Shaken Baby Syndrome—A Forensic Pediatric Response

To the Editor. As physicians who specialize in the diagnosis and treatment of victims of child abuse, we feel compelled to speak out regarding the scientific evidence as portrayed in the trial of Louise Woodward for the murder of 8-month-old Matthew Eappen. Both in the United States and in England, media publicity surrounding the case has led to considerable sentiment that she was convicted despite allegedly irrefutable scientific evidence presented by the defense that the infant's injuries had occurred days to weeks earlier. Many in the media and the public have failed to credit the jury in this case with having had the intelligence to understand that the prosecution put forward well-established medical evidence that overwhelmingly supported a violent shaking/impact episode on the day in question, when Matthew was in the sole custody of Ms Woodward. The hypothesis put forward by the defense that minor trauma caused a “re-bleed” of an earlier head injury can best be characterized as inaccurate, contrary to vast clinical experience, and unsupported by any published literature. The “re-bleed” theory in infants is a courtroom “diagnosis,” not a medical diagnosis, and the jury properly rejected it.Infants simply do not suffer massive head injury, show no significant symptoms for days, then suddenly collapse and die. Whatever injuries Matthew Eappen may or may not have suffered at some earlier date, when he presented to the hospital in extremis he was suffering from proximately inflicted head injuries that were incompatible with any period of normal behavior subsequent to the injury. Such an injury would and did produce rapidly progressive, if not immediate, loss of consciousness.The shaken baby syndrome (with or without evidence of impact) is now a well-characterized clinical and pathological entity with diagnostic features in severe cases virtually unique to this type of injury—swelling of the brain (cerebral edema) secondary to severe brain injury, bleeding within the head (subdural hemorrhage), and bleeding in the interior linings of the eyes (retinal hemorrhages). Let those who would challenge the specificity of these diagnostic features first do so in the peer-reviewed literature, before speculating on other causes in court. Indeed, the courtroom is not the forum for scientific speculation, but rather the place where only, according to the US Supreme Court in Daubert v Merrill Dow,peer-reviewed, generally accepted, and appropriately tested scientific evidence should be presented.We endorse a panel of medical experts to offer a scientifically based analysis of the medical testimony offered in this case and others so that some guidelines can be established for the courts on future admissibility of scientifically supportable medical testimony.