A Rebuttal to the Joint Statement on Shaken Baby Syndrome,
Minister of Public Works and Government Services, Ottawa, 2001.
Harold E Buttram, M.D.
November 27, 2001
Introduction:
At the present time there is a concerted international campaign to train
and mobilize health services, child welfare, police services, justice,
education, social services, and other organizations in the
identification of child abuse under the general term of shaken baby
syndrome, the frequent end result being the accusation and conviction of
parent or caretaker of this crime through the court systems. The Joint
Statement on Shaken Baby Syndrome (SBS), cited above, is a typical
example of this campaign. These accusations and convictions are largely
centered in the United Kingdom, Australia, Canada, and America, where
they are being seen with increasing frequency.
Very tragically, child abuse does occur and deserves appropriate
punishment. However, it is equally tragic when a family, already
grieving over death or injury of their infant, finds a father or mother
unjustly accused, convicted, and imprisoned for murder or injury of the
infant, a murder of which he or she is innocent. In most instances
these families are not only devastated emotionally but ruined
financially so that their defense falls upon public defenders, which
very often seals their fate regardless of the merits of the case.
Personally I am a late-comer to this field following in the footsteps of
two pioneers, both Australians, Viera Scheibner, Ph.D. and Archivedes
Kalokerinos, a medical physician. Based on personal communication, Dr.
Scheibner has written reviews of 56 cases and testified in defense of
parents in some of them, all of whom she feels were innocent of charges
of SBS. Dr. Kalokerinos has worked in defense of 33 cases. In
virtually all of these cases there was a time-related onset of signs and
symptoms following vaccines. Other doctors have almost always dismissed
this association as coincidental, but this is not reasonable. By their
inherent nature, coincidental occurrences may be expected occasionally
but not with an incidence approaching 100 % as has been observed by Drs
Scheibner, Kalokerinos, and the relatively few in which I have been
involved.
If a large portion of accusations and convictions of SBS are the result
of misdiagnosis, as we believe, then we are witnessing a rapidly growing
reign of terror against the families of English-speaking countries.
As described in the medical literature, SBS commonly describes a
combination of subdural hematoma (brain hemorrhages), retinal
hemorrhages, and diffuse axonal injury (diffuse injury of nerve cells in
brain and/or spinal cord) as the triad of diagnostic criteria. In some,
the presence of rib or other fractures is also taken as a sign of child
abuse. (1-4) These basic concepts of SBS, which originated approximately
30 years ago, remain a basis for most SBS accusations and convictions
today in spite of newer scientific publications which promise to
revolutionize these older concepts. The following paper will address a
general review with comparison of older and newer concepts, showing that
many of the premises and claims on which SBS accusations and convictions
are being made are flawed and erroneous.
In order to maintain simplicity and avoid cumbersome length from
repetition, this paper includes several appendices to which the reader
will be referred when appropriate.
Premises and Claims Involved in SBS Accusations and Convictions:
In the joint statement on SBS from Canada, one finds the following
statements:
"Injuries that characterize Shaken Baby Syndrome are intracranial
haemorrhage (bleeding in and around the brain); retinal hemorrhage
(bleeding in the retina of the eye); and fractures of the ribs and at
the long ends of bones. Impact trauma may produce additional injuries
such as bruises, lacerations or other fractures. Shaken Baby Syndrome
is a condition that occurs when an infant or young child is SHAKEN
VIOLENTLY (emphasis ours)....
"Shaken Baby Syndrome may be severely underestimated due to missed
diagnosis and underreporting....
"Shaken Baby Syndrome can occur at any age but occurs most frequently in
infants less than one year of age...
"The severity of the shaking force required to produce injury is such
that it cannot occur in any normal activity such as play, the motions of
daily living or a resuscitation attempt. The act of shaking that
results in injury to the child is so violent that untrained observers
would immediately recognize it as dangerous..."
"Violent shaking has its most serious effect on the infant's head,
causing it to whip backward and forward and to undergo rotational
forces. The shaking causes the shearing of blood vessels around the
brain, leading to a subdural haematoma (a haemorrhage around the
brain). The brain itself may be injured as it smashes against the skull
during shaking. Nerve cells in the shaken brain may be damaged or
destroyed."
Rebuttals:
Five of the above-statements will be quoted below and used as examples
of common claims regarding the Shaken Baby Syndrome, to be followed by
rebuttals:
Claim 1: "Shaken Baby Syndrome (SBS) is a condition that occurs when an
infant or young child is shaken violently.".. "It cannot occur in any
normal activity such as play, the motions of daily living, or a
resuscitation attempt." (In the courts today it is becoming common if
not universal to accept the findings of retinal hemorrhages and subdural
bleeding as diagnostic of SBS and child abuse if found in the absence of
known accidental cause or illness).
Rebuttal: In an article by Jennian F Geddes, a neuropathologist at
Royal London Hospital, and colleagues, Geddes's team studied the brains
of 53 children suspected of dying from deliberate injury. (5) Of the 53
children, 37 were less than a year old.
In the past, brain damage in such circumstances has been blamed on the
brain banging against the skull as a baby is violently shaken or
struck. It has been thought that this direct assault causes a
characteristic kind of damage to the axons of nerves known as diffuse
axonal injury (DAI). However, the researchers found evidence of DAI in
only two of the 37 babies. Instead they found that three-quarters of
the 37 babies had died because they stopped breathing as a result of
previously unseen and undescribed pathology that was focused on the
cranio-cervical junction, the point where the brain meets the spinal
cord, where a (non-violent) rocking motion can damage the vital part of
the spinal cord that controls breathing. When babies stop breathing as
a result of this injury, subsequent lack of oxygen causes the brain to
swell dramatically, which in turn causes hemorrhagic complications and
brain damage formerly attributed to violent shaking or blows.
The cranio-cervical junction is uniquely vulnerable in very young
babies, the authors explained, because their neck muscles are weak and
their heads relatively large and heavy.
The researchers found subdural hemorrhages in 72% of the 53 cases,
although most were too superficial to cause death. Also, retinal
hemorrhages were found in 71% of the 38 cases in which eyes were
examined, but the authors felt that these resulted from a lack of oxygen
to the brain (and the brain edema or swelling) rather than trauma.
In a news interview about her study, Geddes said that such injuries
could not happen just by bouncing a child on your knee or in normal
every day interactions between mother and child.
"They would have to involve vigorous unsupported movement of the head."
She believes most people would realize that this would be dangerous,
"but you could imagine scenarios that might produce the damage without
it being deliberately inflicted," Geddes stated. (6)
Also commenting on these findings, John Binns, a criminal defense
solicitor with Victor Lissack & Roscoe of London, stated:
"Unless it is certain that injuries were caused by gross injuries or
worse, the judge will direct the jury to acquit. On the basis of these
findings it is impossible to imagine a prosecution succeeding in
anything but the clearest cases." (6)
Pursuing the issue of the retinal hemorrhages, experience has shown that
some courts hold retinal hemorrhages alone as diagnostic of SBS, in the
absence of any other finding usually associated with the SBS diagnosis.
This is very difficult to understand. In none of the original articles
on SBS (1-4) was it stated or inferred that child abuse could be
diagnosed on basis of retinal hemorrhages alone. John Plunkett, M.D.
pointed out this fallacy in the American Journal of Forensic Medicine
and Pathology in which he says:
"I do not understand the 'retinal hemorrhage' litmus test for shaken
infant. No one knows what causes retinal hemorrhage, although it is
highly correlated with rotational deceleration injury/subdural
hemorrhage in children, but retinal hemorrhage indistinguishable from
that found in rotational deceleration may be found in association with
ruptured vascular malformations, arachnoid cysts, and CNS (central
nervous system) infections." (7)
There are other causes of retinal hemorrhages. In the text, Ocular
Differential Diagnosis, by Frederick Hampton Roy, M.D., increased
papilledema and increased intracranial pressure (from any cause) are
listed as possible causes of retinal hemorrhages, as well as the DPT,
polio, and MMR vaccines. (8) Retinal hemorrhages have been caused by
occlusion of the central retinal vein following a hepatitis B vaccine,
(9) and childhood resuscitation following events other than trauma.
(10-12)
Claim 2: "Shaken Baby Syndrome may be severely underestimated due to
missed diagnosis and underreporting."
Rebuttal: In an article entitled "The Mistaken Diagnosis of Child
Abuse," Kirschner and Stein made the following comments:
"The suspected diagnosis of child abuse may prove to be unfounded.
Reports in the literature have focused on unusual diseases and folk
medicine practices that may mimic abuse. We report ten cases where
allegations of abuse were lodged against parents because the treating
physicians in the emergency room mistook life-threatening illness or
postmortem artifacts for inflicted injury...Although the histories
related by the parents were in all cases truthful and consistent with
the results of physical examinations of the child, the involved
physicians failed to make a correct diagnosis. Not only a lack of
experience with severe childhood illness and death but also an attitude
of suspicion and/or hostility probably contributed to these
misdiagnoses." (13)
Along a similar vein, in a letter to the British Medical Journal,
English and Sutliff expressed their concerns about injudicious
questioning of parents by emergency room doctors when accidentally
injured children are brought in for care. They state:
"Many parents are insecure and uncertain anyway, especially those with
known predisposing factors in their case histories, such as being young,
having had children in special care units, multiple births, and abnormal
children. While the doctor's primary aim is rightly to protect the
child from non-accidental injury it must be remembered that this is
achieved only by giving insecure families more support, and that the
alienation achieved by what is perceived as a witch hunt is strongly
counterproductive. Arguably, the deterioration in relations between
parents and health service personnel we have observed may actually lead
to more rather than less non-accidental injury." (14)
Claim 3: "Shaken Baby Syndrome can occur at any age but occurs most
frequently in infants less than one year of age..."
Answer: This statement is entirely correct. The great majority of
cases where parents are accused of SBS occur in infants below one year
age, most during the first six months of life. It is included here as
an introduction into a highly pertinent survey in this controversial
area.
This survey concerns an unpublished series of 25 cases involving
accusations or convictions for the SBS, largely collected by attorney
and jury counselor Toni Blake of San Diego, California (personal
communication 2000), which have the following features: 1) All occurred
in fragile infants born from complicated pregnancies. Problems included
prematurity, low birth weights, drug/alcohol problems, diabetic mothers,
or other maternal complications. 2) All infants were 6 months of age or
younger. 3) Onset of signs and symptoms occurred at about 2, 4, or 6
months age, within 12 days of vaccines. 4) All infants had subdural
hematomas. 5) Some had multiple fractures.
It is my understanding that this series is now much larger than the
original 25 cases and will in due time be made public. When this does
occur, it may prove to be of invaluable aid for embattled parents and
caretakers accused and/or convicted of SBS.
Claim 4: "Violent shaking has its most serious effect on the infant's
head, causing it to whip backward and forward and to undergo rotational
forces. The shaking causes the shearing of blood vessels around the
brain, leading to a subdural haemotoma. The brain itself may be injured
as it smashes against the skull during shaking..."
Rebuttal: It is true that violent trauma, either accidental or
non-accidental, can result in the pathologic changes described above.
However, the study of Dr. Jennian Geddes and colleagues previously
reviewed showed that, in a large majority of babies examined, death had
come about by an entirely different mechanism in which violent trauma
played no role. Also, as will be reviewed below, there are valid
grounds for believing that, in many of these cases, the brain edema
(swelling) with inflammation and hemorrhages may be the consequence of
vaccine reactions.
Claim 5: "Injuries that characterize the Shaken Baby Syndrome
are...fractures of the ribs and ends of the long bones." (In courts the
presence of fractures are generally accepted as pathognomonic, or
diagnostic of child abuse, in the absence of known accidental trauma.
This simplistic view lacks an acknowledgement, or even an awareness,
that there are a number of metabolic causes predisposing to spontaneous
fractures or to fractures from minimal trauma during infancy. Infants
born from problem pregnancies, as in the previously mentioned series of
attorney Toni Blake, are especially prone to such bone disorders. Some
of these will be outlined in the following):
Rebuttal: In instances where rib fractures of unknown cause are found
in infants, prosecutors often use the fractures as evidence of child
abuse. In this regard there are two situations in which spontaneous
fractures are prone to take place: temporary brittle bone disease
(TBBD) and scurvy, both of which are characterized by imperfect
connective tissue formation in fetal or infant skeletal tissue. In 26
infants with multiple fractures that fit the criteria of TBBD, (15-16)
there was a striking association between TBBD and decreased fetal
movement during pregnancy, which might occur in extreme prematurity,
multiple birth pregnancies, and chronic oligohydramnios (deficiency of
amniotic fluid) as a result of inadequate uterine space for fetal
movement.
Vitamin C deficiency may contribute to inadequate connective tissue
formation in the bones before birth, making them susceptible to
green-stick fractures and/or metaphyseal plate (costochondral junction)
slippages in utero or during the mechanical stresses of childbirth. Dr.
A Kalokerinos quoted from an older text dealing with scurvy that states:
"Scurvy disrupts these areas, the bone breaks down, and the ribs may
over-ride, forming in typical cases 'beads.' Then the healing commences
with new bone formation looking just like true healing fractures.
Furthermore, not all the ribs will be involved in this process, and the
changes will not all occur at the same time - giving the appearance of
multiple fractures of different ages." (17)
A study of children at the Royal Children's Hospital, Victoria,
Australia has cast doubt on the acceptance of multiple metaphyseal plate
fractures as definite roentgenologic (X-ray) evidence of battering.
This type of fracture occurs in scurvy without undue trauma to the
child. (18)
Vaccines, Scurvy, and Hemorrhagic Diatheses:
Physicians and the lay-public alike generally think of scurvy as an
historical disease of the days of wooden sailing ships, which was
eliminated by the introduction of limes or other citrus fruit into the
diet. However, in a generation of young people and their families
increasingly turning to commercially processed "fast foods" as a major
part of their diets, subtle forms of scurvy may be returning, and being
subtle or "sub-clinical," it is seldom recognized for its true nature.
As indicated by the following story, it is not only possible but
probable that vaccines may in some instances be escalating scurvy from a
smoldering to a fulminating phase, which is then misinterpreted as
Shaken Baby Syndrome:
In the 1970s Dr. Archivedes Kalokerinos, than stationed as a medical
physician among the Australian aborigines, was trouble by a very high
child mortality rate, in some areas approaching 50%. Dr. Kalokerinos
recognized signs of scurvy among the children, whose diets were very
poor. Observing that the children frequently died following
immunizations, especially if they had colds, he recognized that there
might have been a connection between vitamin C deficiency and the
vaccines. With improved nutrition, oral vitamin C supplementation,
injectable vitamin C during acute crises, and avoiding immunizations
during minor illnesses, infant mortality was virtually abolished. (19)
As a result of this work he was awarded the Australian Medal of Merit in
1978.
One of the primary roles of vitamin C in the body being that of
producing and maintaining connective tissue, Dr. Kalokerinos
hypothesized that with minor viral infections further depleting an
already marginal store of vitamin C, the administration of
endotoxin-bearing vaccines would sweep away the residual traces of
vitamin C provoking fulminating scurvy with hemorrhagic complications
from the of weakening of blood vessels.
Childhood Vaccines and Shaken Baby Syndrome:
General Background: Basic Science Deficiencies in Vaccine Testing:
As a result of deficiencies in original pre-licensing safety testing of
current vaccines, large numbers of vaccine reactions may be taking place
unrecognized, especially reactions of a delayed nature. (See appendix 2)
As a general statement, scientific evidence does not support the safety
of immunizations in that safety studies on vaccinations are limited to
short periods only: several days to several weeks. There are no
long-term (months or years) safety studies on any childhood vaccine in
use today. In addition, there are very few before-and-after published
studies on the effects of vaccines on immune parameters and brain
function of babies, studies which are indispensable in formation of a
basic science for the vaccines. Inadequate consideration has been given
to the additive or synergistic adverse effects of multiple simultaneous
vaccines, although in cases of toxic chemicals, two chemicals together
may be 10 times more toxic than either separately, or 3 chemicals 100
times more toxic. (20-22)
Two examples of before-and-after studies from older medical literature
will be cited as examples of these deficiencies. In 1955 AL Low of
Chicago published a study in which he did encephalograms (EEGs) on 83
children before and after pertussis immunization. (23) In two of the
children he found that the EEGs turned abnormal following the
immunizations without other signs or symptoms of abnormal reactions. In
his report he commented,
"This study suggests that mild but possibly significant (emphasis mine)
cerebral reactions may occur in addition to the reported very severe
neurological changes."
Comment: During a time when neurobehavioral problems have become
epidemic among American children, this test suggest that unrecognized
brain injury from vaccines may be far more frequent than officially
recognized. One would think that a preliminary study of this nature
would have been repeated, but a careful search of the literature has
disclosed only one other similar study, one from Japan in which it was
found that 61 children with epilepsy or a history of febrile seizures
showed significant increases in "epileptic spikes" on EEGs following
DTP, DT, or BCG vaccines. (24)
The second example involves the testing of T-lymphocyte subpopulations
(white blood cells which help to govern the immune system) in eleven
healthy adults before and after routine tetanus immunizations. The
results showed a significant though temporary drop in T-helper
lymphocytes. Special concern rests in the fact that in 4 of the
subjects the T-helper cells dropped to levels found in active AIDS
patients. (25)
Comment: If this was the result of a single vaccine in healthy adults,
it is sobering to think of the consequences of a series of multiple
vaccines given to infants with their immature and vulnerable immune
systems.
With a poverty of basic science in current childhood vaccines, as
indicated by these two studies which have never had adequate follow up,
it is probable that many vaccine reactions are taking place unrecognized
as to their true nature. Signs and symptoms mimicking the Shaken Baby
Syndrome may be among these.
DTaP/DTP Vaccines and Shaken Baby Syndrome:
In medical research it is standard procedure to develop an animal model
of a disease for experimentation before proceeding into human studies.
In the case of Shaken Baby Syndrome, these animal models already exist
in publications involving pertussis endotoxin, studies showing reactions
to pertussis which match each and every feature of brain injuries now
represented in courts by prosecutors as proof of the Shaken Baby
Syndrome.
Studies by Iwasa stressed the finding of brain edema as a feature of
pertussis-induced encephalopathy. (26) It is of interest to point out
that there are anecdotal human reports of infants which developed
increased intracranial pressure with bulging fontanelles following DTP
immunizations, which tend to support these animal findings. (27-29) In
addition, in 1972 Galazka reviewed a series of autopsies on children
whose deaths followed the pertussis vaccine. Although limited in
number, findings included brain edema, hyperemia, and soft meninges.
(30) As shown in the study of J Geddes as well as other sources
previously quoted, brain edema in and of itself may result in both
retinal and brain hemorrhages.
Munoz in turn conducted mice studies with pertussigen, an endotoxin
derivative of the pertussis bacteria, in which he found (inflammatory)
infiltrates of lymphocytes surrounding blood vessels in the brain and
spinal cord, findings compatible with an autoimmune encephalitis. (31)
It is noteworthy that vaccines such as pertussis have been used to
induce allergic encephalomyelitis in laboratory animals since 1973, (32)
characterized by brain swelling and hemorrhages similar to that caused
by mechanical injuries.
Allergic Sensitization by Vaccines:
Among the components and combinations of vaccines routinely given to
infants during the first six months of life, the period during which
most complications attributed to SBS take place, those which have been
reported as causing hypersensitivity reactions include pertussis,
(33-34), Hemophilus influenza (Hib), (35) aluminum, (36) the mercury
adjunct thimerosal, (37) and tetanus (38). Depending on the agent,
reactions may be either of an anaphylactic and/or autoimmune nature.
The Controversy of the Latent Period:
According to current guidelines of the Congressional Childhood Vaccine
Injury Act of 1986, the onset of signs and symptoms of encephalitis must
take place within certain time limits following vaccination in order to
qualify for compensation under this act. The current time limit for the
DTP/DTaP vaccines is 3 days, any event taking place beyond this time
limit not being accepted as vaccine-related.
In clinical practice as well as the courts, this time limit has become
accepted as the medical-legal standard. However, there are strong
grounds for believing that this time limit represents human artifact and
not the realities of what is taking place with vaccine reactions. This
subject is too lengthy to include here but is reviewed in Appendix (2).
Hepatitis B Vaccine and the Shaken Baby Sydrome:
In 1994 a special committee of the National Academy of Sciences
(Institute of Medicine) published a comprehensive review of the safety
of the hepatitis B vaccine. When the committee, which carried the
responsibility for determining the safety of vaccines by Congressional
mandate, investigated five possible and plausible adverse effects, they
were unable to come to conclusions for four of them because they found
that relevant safety research had not been done. Furthermore, they
found that serious "gaps and limitations" exist in both the knowledge
and infrastructure (basic science) needed to study vaccine adverse
events. Among the 76 types of vaccine adverse events reviewed by the
IOM, the basic scientific evidence was inadequate to assess definitive
vaccine causality for 50 (66%). The IOM also noted that,
"If research.(is) not improved, future reviews of vaccine safety will be
similarly handicapped." (39)
A scattering of reports suggest that the hepatitis B vaccine may play a
major role, as yet largely unrecognized, in hemorrhagic complications
from vaccines. One especially poignant case involves a mother whose
quadruplets each suffered subdural hemorrhages or bloody spinal fluid
following hepatitis B vaccines. The mother of these children has been
sentenced to 172.5 years in prison.
Among the 109 references provided in Appendix 3 involving reports of
adverse reactions from hepatitis B vaccine, various forms of vasculitis
(inflammation of blood vessels) appear with special frequency along with
a variety of autoimmune neurologic, rheumatoid disorders, and
thrombocytopenia (reduction in blood platelets). Inflammation of blood
vessels, in turn, implies greater fragility and friability of blood
vessels with greater tendency for hemorrhages. In a report of 18 deaths
of neonates following the hepatitis B vaccine by the Vaccine Adverse
Event Reporting System, 1991-1998, hemorrhagic phenomena were common,
including two patients with cerebral hemorrhages, four with pulmonary
bleeding, one with bloody diarrhea, and several with blood in the upper
airway passages. (40) A report in Postgraduate Medicine on acute
hemorrhagic encephalitis cites vaccines as one of the possible causes.
(41) Hypersensitivity vasculitis with swelling and bruising, diagnosed
by biopsy, has been mistaken for child abuse. (42)
Thimerosal; the Mercury Issue:
Prior to 1999 most brands of DTP/DTaP, hepatitis B, and Hib vaccines,
(all of which have been given routinely at ages 2, 4, and 6 months age
for a number of years) contained ethyl mercury in the form of
thimerosal, added to the vaccines as a preservative and an adjuvant to
increase the potency of the vaccine. If one adds 25 micrograms mercury
in a DTP/DTaP vaccine, 12.5 micrograms in hepatitis B, and 25 micrograms
in the Hib vaccine (Hemophilus influenza), it is theoretically possible
that some infants were receiving over 50 or even a 100 times more than
the allowable safe dose according to current U.S. Environmental
Protection Agency (EPA), which limits safe exposure to a maximum of 0.1
micrograms mercury per kilogram of weight per day. (43)
Since 1999 thimerosal has been removed from some vaccines but remains in
others. Tables of vaccines with and with thimerosal are provided for
the U.S. Center for Disease Control. (44)
For over 200 years mercury has been known as a potent neural (brain)
toxin and one of the most toxic of the heavy metals. A possible
mechanism for this toxicity has been disclosed in a recent animal study
in which mercury vapor exposures resulted in retrograde degeneration of
neuronal (brain) membranes, producing molecular lesions similar to those
seen in the brains of patients dying with Alzheimer's disease. (45)
Since August, 1999 a series of Congressional hearings have been taking
place addressing issues of vaccine safety, headed by Congressman Dan
Burton, Chairman of the U.S. House Government Reform Committee. More
recent hearings have focused in part on the thimerosal (mercury) content
of vaccines. Apparently as an off-shoot of these hearings, the
Institute of Medicine, a scientific board usually assigned to evaluate
controversial issues, issued a report on October 1, 2001 entitled,
"Thimerosal-Containing Vaccines and Neurodevelopmental Outcomes." The
IOM report states:
Page 10: "The committee concludes that although the hypothesis that
exposure to thimerosal-containing vaccines could be associated with
neurodevelopmental disorders is not established and rests on indirect
and incomplete information, primarily from analogies with methylmercury
and levels of maximum mercury exposure from vaccines given in children,
the hypothesis is biologically plausible." (Emphasis mine)...Page 11:
"The committee recommends the use of thimerosal-free DTaP, Hib,
hepatitis B vaccines in the United States, despite the fact that there
might be remaining supplies of thimerosal-containing vaccines
available."
The IOM is now on record stating that it is "biologically plausible"
that thimerosal-containing vaccines may be causally related to the
current increases in the childhood neurodevelopemental problems such as
autism, ADHD, speech delays, and other conditions. In my opinion, this
list should include vaccine reactions that are mistakenly diagnosed as
Shaken Baby Syndrome.
Conclusion:
As a conclusion I would like to draw a hypothetical composite picture of
a number of babies diagnosed with the Shaken Baby Syndrome, based on
personal experience as well as the experiences of others with which I am
familiar:
Let us assume that a baby was born prematurely in early 1999, the
product of a complicated pregnancy with maternal diabetes, recurrent
urinary tract infections, and constant nausea which resulted in limited
weight gain during the pregnancy. Diminished fetal movements were noted
by the mother during the latter part of the pregnancy. Labor was
induced at 36 weeks because of oligohydramnios (deficiency in amniotic
fluid). Birth weight was 5 pounds.
The neonatal period was complicated by prolonged jaundice, feeding
problems, nasal congestion, colic, fussiness, and constipation. Just
prior to the routine two-month pediatric visit the baby acquired a head
cold, although there was no fever. At the two-month visit routine
childhood vaccines were administered which included the DTaP, Hepatitis
B, Hemophilus influenza (Hib), and injectable polio. (In 1999 the
hepatitis B vaccine would have contained 12.5 micrograms of thimerosal
(ethyl mercury), and most brands of DTaP would have held 25 micrograms,
most brands Hib 25 micrograms) Calculated on basis of 0.1 micrograms
per day per kilogram body weight of the infant, the 62.5 micrograms of
ethyl mercury would have been over 100 times the allowable amount of
mercury in a given day according to U.S. Environmental Protection Agency
standards for an average weight baby, even more so for a low birth
weight baby born prematurely.
Let us assume further that the baby developed a high fever within hours
of receiving the vaccine along with high-pitched inconsolable crying, at
times accompanied by an arching of the baby's back. The fever and
constant crying did subside after about two days, after which the baby
alternated between somnolence and fretfulness. The parents traded off
nights with the baby and became exhausted. One of these nights, twelve
days following the vaccines, the mother was pacing the floor and rocking
the baby. She was nearly stupefied with fatigue. She later recalled
that, in an unguarded moment, she may have left the head unguarded and
unsupported while rocking the baby so that the head may have flopped
back and forth several times. Several hours later in checking on the
baby in its crib, the parents found that the baby was not breathing.
They attempted artificial resuscitation, called 911, and the child was
rushed to the hospital in an ambulance. Resuscitation was successful in
the hospital emergency room and the baby admitted to a critical care
unit. Initial examinations and tests revealed retinal and brain
hemorrhages as well as evidence of two old rib fractures. Life-support
measures were removed three days following hospital admission when it
was determined that the baby was brain dead.
Autopsy confirmed the findings of retinal/brain hemorrhages and rib
fractures along with the finding of massive cerebral edema (brain
swelling).
Following the baby's death the mother remained numb with fatigue and
grief. While in this state a group of people approached her and
informed her that the autopsy findings were suggestive of the Shaken
Baby Syndrome. Since she was the last person to handle the baby, she
was to be held in custody on suspicion of murdering her baby.
In my opinion, criminal proceedings in such cases, where there is no
conclusive evidence or history of child abuse, perform a gross
miscarriage of justice. If there must be criminal proceedings, as some
insist, I for one believe the charges should be directed elsewhere and
not on the heads of the parents (in this case the hypothetical mother).
Perhaps the only final answer to this dilemma will come when parents are
granted freedom of choice to accept or reject vaccines for their
children based on informed consent. This will give parents the power to
compel adequate vaccine safety testing and surveillance based on the
power of the free market, the ultimate system of checks and balances.
Appendices:
(1) Buttram HE, Shaken Baby Syndrome or vaccine-induced encephalitis?,
Medical Sentinel, Fall, 2001, 6(3): 83-89.
(2) "The Controversy of the Latent Period,"
(unpublished article).
(3) List of 109 publications reporting on Hepatitis B vaccine
reactions.
References:
(1) Weston IT, The pathology of child abuse, in: Heifer RE, Kempe CH,
editors, The Battered Child, University of Chicago Press, 1968: 77-100.
(2) Guthkelch AN, Infantile subdural hematoma and its relationship to
whiplash injury, British Med J, 1971; 11: 430-431.
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