Re: Shaken baby Syndrome - a forensic pediatric response

[Larry Wissow <lwissow@xxxxxxxxxxxxxxxxxxxxxxx>]

I whole-heartedly endorse the importance of having scientifically- sound
testimony in court, and support also the points made about the shaken baby
syndrome itself. I think that one potential error, however, is in taking
at face value any of the testimony by any of the witnesses in any child
abuse trial.  I agree that serious head injury is incompatible with
"normal" behavior and function, but how well corroborated is the
observation that the baby was "normal" in the days prior to the fatal
incident?  How many times have we been told -- in a variety of clinical
settings -- that a child was behaving normally even just before our
examination, only to find a child who is seriously distressed or even
moribund.  So much of what we do in regular, day to day medicine is based
on our faith in the clinical history.  I continue to be humbled by how
hard it is to assess individual cases, or to make reliable generalizations
about something like shaken baby syndrome, when we are constantly
working in situations where the clinical history is unavailable or even
intentionally misleading.

Larry Wissow, MD MPH
Associate Professor
Social and Behavioral Sciences
JHU School of Hygiene and Public Health
Baltimore, MD 21205 USA