Fractures and skin lesions in pediatric abusive head trauma: a forensic multi-center study

AbstractAbusive head trauma (AHT) and its most common variant, the shaken baby syndrome (SBS), are predominantly characterized by central nervous system-associated lesions. Relatively little data are available on the value of skeletal and skin injuries for the diagnosis of SBS or AHT. Thus, the present study retrospectively investigated 72 cases of living children diagnosed with the explicit diagnosis of SBS during medico-legal examinations at three German university institutes of legal medicine. The risk of circular reasoning was reduced by the presence of 15 cases with confession by perpetrators. Accordingly, the comparison with the 57 non-confession cases yielded no significant differences. Skeletal survey by conventional projection radiography, often incomplete, was found to be performed in 78% of the cases only. Fractures were found in 32% of the cases. The skull (43%) and ribs (48%) were affected most frequently; only 8% of the cases showed classic metaphyseal lesions. In 48% of the cases, healing fractures were present. Skin lesions (hematomas and abrasions) were found in 53% of the cases with the face (76%), scalp (26%), and trunk (50%) being the major sites. In 48% of the cases, healing skin lesions were observed. Nearly 80% of the cases with fractures also showed skin lesions. The data prove that SBS is frequently accompanied by other forms of physical abuse. Therefore, skeletal survey is indispensable and should always be done completely and according to existing imaging guidelines if child abuse is suspected.

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Abusive head trauma in court: a multi-center study on criminal proceedings in Germany

International Journal of Legal Medicine ◽

10.1007/s00414-020-02435-5 ◽

2020 ◽

Vol 135 (1) ◽

pp. 235-244

Author(s):

Katharina Feld ◽

Dustin Feld ◽

Bernd Karger ◽

Janine Helmus ◽

Nneka Schwimmer-Okike ◽

...

Keyword(s):

Head Trauma ◽

Family Environment ◽

Shaken Baby Syndrome ◽

Abusive Head Trauma ◽

Infants And Toddlers ◽

Criminal Proceedings ◽

Multi Center Study ◽

Living Children ◽

Close Family ◽

Center Study

AbstractThe shaken baby syndrome (SBS) is a common variant of abusive head trauma (AHT) in infants and toddlers. Data on the legal outcome of such cases are still sparse. By means of a retrospective multi-center analysis, 72 cases of living children diagnosed with SBS/AHT from three German university institutes of legal medicine were identified. Forty-six of these cases with 68 accused individuals were available and could be evaluated with regard to basic data on the course of the criminal proceedings as well as the profile of the defendants (sub-divided into suspects, convicts, and confessed perpetrators). Criminal proceedings predominantly commenced with a complaint by the treating hospital (62%) and were found to be closed (without judgment) in 50% of the cases, mostly due to a “lack of sufficient suspicion.” Of the 23 cases with judgment, the court decided on acquittal in 4 cases (17%). Imprisonment was the most frequent sentence (16 out of 19 cases with conviction, 84%), whereby the sentence has been suspended on probation in 63% of the cases. Suspects and perpetrators were mostly male and derived from the close family environment of the injured children. All confessed perpetrators stated an “excessive demand” as the reason for the violent shaking of the child. The results of the present study are in line with data from other studies with other legal systems. As many criminal proceedings were closed and the 4 acquittals occurred because the perpetration could not be ascribed to a specific perpetrator, improving the forensic methods for such an unequivocal assignment would be desirable.

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Denialism Preserves Scientific Controversies: a Case Study of Abusive Head Trauma Research

Journal of Controversies in Biomedical Research ◽

10.36255/jcbmr.2020.37 ◽

2020 ◽

Vol 6 (1) ◽

pp. 1-6

Author(s):

Niels Lynøe ◽

Anders Eriksson

Keyword(s):

Head Trauma ◽

Child Protection ◽

Shaken Baby Syndrome ◽

Abusive Head Trauma ◽

Risk Of Bias ◽

Traditional Theory ◽

Scientific Controversy ◽

Circular Reasoning ◽

Trauma Research ◽

Scientific Controversies

The traditional theory of abusive head trauma requires scientific scrutiny. Those who question the validity of this theory have been accused of denialism for the purpose of obfuscating evidence in legal settings and supporting abusive caregivers. The traditional theory holds that abusive head trauma results from “shaken baby syndrome”. In reference to abusive head trauma in the absence of external signs of trauma, we argue that it is the child-protection clinicians and concerned researchers who represent denialism. We have identified three types of denialism in this area: (i) denialism of the presence of a scientific controversy; (ii) denialism of relevant scientific distinctions between abusive head trauma cases with versus without external signs of trauma; and (iii) denialism of circular reasoning as a major risk of bias. The analysis discloses that the scientific controversy pertaining to abusive head trauma is real and that it is problematic to lump together all alleged abusive head trauma, with and without external signs of trauma. Further, it has been ignored that circular reasoning results in a high risk of bias. We conclude that denialism preserves rather than promotes scientific developments on abusive head trauma research.

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Re‐evaluation of medical findings in alleged shaken baby syndrome and abusive head trauma in Norwegian courts fails to support abuse diagnoses

Acta Paediatrica ◽

10.1111/apa.15956 ◽

2021 ◽

Author(s):

Knut Wester ◽

Ulf Stridbeck ◽

Aslak Syse ◽

Johan Wikström

Keyword(s):

Head Trauma ◽

Shaken Baby Syndrome ◽

Abusive Head Trauma

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Abusive Head Trauma: The Relationship of Perpetrators to Their Victims

PEDIATRICS ◽

10.1542/peds.95.2.259 ◽

1995 ◽

Vol 95 (2) ◽

pp. 259-262 ◽

Cited By ~ 4

Author(s):

Suzanne P. Starling ◽

James R. Holden ◽

Carole Jenny

Keyword(s):

Head Trauma ◽

Significant Proportion ◽

Shaken Baby Syndrome ◽

Abusive Head Trauma ◽

Male Victims ◽

Effective Prevention ◽

Physically Abused ◽

Female Baby ◽

Relationship Of ◽

The Relationship

Objective. Abusive head trauma is the most common cause of morbidity and mortality in physically abused infants. Effective prevention requires the identification of potential perpetrators. No study has specifically addressed the relationship of the perpetrators of abusive head trauma ("shaken baby syndrome") to their victims. The objectives of this study were to identify the abusers and their relationship to victims in these cases. Methods. We reviewed the medical charts of 151 infants who suffered abusive head trauma to determine the perpetrator of the abuse. Caretakers were classified by level of certainty: confession to the crime, legal actions taken, or strong suspicion by the staff. The relationship of abusers to victims was analyzed. Results. Male victims accounted for 60.3% of the cases. Twenty-three percent of the children died, although death rates for boys and girls did not vary significantly. Male perpetrators outnumbered females 2.2:1, with fathers, step-fathers, and mothers' boyfriends committing over 60% of the crimes. Fathers accounted for 37% of the abusers, followed by boyfriends at 20.5%. Female baby-sitters, at 17.3%, were a large, previously unrecognized group of perpetrators. Mothers were responsible for only 12.6% of our cases. All but one of the confessed abusers were with the child at the time of onset of symptoms. Conclusions. Our data suggest male caretakers are at greater risk to abuse infants. Baby-sitters are a concerning risk group, because they represent a significant proportion of abusers, and they more easily escape prosecution. In addition, no prevention efforts have been directed at baby-sitters. These statistics could help change the focus of efforts to prevent abusive head trauma.

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