The diagnosis of shaken baby syndrome, the cornerstone of a closely watched case in Massachusetts and many other abuse and murder prosecutions, is facing intense scrutiny around the country amid growing legal challenges to its reliability and underlying science.
Some defense lawyers have seized on research that questions the links between shaken baby syndrome and certain types of brain injuries. They point to specialists who say the brain and eye injuries strongly associated with the trauma can also be caused by accidents and a range of other conditions, including metabolic disorders, blood-clotting problems, and infectious diseases.
“It’s really a move from supposed certainty [about shaken baby diagnoses] toward acknowledgment of unknowns,” said Deborah Tuerkheimer, a Northwestern University law professor and author of “Flawed Convictions: ‘Shaken Baby Syndrome’ and the Inertia of Injustice.” “And those questions have accelerated.”
Since 2001, about 200 shaken baby cases ended when “charges were dropped or dismissed, defendants were found not guilty, or convictions were overturned,” according to a recent report by the Washington Post, in conjunction with Northwestern University’s Medill Justice Project.
In Massachusetts, the state medical examiner’s office is reconsidering its ruling that 1-year-old Rehma Sabir of Cambridge died in 2013 from blunt force head injuries, and that her death was a homicide. Her nanny, Aisling Brady McCarthy, is charged with murder in her death, and her lawyers have submitted reports from a number of specialists challenging the cause of death.
Child abuse specialists say they carefully consider a range of alternatives before determining that a child was intentionally harmed, and say the science around shaken baby syndrome, also known as abusive head trauma, is accepted by an overwhelming majority of physicians and scientists across multiple disciplines. Many dismiss critics as a decided minority who testify almost exclusively for the defense in criminal cases.
But in the presence of findings known in the medical profession as the “triad” — subdural hemorrhaging, bleeding in the retina, and brain swelling — other causes are sometimes overlooked, some medical specialists and lawyers say. Symptoms that were once seen as clear-cut evidence of abuse can be explained in other ways, they say.
In September, for example, prosecutors dropped murder charges against a Malden man when the medical examiner’s office changed its ruling that his 6-month-old son had died from head injuries caused by shaking. Medical specialists consulted by the father’s lawyer found that the boy’s mother and grandmother had a rare genetic defect that makes them more susceptible to ruptures of arteries or veins, and concluded that the infant had died of natural causes.
Alice Newton, the specialist who determined that the child died of abusive head trauma, also ruled in the case of Rehma Sabir, the 1-year-old from Cambridge. Newton determined that Rehma was a victim of abusive head trauma, and there was no other medical explanation for her death.
Tests found that the infant suffered from extensive bleeding in her brain and the backs of her eyes, acute injuries that specialists said led directly to her death.
During the last two years, McCarthy’s lawyers have questioned the cause of Rehma’s death and the validity of shaken baby diagnoses in general, a skepticism summarized in a motion filed last summer.
“This is a shaken baby syndrome prosecution,” they wrote. “That means it is a prosecution based on a scientific hypothesis that has crumbled over the last decade.”
A strong majority of doctors reject that claim. In a 2012 report, the Centers for Disease Control found that “serious traumatic brain injury in young children is largely the result of abuse” and specialists say the science used to diagnose abuse is sound.
“Abusive head trauma and shaken baby syndrome are real,” said Cindy Christian, chairwoman of child abuse and neglect prevention at the Children’s Hospital of Philadelphia. “The science hasn’t shifted, it’s expanded, just like in every area of medicine.”
Christian said critics’ contention that abusive head trauma diagnoses rely exclusively on the presence of the “triad” is mistaken, and that specialists explore all other alternatives.
“It’s never the case,” Christian said. “You don't only look at those three things, you look at the whole picture.”
Kevin Whaley, assistant chief medical examiner in Virginia, said that while there are any number of causes of retinal bleeding, in abuse cases the hemorrhaging is “all over the place.”
Similarly, while an accidental fall might cause some bleeding in the brain, more extensive bleeding is often a sign of abuse. “If a baby is shaken, the head not only goes back and forth, it rotates,” said Whaley, a spokesman for the American Society for Clinical Pathology. “The neck isn’t strong enough to stop the head from moving, and the blood vessels in the brain can’t withstand it.”
Whaley said he begins his investigation with the assumption a child has not been killed, and “tries to prove it’s something else.” Even when the triad of clinical symptoms are present, he looks for other possibilities, he said.
McCarthy’s lawyers say Rehma was sick much of her life and suffered from a bleeding disorder, failure to gain weight, and gastrointestinal problems. At the time of her death, tests revealed several healing fractures that were several weeks old, from a time when she was traveling with her family overseas.
Critics of shaken baby diagnoses say Rehma’s medical issues fit a profile.
“In so many cases, the parents have been in the hospital off and on, and there’s just never been a decent explanation,” Tuerkheimer said. “You just have all these signs that it’s a sick baby.”
Authorities charged McCarthy with murder after determining she had sole custody of the child the day she was injured. But Tuerkheimer said suspected abuse victims in some cases suffered brain injuries before the day in question.
“It’s apparent the baby was not well when it was delivered to the caregiver,” she said. “It’s not only shaking that causes this, you have to rule other things out. Many if not most of these cases seem to be naturally caused.”
McCarthy, who was granted bail early this month, is scheduled to stand trial in October.
John Graef, a pediatrician who cares for newborns at Beth Israel Deaconess Medical Center, said many alternatives to abusive head trauma can be easily ruled out with testing, and that specialists are trained to explore all possibilities. While signs of abuse may sometimes be determined to be accidental, that is rarely the case, he said.
But Keith Findley, assistant law professor at the University of Wisconsin and the codirector of the Wisconsin Innocence Project, said the consensus around shaken baby diagnoses has crumbled.
“There is no gold standard diagnostic criteria for shaken baby syndrome,” he said. “The science is changing.”Peter Schworm can be reached at firstname.lastname@example.org. Follow him on Twitter @globepete.