Pediatricians are always on the lookout for the tragic triad—brain swelling, bleeding in the retina, and damage to the brain’s membranes. These are the telltale signs of Shaken Baby Syndrome. But whether those signs always mean a baby has been abused is the subject of fierce debate. “You simply have people who are unwilling to accept the large body of data or evidence,” Dr. Sandeep Narang of Northwestern University wrote in a press statement this week after vigorously arguing at the American Academy of Pediatrics that SBS represents child abuse. But not everyone is convinced. Deborah Tuerkheimer, also of Northwestern, wrote an article in response to Narang’s work concluding that “the triad can no longer prove guilt.” That’s a significant statement considering Narang’s harangue promotes a law enforcement reactions to a constellation of deadly symptoms.
Make no mistake: The stakes are high. The Centers for Disease Control and Prevention suggest that, each year, at least 1,200 infants are injured after their caregivers vigorously shake them and at least 80 babies die as a result. Experts like Narang maintain that the triad is a near perfect indicator of child abuse, and that these three symptoms do not appear after a baby is accidentally jostled. Based on this, U.S. courts rely on the triad to prosecute caregivers. In at least one case the triad was used to identify a perpetrator, under the assumption that the caregiver last seen with the baby before symptoms of head trauma kicked in must have shaken him.
This week, Narang told AAP that he surveyed 628 physicians who focus on pediatric trauma at top children’s hospitals, and found that between 88 and 93 percent agreed that the triad indicates Shaken Baby Syndrome or Abusive Head Trauma. In other words, the vast majority of physicians surveyed believe that the triad and SBS diagnosis indicate outright child abuse, assuming the medical diagnosis is performed correctly by a competent professional.
Tuerkheimer disagrees with Narang’s assessment. “Regardless of whether it is possible for shaking to bring about the triad, doctors agree on this,” she writes. “The triad can no longer be considered proof that a baby was shaken by the last caregiver.” Experts now know that the triad can appear even without violent, purposeful shaking, she claims, and that it is not necessarily proof of abuse. Although both Tuerkheimer and Narang agree that shaking a baby constitutes child abuse, and that vigorous shaking can cause the triad to appear, they differ strongly over the question of whether accidental injuries run the risk of implicating innocent caregivers.
“The certitude that once surrounded SBS has been dissolving for years; even the AAP calls the new diagnosis ‘less certain’ than the old,” Tuerkheimer writes. “In short, the triad can no longer prove guilt. The pediatric community’s continued commitment to SBS does not change this.”