But her father didn’t speak the same language. He couldn’t tell what she wanted and became more and more frustrated by her screams, which would escalate, as would his anxiety. He had no one to turn to in order to give him support or a break from the constant crying. He may have used one or two methods to attempt to soothe his daughter, but they failed. He didn’t want to fail. He wanted to be viewed as a father who could handle any situation. He was the one left to take care of her. Leaving the house for a half-hour wasn’t an option. What would people think if he did that? He’d be a failure as a caregiver, as a father. Instead, he took his daughter into his hands to control the situation, to make the crying stop.
Final Diagnosis of Patience Gill
1. Craniocerebral trauma:
a. Left cheek contusions
b. Subscalpular contusions, posterior (occipital) and left parietal skull
c. No skull or facial bone fractures
d. Diffuse subdural hemorrhage
e. Scattered subarachnoid hemorrhages
f. Marked cerebral edema
g. Bilateral optic nerve hemorrhages
h. Diffuse axonal injury
i. Retinal hemorrhages
j. Deep posterior neck hemorrhage, small
2. No other injuries identified.
Cause of Death:
Craniocerebral trauma
Manner of Death:
Homicide
Every year, thousands of infants and children are shaken by parents and caregivers. The exact numbers are unknown, as there is no database of Shaken Baby Syndrome (SBS) cases, but cases are estimated to fall between 1,000 and 1,500 cases in the U.S. alone. Since many cases are missed diagnoses or are less traumatic, the actual numbers are most likely in the thousands. The missed cases may be ones that are not ruled as abusive or a child was shaken but not hospitalized, etc. So the estimated number is just a best guess. In 2003, Heather T. Keenan and her associates calculated that approximately three hundered children in the U.S. died from being shaken, which correlates with previous estimates of SBS deaths.
How can a child be injured so seriously by being shaken? A baby’s head is larger than an adult’s. It takes up approximately 25 percent of an infant’s body weight. The head also tends to be floppy, since a baby does not initially have strong neck muscles. These muscles develop and strengthen over time. A large, floppy head makes the forces of shaking severe. It also affects the forces of impact (if impact occurs after shaking).
The damage of shaking occurs within the fragile organs of a child. Shaking tears apart an infant’s developing brain, which is soft and rapidly growing. Across the brain, the connective bridging veins are loosely attached, so when a whipping motion occurs during shaking, the resultant combination is very destructive and potentially lethal for an infant or child. Another injury that occurs from violent shaking is retinal hemorrhage. The eye nestles as a globe within the socket and shaking causes a pulling at the back of the eye, which is where the retina is. This extreme pulling causes tiny hemorrhages throughout the entire retina. These widespread hemorrhages cannot be seen with the naked eye; a trained ophthalmologist is needed for an examination. The physiology of the brain and eye will be explained in greater detail in the next chapter.
Who is shaken? Sixty percent of the victims are male. It is presumed that the reason for this is the perpetrator believes a male child should not cry—even though the child is simply communicating a need. Crying is the number one trigger to initiate a shaking event. For toddlers, the trigger is typically a behavioral one, such as toilet training or temper tantrums. The average age of victims is six months. In the victimology chapter, I will explain the reasons why certain children are targeted to be shaken.
In terms of injury from shaking, only 20 percent come out of the shaking with a “positive” outcome. Approximately 60 percent have lifelong physical consequences—blindness, mental retardation, paralysis and permanent disability. There is a 20 to 25 percent death rate. Male perpetrators have been found to be more lethal shakers.
Besides intracranial bleeding and retinal hemorrhages, shaking an infant or young child can cause cerebral edema, body fractures and other injuries. Research has not shown how severe the shaking must be to cause these injuries, so in prevention efforts, parents are cautioned to not shake babies at all. Perpetrator accounts and comparison studies to accidental injuries put the common injuries found in SBS in the violent to severe shaking arena. Light tossing, play, sudden movements, jostling and light shaking (captured in abuse videos) have been shown not to cause the high-level injuries diagnosed by clinicians.
Child abuse statistics for many parts of the world, including the United States, are indicative of worldwide trends. One study that captured what SBS is all about and that signalled the seriousness of the condition was a recent one from 2013. Thomas Niederkrotenthaler and his group found that shaking injuries were much more severe and more lethal than accidental head injuries. Using the new Centers for Disease Control and Prevention definition for abusive head trauma (AHT), they searched a children’s hospital inpatient database and found the national rates for AHT were 39.8 per 100,000 population for children less than one year old and 6.8 per 100,000 population for children one year old. They reported the demographics of AHT as being: more often less than one year of age, male, enrolled in Medicaid, hospitalized longer, died during hospitalization, seen at children’s hospitals and hospitals outside the Northeast.
The researchers recommended targeting socioeconomically disadvantaged families with children less than a year old who live in the South, Midwest and West for prevention purposes. The authors proposed that a more concentrated study of hospitals and hospital regions would be significant in reporting AHT injury.
Why do parents and caregivers shake children? There are multiple reasons, but ultimately it comes down to control as well as a lack thereof. It is a double-edged sword—a crying child who can’t be soothed effectively and an out-of-control parent or caregiver. It is a punishment inflicted on someone who is completely vulnerable. Some individuals just don’t care for infants and children and they are placed in a situation where they are alone with one without support. That can become very dangerous.
In taking the steps to charge and bring a perpetrator of SBS to court, there first needs to be a medical diagnosis. This can be a problem because doctors can come up with wrong diagnoses. Dr. Carol Jenny looked at missed diagnoses of SBS in the 1990s and found that ER and doctor’s office visits missed signs that a baby had been shaken 30 percent of the time, especially if an infant had a moderate shaking event and was not in dire need of medical attention, but rather was fussy, irritable, vomiting, etc. These symptoms can be confused with a virus or other ailment, especially without the use of a CT scan to rule out head injury. Subsequent shakings in the home may cause more dramatic injuries because the abuser may dangerously assume that the baby wasn’t really harmed by the initial shaking and he or she wasn’t blamed for the abuse, so the baby is shaken again and the shaking is usually harder.
SBS is a tragedy that can be prevented. There are a plenty of ways to soothe a crying infant, just as there are signs of potential danger that parents can perceive when leaving their child with a caregiver. The chapters that follow will not only describe the history and physiology of SBS, but also how we are all affected legally, socially and emotionally by this deadly form of child abuse.
Elijah Fisher
My name is Emily Bodily and I am the Parent Spokesperson for the National Center on Shaken Baby Syndrome. My son was shaken in 1998 and, after putting up a valiant fight for four days, my precious son, Elijah, lost the fight and passed away.
The story begins when my son Elijah was sixteen months old and went for a visit with his biological father, Jason, for the weekend of December 19. My nightmare began with a phone call from Jason on the morning of Monday, December 21. He told me Elijah had fallen off