Doctor queries shaken baby symptoms

AN INTERNATIONAL expert in inflicted brain injury has challenged the use of specific injury patterns to diagnose shaken baby syndrome, calling for doctors to update their training as new evidence emerges.

Colin Smith, a senior lecturer in pathology at the University of Edinburgh, urged doctors to be more open-minded when assessing children with traumatic brain injuries.

His comments come as 145 incidents of a baby being shaken were reported to the NSW Department of Community Services in 2010-11, compared with 133 the year before - though many doctors believe the condition is under-diagnosed.

When three symptoms occurred together - blood between the brain and the skull, retinal rupture and brain swelling - doctors usually concluded the baby had been violently shaken, Dr Smith told the annual conference of the Royal College of Pathologists of Australasia last week.

But there was growing evidence other conditions, such as lack of blood flow to the brain from a seizure or breathing obstruction, could cause similar injury. "What was considered to be absolute fact and a guarantee of conviction is now much more circumspect," he said.

"Those injuries and their relationship with head injury have been challenged by scientific, peer-reviewed literature."

Doctors were trained to diagnose shaken baby syndrome until proven otherwise, he said, and may have difficulty accepting alternative explanations.

"They see the triad of injuries and don't question it," he said. "It is also very hard to differentiate between deliberate and accidental trauma.

Julie Fordham, an associate professor of forensic science at the University of Western Australia and a criminal lawyer, said wrongful convictions happened "frequently enough to be worried about".

"Some people do kill their babies," she said. "But you can't unjustly convict someone either, based on science that is in a constant state of flux."

Dr Terry Donald, a child protection and forensic paediatrician at the Women's and Children's Hospital in Adelaide, said that while experienced doctors were sometimes more circumspect about the cause of head injury in young children, it was "quite legitimate" for less experienced doctors to be concerned by those same injuries.

Original report here




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