Get informed, and keep up to date.
According to the United Nations, 80% of children who die from violence are under age 6, and of those, 40% are infants (Child Welfare Information Gateway [CWIG], 2006; Pinheiro, 2006). The most common cause of violent death for this age group is head injury, followed by blunt force trauma to the child’s body. Although there are many possible sources of traumatic head injury, in 1971 it was suggested that shaking could cause subdural hematomas (and associated cerebral edema), one of the most common types of intracranial injuries seen in deceased infants (Guthkelch, 1971). It was purported that shaking was the mechanism responsible for shearing or tearing the cortical bridging or connecting veins in the brain, which, in turn, caused hematomas. One year later, in 1972, pediatric radiologist John Caffey coined the term “whiplash shaken baby syndrome” to describe a cluster of physical symptoms found in severely traumatized infants. These signs or symptoms included brain injury (i.e., subdural and/or subarachnoid hemorrhages), retinal hemorrhages, and little to no external evidence of head trauma (Caffey, 1972a). Caffey concluded that this type of traumatic intracranial bleeding, similar to that seen in “whiplash” victims, was inflicted by shaking (Caffey, 1972a, 1972b, 1974). Eventually this cluster, or triad, of clinical findings in infants and children came to be known as either “shaken baby triad” or “shaken baby syndrome” (SBS). When additional symptoms consistent with the infant’s head striking a solid or semi-solid surface (such as cranial fractures) were present, the condition was referred to as “shaken-impact” or “shaken-slam.”
Characteristics of the Crime
Shaken baby syndrome is thought to be caused by an adult grasping an infant by the torso or arms (pressed against the sides) and shaking the child back and forth in quick, jerky motions (British Broadcasting Corporation [BBC], 2008; Emerson, Pieramici, Stoessel, Berreen, & Gariano, 2001; Caffey, 1974). In the process, some (but not all) shaking victims might be thrown onto a bed, a couch, or the floor. Infant brains are especially vulnerable to this type of injury as their incomplete development results in a larger space between the brain and the skull in which greater acceleration can be achieved. Despite the brain’s relatively small size, an infant’s head represents one-fourth to one-third of his or her body weight with high water content. Supported by a weak neck, when the infant is shaken, the head essentially “flops” or “flaps” against the chest and back. This action produces closed head trauma, which is the characteristic and universal symptom of SBS. In the most severe cases of shaking, the victim will either instantly or rapidly fall into unconsciousness or a coma, followed by death. In less severe cases, the victim may manifest a number of physical and behavioral signs of head trauma. Irritability is one of the most common symptoms associated with less severe shaking, especially when seen concomitantly with drowsiness and/or vomiting (that may be projectile) without diarrhea. The eyes of shaking victims may appear “glassy” or may show no or impaired tracking. Either or both pupils may be fixed or show evidence of blood pooling. In virtually all cases of mild to moderate shaking there is some degree of lethargy. Victims of shaking may show reduced or no appetite and may have difficulty with sucking or swallowing which, in turn, may result in choking. The skin tone of some victims may appear pale or bluish, breathing may be irregular, and the child may be unable to smile or vocalize. The infant or child may show decreased muscle tone, swelling of the head, an inability to lift or turn the head, or bizarre positioning of the head in relation to the body. As deterioration advances, the child may suffer from altered consciousness, convulsions, or seizures. In addition to the above, there are numerous indicators of shaking that may not be readily apparent. These include abnormally low blood pressure, mild to moderate anemia, abdominal and/or chest injuries, soft tissue swelling (resulting from underlying fractures), and a swollen or tense fontanel (resulting from cerebral edema). In addition to possible impact-induced skull fractures, the victim may suffer from a number of other fractured bones, including the collarbone, any of the long bones, and, most telling, the back of the ribs (Minns & Busuttil, 2004; Glass, Norton, Mitre, & Kang, 2002). Despite the number of signs and symptoms of SBS, it has been suggested that in approximately one-third of those infants seen by private physicians or in emergency rooms, abuse-induced head trauma is completely missed or misdiagnosed upon first presentation (Kemp, Stoodley, Cobley, Coles, & Kemp, 2003; Jenny, Hymel, Ritzen, Reinert, & Hay, 1999; Ewing-Cobbs et al., 1998; Alexander, Crabbe, Sato, Smith, & Bennett, 1990). The difficulty in accurately diagnosing SBS may be attributed to several factors. In addition to the fact that there may be no external evidence of injury, the symptoms of SBS and their onset vary from case to case, with no accepted explanation for this variety. Even with severe shaking, while the symptoms may appear immediately, they may not reach their peak until approximately 6 hours later. With sublethal shaking, symptoms such as lethargy, irritability, poor feeding or appetite, and vomiting may wax and wane over the course of days or weeks. Many of the more readily identified but nonspecific signs and symptoms of shaking may be attributed to and, in fact, caused by a number of other conditions. Frequently, SBS is misdiagnosed as a persistent viral infection (including meningitis) or flu, dehydration, vitamin C or K deficiency, feeding dysfunction, colic, failure-to-thrive, or sudden-infant-death syndrome (Jenny et al., 1999). When victims are placed on life support before a thorough evaluation can be completed, at autopsy the symptoms caused by SBS may be attributed to the effects of artificial respiration on the brain. Obtaining an accurate history in the process of diagnosing SBS is difficult at best, especially as there are generally no witnesses to shaking. If the perpetrator takes the child for medical attention, for a number of reasons he or she may be unwilling or unlikely to provide a truthful description of what preceded the onset of symptoms, further complicating accurate diagnosis.The American College of Forensic Examiners International began in 1992; it is still here. Most membership associations rise and fall in less than a decade, but the passion of ACFEI’s founder, Dr. Robert O’Block, and the thousands of reputable people his associations help each year, has fueled continued growth since ACFEI’s inception nearly two decades ago.
As we continually improve our continuing education coursework, Web presence, and printed publications, that growth is bound to continue. The fields in which our members work, study, and fight are not going anywhere anytime soon, and are dynamic and ever evolving. When you join the American Board for Certification in Homeland Security, the American Association for Integrative Medicine, the American Psychotherapy Association, or the tried-and-true American College of Forensic Examiners Institute, you will see that we rise above the competition in offering continuing education excellence. Dr. Robert O’Block has created a unique opportunity for you to meet like-minded professionals to network, learn, and teach one another and the world at large.
To learn more, please visit www.acfei.com.
What is it that draws so many—nurses, physicians, soldiers, investigators, government employees, psychologists, psychiatrists, social workers, and a sheer multitude of other honorable professions—into the American College of Forensic Examiners Institute fold? Let me share with you just a few of the numerous reasons so you can better decide for yourself, as thousands wisely did before you:
Accreditation. The American College of Forensic Examiners Institute is an approved provider of continuing education by the following:
Continuing education alignments. In addition to the several accreditations above, we are also proud to inform you that:
To learn more, visit www.acfei.com
By Randy Noblitt, PhD, FACFEI, and Pamela Perskin Noblitt
The Social Security Administration (SSA) has established procedures whereby disabled
claimants can apply for Social Security Disability (SSD) and Supplemental Security
Income (SSI) benefits. This article addresses the criteria by which this agency makes
determinations and why helping professionals are duty-bound to provide advocacy and
support for their legitimately disabled patients. Furthermore, it provides guidance regarding definitions and processes involved in disability determination. Finally, this article challenges helping professionals to rise to the defense of their disabled clients and patients to provide the support and advocacy consistent with professional ethics.
By Randy Noblitt, PhD, FACFEI, and Pamela Perskin Noblitt
The Social Security Administration (SSA) has established procedures whereby disabled
claimants can apply for Social Security Disability (SSD) and Supplemental Security
Income (SSI) benefits. This article addresses the criteria by which this agency makes
determinations and why helping professionals are duty-bound to provide advocacy and
support for their legitimately disabled patients. Furthermore, it provides guidance regarding definitions and processes involved in disability determination. Finally, this article challenges helping professionals to rise to the defense of their disabled clients and
patients to provide the support and advocacy consistent with professional ethics.
By Randy Noblitt, PhD, FACFEI, and Pamela Perskin Noblitt
The Social Security Administration (SSA) has established procedures whereby disabled
claimants can apply for Social Security Disability (SSD) and Supplemental Security
Income (SSI) benefits. This article addresses the criteria by which this agency makes
determinations and why helping professionals are duty-bound to provide advocacy and
support for their legitimately disabled patients. Furthermore, it provides guidance regarding definitions and processes involved in disability determination. Finally, this article challenges helping professionals to rise to the defense of their disabled clients and
patients to provide the support and advocacy consistent with professional ethics.
By Randy Noblitt, PhD, FACFEI, and Pamela Perskin Noblitt
The Social Security Administration (SSA) has established procedures whereby disabled
claimants can apply for Social Security Disability (SSD) and Supplemental Security
Income (SSI) benefits. This article addresses the criteria by which this agency makes
determinations and why helping professionals are duty-bound to provide advocacy and
support for their legitimately disabled patients. Furthermore, it provides guidance regarding definitions and processes involved in disability determination. Finally, this article challenges helping professionals to rise to the defense of their disabled clients and
patients to provide the support and advocacy consistent with professional ethics.
By Randy Noblitt, PhD, FACFEI, and Pamela Perskin Noblitt
The Social Security Administration (SSA) has established procedures whereby disabled
claimants can apply for Social Security Disability (SSD) and Supplemental Security
Income (SSI) benefits. This article addresses the criteria by which this agency makes
determinations and why helping professionals are duty-bound to provide advocacy and
support for their legitimately disabled patients. Furthermore, it provides guidance regarding definitions and processes involved in disability determination. Finally, this article challenges helping professionals to rise to the defense of their disabled clients and patients to provide the support and advocacy consistent with professional ethics.
According to the United Nations, 80% of children who die from violence are under age 6, and of those, 40% are infants (Child Welfare Information Gateway [CWIG], 2006; Pinheiro, 2006). The most common cause of violent death for this age group is head injury, followed by blunt force trauma to the child’s body. Although there are many possible sources of traumatic head injury, in 1971 it was suggested that shaking could cause subdural hematomas (and associated cerebral edema), one of the most common types of intracranial injuries seen in deceased infants (Guthkelch, 1971). It was purported that shaking was the mechanism responsible for shearing or tearing the cortical bridging or connecting veins in the brain, which, in turn, caused hematomas. One year later, in 1972, pediatric radiologist John Caffey coined the term “whiplash shaken baby syndrome” to describe a cluster of physical symptoms found in severely traumatized infants. These signs or symptoms included brain injury (i.e., subdural and/or subarachnoid hemorrhages), retinal hemorrhages, and little to no external evidence of head trauma (Caffey, 1972a). Caffey concluded that this type of traumatic intracranial bleeding, similar to that seen in “whiplash” victims, was inflicted by shaking (Caffey, 1972a, 1972b, 1974). Eventually this cluster, or triad, of clinical findings in infants and children came to be known as either “shaken baby triad” or “shaken baby syndrome” (SBS). When additional symptoms consistent with the infant’s head striking a solid or semi-solid surface (such as cranial fractures) were present, the condition was referred to as “shaken-impact” or “shaken-slam.”
According to the United Nations, 80% of children who die from violence are under age 6, and of those, 40% are infants (Child Welfare Information Gateway [CWIG], 2006; Pinheiro, 2006). The most common cause of violent death for this age group is head injury, followed by blunt force trauma to the child’s body. Although there are many possible sources of traumatic head injury, in 1971 it was suggested that shaking could cause subdural hematomas (and associated cerebral edema), one of the most common types of intracranial injuries seen in deceased infants (Guthkelch, 1971). It was purported that shaking was the mechanism responsible for shearing or tearing the cortical bridging or connecting veins in the brain, which, in turn, caused hematomas. One year later, in 1972, pediatric radiologist John Caffey coined the term “whiplash shaken baby syndrome” to describe a cluster of physical symptoms found in severely traumatized infants. These signs or symptoms included brain injury (i.e., subdural and/or subarachnoid hemorrhages), retinal hemorrhages, and little to no external evidence of head trauma (Caffey, 1972a). Caffey concluded that this type of traumatic intracranial bleeding, similar to that seen in “whiplash” victims, was inflicted by shaking (Caffey, 1972a, 1972b, 1974). Eventually this cluster, or triad, of clinical findings in infants and children came to be known as either “shaken baby triad” or “shaken baby syndrome” (SBS). When additional symptoms consistent with the infant’s head striking a solid or semi-solid surface (such as cranial fractures) were present, the condition was referred to as “shaken-impact” or “shaken-slam.”
According to the United Nations, 80% of children who die from violence are under age 6, and of those, 40% are infants (Child Welfare Information Gateway [CWIG], 2006; Pinheiro, 2006). The most common cause of violent death for this age group is head injury, followed by blunt force trauma to the child’s body. Although there are many possible sources of traumatic head injury, in 1971 it was suggested that shaking could cause subdural hematomas (and associated cerebral edema), one of the most common types of intracranial injuries seen in deceased infants (Guthkelch, 1971). It was purported that shaking was the mechanism responsible for shearing or tearing the cortical bridging or connecting veins in the brain, which, in turn, caused hematomas. One year later, in 1972, pediatric radiologist John Caffey coined the term “whiplash shaken baby syndrome” to describe a cluster of physical symptoms found in severely traumatized infants. These signs or symptoms included brain injury (i.e., subdural and/or subarachnoid hemorrhages), retinal hemorrhages, and little to no external evidence of head trauma (Caffey, 1972a). Caffey concluded that this type of traumatic intracranial bleeding, similar to that seen in “whiplash” victims, was inflicted by shaking (Caffey, 1972a, 1972b, 1974). Eventually this cluster, or triad, of clinical findings in infants and children came to be known as either “shaken baby triad” or “shaken baby syndrome” (SBS). When additional symptoms consistent with the infant’s head striking a solid or semi-solid surface (such as cranial fractures) were present, the condition was referred to as “shaken-impact” or “shaken-slam.”
Copyright ©2009
ABFSW,
ACFEI,
and ABCHS. All rights reserved. Dr. Robert O'Block, Founder, CEO, and Publisher.
Managed by Management Executives, Inc. -
Visit our other sites -
Contact