A Call for More Scrutiny in Cases of Shaken Baby Syndrome | Waney Squier | TEDxWandsworth

A Call for More Scrutiny in Cases of Shaken Baby Syndrome | Waney Squier | TEDxWandsworth


Translator: Inas Mar
Reviewer: Association Adikia I am a mother, a grandmother,
a pathologist and a scientist. I want to tell you
Linda’s story. Linda and James had a baby boy called Tom.
He was Linda’s third baby. When he was about four months old,
she was alone with him one night. I think many of you may have looked
after young children at some time, your own children, grandchildren
or while babysitting. Sometimes, you’ve been alone with them. This particular night, James is working and Linda became concerned
about Tom’s breathing. She phoned her doctor and she said, “I woke up to give him his feed
and found he wasn’t breathing, not until I picked him up
and lifted him out of his cot. And then, he was fine.
He’s right as rain now.” But the doctor decided
to visit anyway. He found Linda a calm
and experienced mother. He examined baby Tom who had
a mild fever and was a bit snuffly, but he found nothing else and concluded
there was nothing seriously wrong, so he left. But there was something wrong. Because an hour later,
Linda found Tom unconscious. He was not breathing
and had no pulse, so she called an ambulance
and he was rushed to hospital, and put on a life-support machine. A consultant pediatrician examined Tom and found he had bleeding
in the retina, the membrane
at the back of the eyes. A brain scan showed he had
a thin film of blood in the dura, the membrane
that surrounds the brain and the brain was swollen. He had just those three things,
nothing else. But 24 hours later,
Tom was dead. Linda was arrested and charged
with killing her baby. At her trial, Linda was described
as a woman of good character, a caring and careful mother. She said she’d done
nothing to harm Tom, but she couldn’t explain why he collapsed. But doctors, medical experts,
said that those three findings meant that Tom must
have been violently shaken some time after the doctor
had left her house. The jury found Linda guilty and she was
sentenced to three years in prison. A few years later, she appealed
and her conviction was overturned. So she’d been innocent all along! Her name was cleared,
but her life was ruined. Her parents had died,
and James had left her. And because she was in prison, when Tom was buried,
nobody told her. So she was denied the opportunity
of attending her own son’s funeral. But that’s not all. While Linda was on bail awaiting
her trial, she became pregnant. She gave birth to a little girl,
Lucy, when she was in prison. Lucy was immediately taken away
and placed for adoption. Even when her name was cleared,
her conviction overturned, Linda was not allowed
to make contact with her daughter. She lost Tom,
and now she lost Lucy as well. This is not a dystopian nightmare,
this is a true story. And it’s a story that’s repeated day in,
day out, all around the world. In the US, some 2,500 people
are in prison, five of them on death row,
awaiting their execution. In this country, we hear the story
hundreds of times every year in our courts. It’s heard in Sweden, in France,
in Australia and New Zealand. And what all of these stories
have in common is that a doctor
has made the diagnosis of “shaken baby syndrome.” In Linda’s case, I was one
of those doctors. As a pediatric neuropathologist, I studied the brains of babies
who’ve died, hoping to find out why. The police asked me to examine
Tom’s brain, which I did. It was swollen,
nothing out of the ordinary, but that fitted with what the other
doctors were saying in this case: shaken baby syndrome. They believed in it,
and I believed in it. So my report was part of the evidence
that cost Linda so much. What is “shaken baby syndrome?” Central to it is a young baby who presents with one or more
of those three features that Tom had, known together as the triad
of retinal haemorrhage, subdural haemorrhage
and a swollen brain. Remember that word “triad,”
because I’m going to be using it again. There are many causes of the triad, but historically, it was
associated with trauma. Now these babies have
no evidence of trauma. They have no head impact,
no fractures, no bruises. So the shaken baby hypothesis
depends on the assumption that shaking is the cause, and that shaking can generate
enormous forces, equivalent to a fall from a second storey
window or a road traffic accident. And what’s more, the shaking
event is never witnessed, and its effects are
almost always immediate. So with this hypothesis,
it’s easy to identify the perpetrator. It’s the person who was
alone with the baby, and who brought him for medical care. The idea that shaking might cause
the triad was first proposed back in the early 70s
by a small group of doctors in the US. It wasn’t based on research studies
but on anecdotal reports, an article in Newsweek
and speculation. Nobody then, had ever witnessed
a normal baby being shaken and develop the triad. And nobody has, to this day. So you might be
wondering, as I did, how such a tenuous hypothesis
could ever have been accepted? Well, back then, these doctors
were deeply concerned that parents might be harming
their babies and absolutely rightly so, because some parents do. So laws were introduced
across the US, requiring doctors to report even the mere
suspicion of abuse. Failing to do so could result
in prosecution. On the other hand, when doctors do
report something as abuse, they’re granted immunity from prosecution, even if their report
is unfounded or totally false. And so, reports of abuse went from tens,
to hundreds, to thousands a year. And the shaken baby hypothesis grew
from an idea, speculation, into a “syndrome”
and that syndrome was taught as fact in the textbooks and in medical schools. Well, this was nearly
50 years ago. By now, you’re probably thinking
that researchers must have found the evidence-base
to support this hypothesis. But they haven’t. It wasn’t even tested until 1987,
when bio-mechanical studies showed that adults shaking a crash test dummy
as long and as hard as they could generated only half the forces
of about one foot fall. Now, that’s not even as much as
a baby rolling off a bed. Clearly, we can’t do these
biomechanical experiments on babies but we can learn
by observing the world around us. Some of you might remember
that, many years ago, we used to put young babies
in forward-facing car seats. If those cars were involved
in head-on collisions, the babies suffered enormous whiplash. But case studies of those babies showed
they didn’t have the triad. They had fractures
and dislocations of the neck. In 2001, Jennian Geddes,
a neuropathologist and colleague in London showed that the brain damage
in babies alleged to have been shaken was not due to traumatic tearing
of the nerve fibers of the brain as we had thought,
but is due to lack of oxygen. That’s something that’s seen in babies
dying from all sorts of natural conditions and indeed, it’s seen in babies
who have collapsed and died while being nursed
on a ventilator, like baby Tom. A few years later, brain scans showed
that almost half of normal new-born babies have subdural haemorrhage. A similar number
have retinal haemorrhage. So two of the cardinal features
of Shaken baby syndrome are common in normal babies
after normal birth. These two findings are also seen in babies dying from a whole range
of natural conditions as well as minor accidents
and low falls. So, if we turn to the medical literature
for evidence to support this hypothesis, we find it’s riddled with errors,
mostly due to circular logic and poor case definition. At the end of last year,
an independent authority in Sweden published its review
of more than 3,700 research papers and found only two that offered
any support to the hypothesis that shaking causes the triad. Just think about that: nearly 4,000 papers and only two offered any support, and those two were both found to be
of only moderate scientific quality. So today, as I stand here,
I’m sure that shaking can harm babies, and we certainly shouldn’t shake babies. But nearly 50 years of research
have failed to provide us with the justification
to make the assumption that a baby who has the triad
or any one of its components must have been shaken. That leaves us with
the hypothesis that it seems it’s not fit for purpose
for diagnosis, or in the Courts. In the courts,
it gets a bit more complicated. Back in 2001, the Geddes research
stopped me in my tracks. It wasn’t what I had expected. So I read everything I could
about Shaken baby syndrome. As a scientist, I’m ashamed
to admit I hadn’t done so before. I’d been making the diagnosis based on
my uncritical acceptance of what was in the textbooks
and what I had been taught. I was startled to learn that there was no scientific
foundation for the hypothesis. The triad is nearly
a function of immaturity. It’s infant brain’s response
to a whole range of different conditions. So what I had been taught was wrong. What I believed was wrong, and importantly, what I had been
telling the courts was wrong. So I had to change my mind. Having given evidence for
the police in Linda’s first trial, I gave evidence to support her
in her appeal. I wasn’t on my own, but my voice
was certainly now in the minority. But changing my mind
turned the tables on me. Back then, in the criminal courts,
judges and juries were also questioning
the hypothesis and were tending to acquit parents
accused of shaking their babies. But in the Family Courts,
the courts that decide, typically behind close doors, whether mothers like Linda
can keep their babies, they were ever more adamant
in their endorsement of the hypothesis. It wasn’t very long before I was harshly
criticized by family courts judges, because I was challenging
the majority view. In 2010, a report was made
to the General Medical Council, the doctors’ licensing authority,
on the basis of those judicial criticisms. The complaint didn’t come
from the judges who made them, nor did they pursue any of the avenues
available to them to restrict me. No, the complaint came from the police, because I was,
and they actually said, “I was confusing juries with science.” (Laughter) And I was getting in the way of them achieving their desired rates
of conviction in these cases. The complaint was not about my evidence
while I was a prosecution expert, it was only about cases where
I challenged Shaken baby syndrome. My published research on the subject
was never questioned, nor the content of my opinions. It was just the way I expressed them and ironically, my use of the scientific
literature to support my views. I faced a six months hearing, and my licence to practice
medicine was suspended. I was struck off. I appealed
and my license was restored, but I was banned from giving evidence
in the courts for three years. All of this has had a profound effect
on the delivery of justice. Back in 2005, Linda had seven
medical experts to support her. Today, she would likely have none. Experienced, highly qualified doctors
are afraid to become expert witnesses and to challenge the hypothesis
for fear of suffering the same fate as me. Instead, prosecution experts
are emboldened and today, cases are routinely decided on the basis
of such careless opinions such as: “It’s generally considered” or “Most doctors believe
that shaking causes the triad.” These are articles of faith. They have no scientific foundation. Science is not a democracy. Scientific fact is determined
by experiment, by observation, not by how many people happen
to believe in one hypothesis or another. But today, these opinions are unlikely
to meet any significant challenge. And this leaves families defenceless against unfounded allegations of abuse. What can we do?
There are two things. Firstly, at the point of initial contact,
when a baby with the triad or any part of it is brought
to a hospital for medical care, we must have in place, as standard, a protocol for the complete
and rigorous medical, familial and social
assessment of every case and look for all
of the causes of the triad. Getting it wrong at this initial stage means that parents
are assumed to be guilty, and have to prove their innocence,
which is a complete reversal of the burden of proof
of our legal system. Getting it right at this stage means that we will identify
the treatable causes of the triad and can get on with treating them
and save these babies’ lives. If we do find evidence
of violence and abuse, then we can be stringent
in our prosecution of offenders and increase the rates of conviction
of the real child abusers. If we don’t find evidence
of violence and abuse, we can save the emotional and financial
burden of unnecessary prosecutions. Sometimes, there will be
no clear diagnosis, and doctors must not be afraid
to say clearly and unequivocally, “I don’t know.” The second place where something
must be done concerns the courts. All of us, we must demand an Inquiry so we can all see
what is happening in these cases, particularly behind the closed doors
of the Family Division. These courts have the power to impose
draconian sentences. The separation of a baby from his mother
is a life sentence for that baby. It’s a life sentence for his mother. It’s a life sentence for his father,
for his siblings. It’s a life sentence
for every member of the family. Is it right that decisions of such gravity
should be made in secret, hidden from public scrutiny
and accountability? Is it right that in an area of medicine
which has become so controversial, and opinions so polarized,
that these courts, in order to save money,
should appoint a single doctor as the expert to represent
both sides of the argument? Is it right that a doctor whose views
are entrenched in the belief system should go unchallenged,
unquestioned by his peers? No, the courts must hear the scientific dissent on Shaken
baby syndrome, fully and fairly. These courts must be opened.
Justice must be seen, to be done. Otherwise, it is not justice. If we do nothing,
then ordinary people, people who have already suffered
the tragedy of the death of a baby, will continue to have
their families torn apart by incorrect and unscientific opinions. Mothers like Linda
go to prison and babies like Lucy suffer
forced adoption on the basis of belief. This lies at the feet
of the medical profession who has forgotten the fundamental
principle of medicine: “First, do no harm.” By ignoring the science
and adopting unproven hypothesis, doctors have done great harm,
and have led the courts astray. If we do nothing,
this travesty will continue. This travesty of the willful
refusal of the courts and the doctors advising them
to recognize the science that shows they’re wrong, will continue. If we do nothing,
they will continue to do harm to innocent babies and their families. Thank you for listening. (Applause)

28 comments / Add your comment below

  1. Thank you, Dr. Squier, for this careful yet compelling presentation. Your tale is sobering.

    My hat is off to your intellectual honesty. First, you were willing to rethink the common knowledge based on your own scientific understanding, and now you speak the truth you see, even though your message is not popular. After my own journey through the medical literature, I can confirm that your are absolutely right: Misinformed diagnoses of shaken baby are causing untold suffering to innocent families.

  2. THIS IS ONE OF THE MOST IMPORTANT AND GREATEST TEDX TALKS MADE! THANK YOU FOR TALKING ABOUT THIS!! THIS NEEDS TO BE TALKED ABOUT MORE.

  3. Such an important talk, so brilliantly explained. So many people have suffered because of this 'syndrome'. Do hope this talk communicates this message.

  4. I have met this amazing scientist. One thing she said to me has remained with me, she said: "The Science must be defended". This amazing woman has the courage of Galileo and the worlds greatest scientists who ever lived. Despite the many personal attacks on her, she rises above it and courageously defends the science. If Scientists are not allowed to go against dogma and consensus, then science has degenerated into a religion based on faith.

  5. An excellent talk. They ruined that young mother’s life! This is a matter of great concern! I have a 5 month old granddaughter and are reading on health matters of babies quite frequently. I recently heard a similar story from a friend of ours. His grand child in New Zealand was diagnosed with shaken baby syndrome and the carer. Will stand trial in court soon. I had my doubts when he told us the story. Has any scientific research proven a relationship between infant vaccinations and shaken baby syndrome? This is a topic that doctors prefer to rather ignore because of fear of losing their license. I watched the documentaries and were shocked. I am eagerly awaiting your answer .

  6. Excellent talk – thank you very much Dr Waney Squier! We need more doctors to have the courage to admit that they have accepted much of their medical training due to, as Waney states here, 'uncritical acceptance' and relying on what they have been taught. I wonder how many of these 'SBS' cases are in recently vaccinated babies? Probably most – if not all. Most doctors have embraced vaccination with 'uncritical acceptance' and what they have been taught. Yet when you study the history of vaccination it is based on unfounded science and flawed theories. I hope Waney will inspire other doctors to have the courage to speak out and prevent all these injustices.

  7. Can't think of the name of the doctors who believe shaken baby syndrome can be related to how a baby responds to vaccines. Makes sense since this "syndrome" came about as more vaccines we're being given in the 70's…

  8. This is not the only area where family courts destroy families based on speculation. I've never defended a family accused of SBS, but I have for Munchausen Syndrome by Proxy. You could almost replace MSBP for SBS and give the exact same speech.

  9. I believe shaken baby syndrome is 100% real
    But also believe doctors and welfare workers use it as a “catch all” diagnosis in suspected child abuse cases..

  10. Thank you Dr for having the courage to speak about your experience on the subject. Families need your help and more importantly doctors need your help with their courage to come forward. If only doctors had a fraction of your courage ma’am we could evolve at a much faster pace without destroying families across the globe.

  11. As a victim of SBS, I don’t believe it’s just shaking. Like she said, there’s more than just the triad or even things
    not related to it. I don’t know much about my condition, but I know the retinas in my eyes were detached and I suffered from seizures. I’m told I’m lucky to be alive. Of course not every family is guilty, but I know for sure my first parents did more than shake. People should not have to suffer because of doctors beliefs. I support you.

  12. As someone who has taken care of little babies and toddlers….I still find it suspicious when a child just stops breathing in anyone's care. Have I just been lucky? All the children left my care in the same health they were, when their parents left them in my arms. However, I would never want anyone to be wrongfully accused of such terrible abuse. What a nightmare scenario.

  13. And there could be numerous types of shaking behind doors . If shaken too much especially by a man , yes i do indeed believe that a baby could suffer from more than sbs , sorry not sorry . ??‍♀️?

  14. How strange that inspite of her narrative clearly pinpointing the police as the ones complaining about her use of science in the courts, she ends her talk with the message to reform attitudes towards science and the strengthening of the scientific method and perspective in courts and in research. The culprit here is the privatised prison system and the family courts in collusion with them. Police need to fulfil their quotas; they are less concerned with justice than with keeping their jobs in a for-profit prison industry. It's the prison system that needs to be reformed to see less injustice and weird behavior and attitudes towards scientific knowledge and its use in legal cases.

  15. You were a useful tool of the State to attack and destroy families. You were discarded and drummed out the moment your usefulness to police oppression was over. Congrats on waking up.

  16. Wow what a powerful and sobering talk. Makes you wonder just how much of current medical practice is in fact based on "uncritical acceptance" and circular logic and not well proven science. I think this is probably the case for a lot of things not just SBS. I am very distrustful of mainstream medical practice in the western world and this only increases as I learn more and more.

  17. According to Flawed Convictions: "Shaken Baby Syndrome" and the Inertia of Injustice" by Deborah Tuerkheimer, there are hundreds of cases of parents or care-givers convicted of SBS in US prisons. Many received life sentences, and a LOT received far more than 3 years in prison. The sentences in the US judicial system seem incomprehensible especially when compared with sentences in far more obvious crimes.

  18. You can go further with this and look to what is now being revealed about vaccine injury where a baby's brain can be affected by aluminium, etc which can cause brain injury.

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