Shaken Baby Syndrome: Reviewing a Helpful Resource for Practitioners in This Field

In this article, Bryan Cox KC reviews the recent publication ‘Shaken Baby Syndrome – Investigating the Abusive Head Trauma Controversy’, relating it to his own experience representing those who have faced allegations of baby shaking.

A recent publication by Cambridge University entitled Shaken Baby Syndrome-Investigating the Abusive Head Trauma Controversy, Press (Online 2023; Hardback 2024) will be of interest and assistance to those engaged in cases concerning allegations of so called ‘Shaken baby syndrome’ (SBS), both in the criminal and family courts.
The authors state that the book is about “the scientific reliability of a causal connection between abusive shaking and the constellation of intercranial findings in infants”, and define SBS as the “medical hypothesis according to which, with few exceptions, all infants presenting with retinal and subdural haemorrhage possibly associated with bridging vein thrombosis with no history or evidence of major trauma are presumed to have been violently shaken moments before showing signs of neurological compromise”. This “hypothesis” is characterised as the “sacred scripture”, and subjected to a substantial and rigorous critique.

Controversial Conclusions for SBS

With the caveat that the perspective of the authors is to present the ‘case against’, rather than the ‘case for’ SBS, this is a serious and comprehensive academic work consisting of 27 chapters from a multidisciplinary team of eminent authors, including (as one might expect) paediatricians, radiologists and neurosurgeons, but also two professors of law, a mathematician, a biomechanical engineer and a neuroscientist.
It is perhaps unsurprising that the controversial neuropathologist, Waney Squier, is among the authors – those who practice regularly in this field will be familiar with her controversial opinions which she has maintained over the years, including in the face of adverse judicial comment, and it is plain that her scepticism about the ‘received wisdom’ concerning SBS remains undiminished. The authors draw extensively from experience and research from across the world, including statistical evidence, and the fundamental point of the book is to highlight the absence of scientific evidence to support what the authors persuasively contend is an unproved hypothesis.
The authors conclude that “decades of experimental and operational research, most notably in neuropathology, have failed to verify the hypothesis”. A “circularity bias” is identified as a major flaw in current thinking about SBS because so many publications are based on case series, case studies, or observational studies without any proper reference test, where the diagnostic process has been insufficiently rigorous, and non-abusive causes have in consequence been overlooked. The authors cite substantial data in support of their argument, derived from both the UK and abroad.
This book is the first of its kind to pull together in one place such a broad multidisciplinary critique of SBS. Some chapters provide interesting background and context, but a number go further and, in addition to providing a detailed yet clear explanation of the complexities of the medicine behind SBS, focus on the weaknesses in the position of those who subscribe wholeheartedly and uncritically to the SBS hypothesis. For example, there is an interesting chapter on the importance of predisposing factors in the context of head injury which, it is argued, are often ignored or misdiagnosed, and chapter 9 is essentially a reasoned explanation from one paediatrician as to how and why he became an SBS sceptic.

What Does This Mean for Baby Shaking Court Cases?

Long experience defending in the Crown Court and representing parents facing allegations of baby shaking in the family court, teaches that it is often nigh impossible to identify suitable experts prepared to engage in critical examination of a prosecution case, let alone mount a serious challenge to the received orthodoxy. Indeed, I have recent experience of one medical expert in the field who declined to acknowledge that there were legitimate differences of opinion in the medical community in relation to SBS.
It is therefore vital that those practising in this field are familiar with the limitations and weaknesses in the SBS hypothesis, and able to subject it to rigorous examination so that the evidential weight of the medical evidence is properly circumscribed. In particular, it is crucial that those asserting SBS are not permitted to present it as established fact – rather than hypothesis (albeit a widely accepted one). The evidential weight of the medical evidence in any given case will inevitably vary, but the state of medical knowledge is not such that clinicians should be permitted to assert that findings of abuse must axiomatically follow from evidence of the so called ‘triad’ of medical findings.
This book amply demonstrates the fallacy of such an approach and, in addition to providing pointers to the type of expertise that may assist, provides important and valuable ammunition to those seeking to mount serious challenge to the SBS hypothesis, not least by explaining its possible weaknesses and limitations. I recommend it as instructive reading for those involved in this area of the law.

If you or your client are under investigation for baby shaking, domestic violence or abuse, please contact our clerks to enlist the representation of a family law barrister with extensive experience in the field.

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Bryan Cox KC

Bryan Cox KC

Call: 1979 Silk: 2005

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