometimes in the absence of other physical signs of harm, has played a key role in convictions for abuse.
鈥淐ritics are afraid people who鈥檝e abused infants might go free, or parents will cover up abuse鈥�
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But there is growing debate over whether these symptoms can have other causes, and the latest study could throw some existing convictions into doubt. The study鈥檚 findings imply that 鈥渨e鈥檝e been breaking up families and imprisoning caretakers 鈥� with at least three in the US still on death row 鈥� based on flawed forensic science鈥�, says Heather Kirkwood, a lawyer in Seattle.
To examine the quality of evidence supporting the triad alone as a hallmark of child abuse, a team in Sweden narrowed 3700 abusive head trauma studies down to 1000 that were relevant to the triad of symptoms. Of these, 30 met their strict criteria, such as having a large enough sample size, and not including cases that involved extra injuries in addition to the triad. Of these, they deemed only two studies, both conducted in France and published in 2010, to contain plausible evidence that the triad of symptoms, in the absence of other injuries, point to child abuse. However, the team decided that these didn鈥檛 show sufficient support for the triad alone as definitive evidence of abuse, in part due to a lack of detail about the adults鈥� confessions of shaking.
鈥淥ur main finding is that there鈥檚 very low-quality scientific evidence for the claim,鈥� says , a specialist in general medicine at the Karolinska Institute in Stockholm, and leader of the team, whose report was published last month. 鈥淵ou can鈥檛 use these studies to say that whenever you see these changes in the infant brain, the infant has been shaken 鈥� it鈥檚 not possible according to current knowledge.鈥�
Alarmed response
While the team didn鈥檛 seek to determine alternative causes of the triad, some studies suggested small falls or bleeding in the head during vaginal births may also be associated with these symptoms.
The conclusions have prompted alarm among some doctors. New 杏吧原创 has seen letters sent prior to publication expressing concern over the report鈥檚 content.
The American Academy of Pediatrics (AAP), the Society for Pediatric Radiology in the US, and the European Society of Paediatric Radiology (ESPR) all urged the 鈥� the Swedish agency that commissioned the report 鈥� to let them see a draft and have a say on the contents of the report before publication.
鈥淨uite a few courts have recognised there鈥檚 a legitimate controversy,鈥� says Kirkwood. 鈥淚f the courts take the next step and recognise that there is no reliable evidence base for abusive head trauma, the next logical step would be to eliminate prosecution testimony on this. For obvious reasons, opponents of the report don鈥檛 want this to happen 鈥� hence the last minute effort to stop the Swedes from publishing.鈥�
鈥淲hat we wanted was a chance to review it before it was published,鈥� says Robert Block, chairman of the , and a former president of the AAP. The SBU declined to let the societies comment on the report before publication, with director general Susanna Axelsson telling them it had already been extensively reviewed by external experts, as well as carefully looked over by the SBU board of directors and scientific advisory board.
But this hasn鈥檛 stopped criticism of the report. Three of the six-member study team has no knowledge of abusive head trauma, says Block, who also criticises recent court cases. 鈥淭here has been a groundswell of biased, incorrect and sometimes outright lying in courts, and gullible media that misrepresent the facts about the diagnosis of abusive head trauma,鈥� says Block.
The report is currently being translated into English. 鈥淲e are reserving our opinion until we have seen an official transcript, but fear their conclusions will cause diagnostic difficulties,鈥� says Amaka Offiah, chair of the ESPR鈥檚 child abuse task force.
Legal impact
Lyn枚e says opposition to the report is understandable. 鈥淭hey鈥檙e afraid people who have abused infants might go free, or that parents will use the report as a cover-up for abuse,鈥� he says.
But the report has been backed by Iain Chalmers at the Cochrane Collaboration, which conducts evaluations of scientific evidence in health that are often considered the gold-standard in systematic reviews. The team seems to have done a thorough job, he says.
Critics argue that the so-called triad isn鈥檛 solely relied upon for diagnosing abusive head trauma. 鈥淭he diagnosis is made when thorough physical, radiological, laboratory and other examinations point towards trauma, and confessions by adults who have injured children help our understanding,鈥� says Block. Courts seldom look at the triad on its own, says Offiah.
However, confessions are problematic, and Lyn枚e says that a reliance on these is at the heart of why scientific support for the triad is so weak. Studies involving confessions often fail to explore whether other events, such as breathlessness, unconsciousness or choking, may have occurred before the confessed shaking.
The study鈥檚 conclusion may affect several ongoing legal cases in the UK. 鈥淲e have both appeals and new cases at various stages of development,鈥� says Bill Bache, a lawyer in the UK. The Swedish report is welcome, he says, but arguing its findings in court is likely to be difficult due to a lack of expert witnesses to call upon (see 鈥�Can鈥檛 get a witness鈥�). 鈥淭here are not many people who can speak authoritatively about this issue,鈥� he says.
Can鈥檛 get a witness
Despite questions over evidence for 鈥渟haken baby syndrome鈥�, there is a lack of expert witnesses willing to speak on behalf of UK defendants.
Pathologist Waney Squier, at John Radcliffe Hospital in Oxford, has previously argued that, on their own, the triad of symptoms taken as a sign of child abuse may have other causes. But her court appearances led to her being struck off the medical register in March. A High Court judge ordered her reinstatement last week, but she is banned from giving court evidence for three years.
Her experience could deter others. 鈥淚 still feel that it鈥檚 not safe to give an opinion, so I can鈥檛 risk my job by giving evidence in court,鈥� says Irene Scheimberg at the London Hospital, one of the few other experts in the UK who could speak on behalf of the defence.
鈥淓xpect to see a lot more false convictions in the UK,鈥� says Heather Kirkwood, a lawyer in Seattle.
This article appeared in print under the headline 鈥淪haken baby science questioned鈥�
