Comments on: When you’re wrong about child abuse

By: Anonymous

Anonymous — Mon, 01 Oct 2007 19:32:00 +0000

This reminds me of thinking about SIDS back in the 1970's. The idea was many parents were accused of killing their kids, when the child really had another, poorly understood underlying disease.

I seem to recall that sort of idea getting into those doctor melodramas in the 1970's.

A dead child, a guilt-wracked parent, who maybe did shake the child at some time, but the shaking had nothing to do with the death. Maybe it's a delayed complication of that bang on the head when the kid climbed the furniture and fell off a month previously.

With shaken baby syndrome, I wonder if we really know what we think we know about the condition.

By: Anonymous

Anonymous — Sat, 29 Sep 2007 17:30:00 +0000

Ronald Uscinski MD, the doc who questions the mechanism of shaken baby syndrome, and has an alternate theory to explain the findings. He’s a pediatric neurosurgeon at Georgetown.

By: Anonymous

Anonymous — Sat, 29 Sep 2007 17:25:00 +0000

Here's the references:
1.Plunkett J. Fatal pediatric head injuries caused by short-distance falls. Am J Forensic Med Pathol 2001;22: 1-12 [PubMed].
2.Geddes JF, Hackshaw AK, Vowles GH, Nickols CD, Whitwell HL. Neuropathology of inflicted head injury in children. I. Patterns of brain damage. Brain 2001;124: 1290-8 [PubMed].
3.Clark BJ. Retinal hemorrhages: evidence of abuse or abuse of evidence? Am J Forensic Med Pathol 2001;22: 415-16 [PubMed].
4.Clark BJ, Adams GG, Luthert PJ. Retinal haemorrhages in infant head injury. Brain 2002;125: 677-8 [PubMed].
5.Uscinski R. Shaken baby syndrome: fundamental questions. Br J Neurosurg 2002;16: 217-19 [PubMed].
6.Ommaya AK, Goldsmith W, Thibault L. Biomechanics and neuropathology of adult and paediatric head injury. Br J Neurosurg 2002;16: 220-42 [PubMed].
7.Vinchon M, Noizet O, Defoort-Dhellemmes S, Soto-Ares G, Dhellemmes P. Infantile subdural hematomas due to traffic accidents. Pediatr Neurosurg 2002;37: 245-53 [PubMed].

By: Anonymous

Anonymous — Sat, 29 Sep 2007 17:24:00 +0000

Just one citation.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=539411

With the December 2002 issue of the JRSM I received a colour brochure advertising the European Conference on Shaken Baby Syndrome, to be held in Edinburgh in May 2003. The chief sponsor is the National Center on Shaken Baby Syndrome, USA, but supporters include the RSM. Shaken baby syndrome (or shaken impact syndrome) is a hypothetical condition, albeit believed in by some with a religious passion. In the hurly-burly of full-time paediatric neurological practice I used to believe in it myself; however, within the past two years publications from several centres have critically questioned the assumptions underlying the concept and the diagnosis1,2,3,4,5,6,7. If the purpose of the conference is scientific enquiry and rational discourse, it is surprising that the authors of these publications are entirely absent from the list of invited speakers.

By: Anonymous

Anonymous — Sat, 29 Sep 2007 17:23:00 +0000

What the article suggests is, despite the doctor's "100% certainty", we don't know as much as we think we do about shaken baby syndrome.

I'm not convinced. I wonder if the forces caused by shaking, that are allegedly disrupting blood vessels intracranially.....I wonder if those forces would have snapped the neck long before anything was hurt in the brain.

I wonder if some of these bleeds are spontaneous or old.

Of course, there's child abuse. But the cases cited in the article would make me want to revisit the theory.

By: Anonymous

Anonymous — Thu, 27 Sep 2007 00:59:00 +0000

All docs are wrong sometimes. What is scarey is that he never thinks that he is. Humans have a great tendency to overestimate the degree of certainty of what they think they know. He doesn’t need to be barred from practice or courts. I am sure that he has saved a lot of abused kids. What he does need is some humility and an appreciation of his own fallability.

There is no way that any person can be 100% certain about what happened if they weren’t there to witness the event.

By: Anonymous

Anonymous — Thu, 27 Sep 2007 00:19:00 +0000

It comes down to what fraction of actual cases of abuse we wish to find.
Clinical suspicion to prompt the legal machine rolling can have either a high threshold (at the expense of missing many cases of abuse) or a lower threshold with the expense of some cases of false positives). No matter where you set the threshold, there will be both some cases missed and some cases overcalled. It comes down to what is an acceptable ratio.
If you hold that there can be no cases of false positive (i.e. accusation without actual guilt) then there can be essentially no professional reporting; kids will stay in homes and die. Some intermediate ground must be accepted. As a society, in order to protect these kids, we acknowlege that some families will be put through the mill. Part of the child abuse reporting system must exist entirely to service this group, to provide professional counseling, to reimburse people for lost work, to help them regain social standing and provide everything possible to make them whole again. After all, if families are hurt in the effort to help children, then children are hurt. Exonerated families must be adequately helped when the system is done with them.

By: Anonymous

Anonymous — Wed, 26 Sep 2007 23:46:00 +0000

ian121 offers a perfectly ridiculous view point; if any professional is every wrong about any judgment call then they should never be permitted to practice their trade again, and at the very least should never have their opinion valued again.

Hate to break it to you, but everyone in every profession no matter how conscientious, learned and well meaning has been wrong. The good ones recognize instances where they have been wrong and learn, the best admit it and help other learn from it too. Those who claim perfection most certainly are not and are the dangerous charlatans.
I much prefer those who admit fallibility and strive to do better over those to maintain the illusion of infallibility at the expense of the truth.

By: ER doctor

ER doctor — Wed, 26 Sep 2007 17:46:00 +0000

the article says he’s been wrong more than once. indicates he’s been disproven in court. that he’s an old fart with old medical knowledge, and bases his decisions on less than uptodate information.

i agree, accusing people of abuse is very serious. but, i also understand that it’s difficult for doctors/teachers to really access the entire situation in such little time. the social services in these cases…failed. largely (it sounds like) because they gave too much ‘credit’ to an old-school doctor on a mission.

foster care is child abuse…especially when a very nurturing (non-abusive) family is broken up in the process…

…shame on the doctor, the social workers, and everyone involved in this very inefficient system (it shouldn’t take months for ‘things to be straightened out’). at least the court (and tens of thousands of dollars) set the record straight.

By: ian121

ian121 — Wed, 26 Sep 2007 16:06:00 +0000

How do you know he’s been wrong more than once?

And if he has been, then why is he allowed to still practice or at the very least offer his opinion to courts, etc.?