by Terri LaPoint
Health Impact News
There has been an increase in recent years in the number of cases of Shaken Baby Syndrome and Abusive Head Trauma. Is this due to an increase in the number of child abusers, better recognition of the symptoms which leads to more accurate diagnoses, or is something else happening? Could it be that increased awareness of Shaken Baby Syndrome in the medical profession has led to overdiagnosis of abuse when there could be other explanations for the symptoms?
If it is the latter, then there stands a good chance of innocent parents or caregivers being blamed, perhaps criminally, for something that they did not do.
At Health Impact News we have covered many cases of parents who were arrested or lost their children to Child Protective Services after being accused of Shaken Baby Syndrome or abuse even though there are legitimate medical conditions accounting for the symptoms.
In what is believed to be the first study of its kind, researchers in Sweden set out to examine this crucial question. They published their findings in the European Journal of Public Health on Tuesday, April 17, 2018. (link )
Infant abuse diagnosis associated with abusive head trauma criteria: incidence increase due to overdiagnosis? 
This study follows up Sweden’s Council on Technology and Social Evaluation and their National Medical Ethics report in 2016 that concluded the science behind SBS is not credible. (Article here .)
The European Journal of Public Health study found that there is a large increase in the number of babies diagnosed with Shaken Baby Syndrome (SBS) or Abusive Head Trauma (AHT), but the increase is not due to increased occurrence of abuse but rather due to an increase in physicians making the diagnosis of abuse.
As the saying goes, “to the man with a hammer, everything looks like a nail.” As doctors became more aware of Shaken Baby Syndrome symptoms, more babies have been diagnosed with it. And more parents are accused of causing it.
To the researchers, the possibility of overdiagnosis “raises ethical and medico-legal concerns.”
The Swedish study was a population-based study. They looked at the records of every baby born in Sweden from 1987 to 2014 with follow-up until a year old.
The hypothesis of our study is that diagnosis of infant abuse is based on SBS/AHT criteria, and that changes in incidence of diagnosis of infant abuse may be due to increased awareness of SBS/AHT criteria.
SBS Diagnosis Lacks Scientific Evidence
The researchers noted that:
Shaken baby syndrome has, since 1997, been questioned as a diagnostic entity, and emerging imaging technology demands further differential diagnostic considerations.
They referenced the 2016 systematic literature review  by the Swedish Agency for Health Technology Assessment and Assessment of Social Service which concluded that “there is not sufficient scientific evidence to establish that the typical damage is certainly caused by skakvåld” or Shaken Baby Syndrome, and that “the children’s symptoms just as well have been caused by birth trauma and not skakvåld.”
Shaken Baby Syndrome as a Diagnosis
From the European Journal of Public Health study:
In 1962 battered child syndrome was first described in a clinical study.
In 1972 it was proposed that subdural haematomas could be caused by whiplash shaking and in 1974 the term ‘shaken baby syndrome (SBS)’ was coined to describe a condition inflicted by violent shaking and identified by the triad retinal haemorrhage, subdural haemorrhage and encephalopathy.
Doctors have been taught to diagnose SBS when “the triad” of symptoms is present – 1) subdural hematoma, or brain bleeding, 2) retinal hemorrhage, and 3) brain swelling, or encephalopathy. Increasingly, the presence of even one of those symptoms can lead doctors to jump to a diagnosis of Shaken Baby Syndrome.
We have seen many cases at Health Impact News where, once any of the symptoms in the triad are seen, doctors, especially Child Abuse Specialists , typically stop looking for any other explanation for the symptoms.
Though many sources use the terms “Shaken Baby Syndrome” and “Abusive Head Trauma” interchangeably, the Swedish study notes that:
The diagnosis of abusive head trauma (AHT), departing from the three diagnostic criteria for SBS, now has a broader categorization that may also include apnoea, seizures, fractures of the skull, metaphyses and shaft of long bones and ribs, and inability of parents/carers to provide an explanation for accidental trauma, the former findings and symptoms being considered highly specific for non-accidental trauma.
Indeed, many of these other symptoms are involved in cases where parents are accused of Shaken Baby Syndrome or other abuse, particularly cases involving some type of brittle bones conditions. The broader diagnostic criteria for Abusive Head Trauma accounts for the cases where parents with children with multiple broken bones report being accused of Shaken Baby Syndrome.
A Typical Scenario
As we have noted many times, there are often real medical conditions accounting for the symptoms, including metabolic bone disorders, Ehlers-Danlos Syndrome, infantile rickets, and vaccine injuries.
In the typical scenario, parents notice a bump on the baby’s arm or leg, or there is a high-pitched scream or seizure, after which the baby stops breathing.
When the baby arrives at the emergency room, doctors do a series of full-body x-rays. The tone at the hospital grows icy as the parents are told that their baby has “multiple broken bones including rib fractures in various stages of healing” and some brain and/or retinal bleeding.
The stunned parents rack their brains for any possible explanation, because, if they are innocent of abuse, they really don’t know what caused the injuries. Because they point to a short fall or have no explanation, the doctors, usually Child Abuse Specialist doctors , see this as the nail in their coffin. Abuse becomes the diagnosis.
Very frequently, these incidents follow shortly after routine vaccinations.
Increased Awareness of Criteria for Diagnosis of Abuse
There has been in Sweden, and around the world, a concerted effort to bring awareness to Shaken Baby Syndrome and child abuse.
In Sweden, battered child syndrome was introduced as a diagnostic criterion during the 1960s, and the triad of SBS was described in the Swedish Medical Journal in 1994.
In 2008, Stockholm County Council published clinical guidelines for the investigation of SBS according to the AHT criteria and the document has been adapted for use in other parts of Sweden.
In 2009, the Swedish Paediatric Society established a child abuse task force to foster awareness of and training in child abuse recognition and reporting, and implementation of the guidelines for investigation and diagnosis of AHT. Subsequently, regional hospital-based child protection centres were established.
As doctors became more aware of Shaken Baby Syndrome and Abusive Head Trauma, more cases were diagnosed. In Sweden:
Altogether 368 infants were diagnosed with maltreatment during the years 1987–2014; 12.3 per 100,000 infants. Seven of the children diagnosed with abuse died, i.e. 0.23 deaths per 100,000 infants and a case fatality rate of 1.9%.
A tenfold increase in diagnosis of infant abuse was observed from the start to the end of the period.
The increase started slowly from 1996, peaking during the years 2008–2014 (figure 1). There was a doubling of the incidence of abuse diagnosis during the years 2008–2014 compared with 1997– 2007 from 12.0 (n = 127)–26.5 (n = 210) per 100,000 infants [odds ratio (OR) 2.21 (95% CI 1.78–2.76)]. Of the 337 cases of infant abuse during the years 1997–2014, 137 had either concomitant diagnoses of subdural haemorrhage, skull fracture, cerebral contusion, traumatic brain injury, convulsions, retinal haemorrhage, rib fracture, or fractures of the long bones.
The increase in abuse diagnoses did not, however, correspond to an increase in the number of the symptoms that were seen by doctors.
With the exception of convulsions, no statistically significant changes in population incidence of subdural haemorrhage, skull fracture, cerebral contusion, retinal haemorrhage, rib fracture or fractures of the long bones could be seen between the two periods [of] 1997–2007 and 2008–2014.
Much of the educational material given to doctors says that babies who are small for their gestational age, preterm, or multiples birthed are more likely to be victims of child abuse. Thus, more cases of SBS and AHT are now being diagnosed in these groups:
Having an abuse diagnosis and being born preterm, Small-for-Gestational-Age or a twin was associated with greatly increased incidences during the latter period, with statistically significant rate ratio changes and aetiologic fractions ranging from 32.6% to 70%.
One explanation could be the risk of metabolic bone disease in relation to being born preterm or SGA or being twin-born.
Interestingly, these conditions are known to be risk factors for brain bleeding and retinal hemorrhaging at the time of birth, before any abuse could have occurred.
Diagnosis of Child Abuse Varies by Region
There were “pronounced regional disparities” in the diagnosis of abuse between the time periods of 1997 to 2007 and 2008 to 2014.
In the South East and the Uppsal-Orebro Regions, there was a slight increase in the percentage of SBS and AHT cases diagnosed. The Southern Region doubled the number of diagnoses, and the Western Region almost tripled.
The Stockholm Region increased almost 6-fold during the same time period, and there was a significant reason for the dramatic increase:
In Stockholm, cases of infant abuse began to rise steeply, concomitant with the establishment of a child protection team and the introduction of a ‘mental vaccination’ against shaking programme in 2008–2010.
A possible interpretation of a contrary effect of the Swedish campaigns is that the increase in diagnosed cases of infant maltreatment did not indicate a real increase in incidence, but instead, a prevalence of overdiagnosis because of enhanced awareness and preparedness of SBS/AHT among health care professionals.
Note: Child Protection Teams at Children’s Hospitals, especially Child Abuse Specialist doctors, are responsible for many findings of abuse in cases where our research shows that there are other medical conditions accounting for the symptoms – conditions for which this specialty of doctors do not generally consider.
Interestingly, the Northern region showed a dramatic reduction, by more than half, of child abuse diagnoses during the time period.
While Accusations Increase, Fewer Parents Are Shaking Babies
At the same time that doctors have been increasingly educated on diagnostic criteria for SBS, public awareness campaigns have been reaching out to parents to educate the public that shaking babies is harmful. One would be hard pressed to find a parent who is not aware of the basics about Shaken Baby Syndrome. This study notes that:
…population surveys showed that Swedish parents reported shaking their children in 18% in 2006, while after an information campaign against shaking, parental reporting of shaking was reduced to almost nil by 2011.
These campaigns are working, yet the number of diagnoses continues to rise, lending credence to the researchers’ conclusion that the diagnostic criteria, not actual occurrences of abuse, is responsible for the increase.
Whether there is an increase in true positive or in false positive cases, the Swedish doubling in cases coincides with the fact that there has been an increased awareness of SBS/AHT among Swedish paediatricians during the latter period of our study, and that doctors may therefore have become more likely to make an infant abuse diagnosis.
A similar finding was reported from a New Zealand hospital study where the incidences of diagnosis of AHT quadrupled from 1991 to 2010 after the establishment of a specialist child protection team; however, the possibility of overdiagnosis was not discussed. [Emphasis added by Health Impact News.]
Tens of Thousands of Innocent Parents May Be Incarcerated for False Accusation of Abuse
Dr. David Ayoub is an American radiologist and expert on infantile rickets. He says that “tens of thousands” of parents may be wrongfully incarcerated for Shaken Baby Syndrome and child abuse.
I get about 1 case per day request, and they are nearly 100% rickets cases. It is RARE that I get a normal bone referral, less than 1%.
I am sure I am consulted in less than 1% of all ongoing cases (regarding SBS charges of child abuse).
There are easily 2,000 cases per year of fractures in infants since the 1980s.
50,000 cases is a reasonable estimate. (Source )
How many more innocent people will lose their children or even be imprisoned for something that they did not do?
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