It really takes me by surprise, the sheer tone and volume of the debate that has unleashed in Sweden on shaken baby syndrome. The debate basically concerns whether there is such a thing as shaken baby syndrome or not. In a country, where a debate, just as fierce, took place on if putting a child into timeout is a violation of children’s rights, the evidence of the existence of a medical condition due to shaking an infant and thus causing brain damage has been questioned by the Swedish Supreme Court, resulting in several verdicts of acquittal. The American Paediatric Association recommends that we abandon the name shaken baby syndrome and use abusive head trauma instead, to indicate that more than one form of traumatic abuse can cause severe brain damage. Nevertheless, people still use the term shaken baby syndrome and so will I for now. It is indeed, the mechanism behind the brain injuries that has been questioned. Forensic specialists have argued that biomechanical studies have not been able to substantiate the injury mechanism believed to be causing brain damage in shaken baby syndrome. They argue that haemorrhages present differently in simulation experiments or that neck injuries should be observable for shaking fierce enough to cause brain damage. The problem is that this is a technical discussion, although admittedly vital in court cases when decisions about guilt and intent have to be made. But what I mean by that the discussion is technical is that we know that shaking an infant is really dangerous. So it’s not like we can say – oh look, because we can’t prove that this infant’s injuries are without doubt due to abuse through shaking, and only that, we can now tell parents that it is safe to shake their infants. Because it really is not. My colleagues in other countries barely understand the debate. Among paediatricians this syndrome has long been an accepted and known entity. The way the diagnosis is made is by ruling out every other possible medical or traumatic explanation. Abuse is never the first thing that comes to mind. There is really a rather compelling number and size of population-based studies where abuse by shaking or a combination of shaking and impact have been linked to brain haemorrhage and injury along with retinal bleeding. Symptoms include apnoe or reduced consciousness and these infants often have other injuries, such as rib or long bone fractures. But this is beside the point. Luckily, the Swedish Council on Health Technology Assessment has launched a project on abusive head trauma and will try to figure out the state of the science in the field. My point is that Swedish journalists have been so keen on and so biased in this debate. I think the reason is that journalists were quick to identify with the accused parents. I find this quite unprofessional and believe that journalists should become aware of their own anxieties that are raised by such accusations, instead of letting their defence mechanisms lead them to decide that the parents are right and the system is wrongdoing them. In one of the most popular daily radio news programs, a convicted father, still in jail, was given 7 minutes of prime media time to give his account and state his innocence. He said the infant had several fractured ribs, two long bone fractures, one of which was older, as well as brain haemorrhage. He said he had accidentally jumped back and sat on the infant when it was lying on the sofa, while he was playing with the older sibling. The paediatrician defending the existence of shaken baby syndrome was given much less time and no one questioned the raving implausibility of the infant’s multiple injuries (old and new) in relation to the father’s story. Given the current situation, the guy might even get acquitted. Dropped charges against parents apparently make much better headlines than the realities of a disabled child who survived abusive head trauma. The dead children don’t have a voice either. I worry that this debate is going to result not in protecting innocent parents, but in throwing out abused babies with the bathwater. I hope to be proven wrong.
For now, however, things are not looking good. The public debate has gone so far as to question the very existence of AHT as a diagnosis. So much so that the Swedish Paediatric Association felt obliged to prepare a communiqué to support AHT as a diagnosis and assert that Sweden is no exception when it comes to the occurrence of such cases.