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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.”
References
Alexander, R., Crabbe, L., Sato, Y., Smith, W., & Bennett T. (1990). Serial abuse in children who are shaken. American Journal of Diseases of Children, 144(1), 58–60. Alexander, R. C., Schor, D. P., & Smith, W .L. (1986). Magnetic resonance imaging of intracranial injuries from child abuse. Journal of Pediatrics, 109(6), 975–979. American Academy of Pediatrics, Committee on Child Abuse and Neglect (AAPCCAN). (2001). Shaken baby syndrome: Rotational cranial injuries – technical report. Pediatrics, 108(1), 206–210. American Academy of Pediatrics, Section on Radiology (AAPSR). (2000). Diagnostic imaging of child abuse. Pediatrics, 105(6), 1345–1348. Bandak, F. (2005). Shaken baby syndrome: A biomechanics analysis of injury mechanisms. Forensic Science International, 151(1), 71–79. Barnes, P. D. (2002). Ethical issues in imaging nonaccidental injury: Child abuse. Topics in Magnetic Resonance Imaging, 13(2), 85–94. Barr, R. G. (2007). What is all that crying about? Bulletin of the Centre of Excellence for Early Childhood Development, 6(2), 1–6. Bennett, S., Grenier, D., & Medaglia, A. (2008). The Canadian paediatric surveillance program: A framework for the timely data collection on head injury secondary to suspected child maltreatment. American Journal of Preventative Medicine, 34(4): Suppl 1, S140–S142. Billmire, M. E., & Myers, P. A. (1985). Serious head injury in infants: Accident or abuse? Pediatrics, 75(2), 340–342. British Broadcasting Corporation (BBC). (2008). Panorama: Shaken babies. BBC One. Monday, 10 March 2008. Caffey, J. (1974). The whiplash shaken infant syndrome: Manual shaking by the extremities with whiplash- induced intracranial and intraocular bleeding, linked with residual permanent brain damage and mental retardation. Pediatrics, 54(4), 396– 403. Caffey, J. (1972a). On the theory and practice of shaking infants. Its potential residual effects of permanent brain damage and mental retardation. American Journal of Diseases of Children, 124(2), 161–169. Caffey, J. (1972b). The parent-infant traumatic stress syndrome. American Journal of Roentgenology, 114(2), 218–229. Child Welfare Information Gateway (CWIG). (2006). Child abuse and neglect fatalities: Statistics and interventions. Washington, D.C.: U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. Children’s Trust Fund (CTF). (2004). Never shake: An educator’s guide to the prevention of shaken baby syndrome. Jefferson City, MO: Children’s Trust Fund. Denton, S., & Mileusnic, D. (2003). Delayed sudden death in an infant following an accidental fall. American Journal of Forensic Medicine and Pathology, 24(4), 371–376. Donohoe, M. (2003). Evidence-based medicine and shaken baby syndrome. Part I: Literature review, 1966– 1998. American Journal of Forensic Medicine and Pathology, 24(3), 239–242. Duhaime, A. C., Alario, A. J., Lewander, W. J., Schut, L., Sutton, L. N., Seidl, T. S., et al. (1992). Head injury in very young children: Mechanisms, injury types, and ophthalmologic findings in 100 hospitalized patients younger than 2 years of age. Pediatrics, 90(2,1), 179–185. Dyer, C. (2005). Diagnosis of “shaken baby syndrome” still valid, appeal court rules. British Medical Journal, 331(7511), 253. Emerson, M. V., Pieramici, D. J., Stoessel, K. M., Berreen, J.P., & Gariano, R. F. (2001). Incidence and rate of disappearance of retinal hemorrhage in newborns. Ophthalmology, 108(1), 36–39. Ewing-Cobbs, L., Kramer, L., Prasad, M., Canales, D. N., Louis, P. T., Fletcher, J. M., et al. (1998). Neuroimaging, physical and developmental findings after inflicted and non-inflicted traumatic brain injury in young children. Pediatrics, 102(2), 300–307. Geddes, J. F., Hackshaw, A. K., Vowles, G. H., Nickols, C. D., & Whitwell, H. L. (2001). Neuropathology of inflicted head injury in children. II. Patterns of brain damage. Brain, 124(7), 1290–1298. Geddes, J. F., Vowles, G. H., Hackshaw, A. K., Nickols, C. D., Scott, I. S., & Whitwell, H. L. (2001). Neuropathology of inflicted head injury in children. II. Microscopic brain injury in infants. Brain, 124(7), 1299–1306. Gena, M. (2007). Shaken baby syndrome: Medical uncertainty casts doubt on convictions. Wisconsin Law Review, 701. Glass, R. B. F., Norton, K. I., Mitre, S. A., & Kang, E. (2002). Pediatric ribs: A spectrum of abnormalities. Radiographics, 22(1), 87–104. Goetting, M. G., & Sowa, B. (1990). Retinal hemorrhage after cardiopulmonary resuscitation in children: An etiologic reevaluation. Pediatrics, 85(4), 585–588. Guthkelch, A. N. (1971). Infantile subdural haematoma and its relationship to whiplash injury. British Medical Journal, 2(759), 430–431. Jenny, C., Hymel, K. P., Ritzen, A., Reinert, S. E., & Hay, T. C. (1999). Analysis of missed cases of abusive head trauma. Journal of the American Medical Association, 281(7), 621–626. Keenan, H. T, Runyan, D. K., Marshall, S. W, Nocera, M. A., Merten, D. F., & Sinal, S. H. (2003). A population-based study of inflicted traumatic brain injury in young children. Journal of the American Medical Association, 290(5), 621–626. Kemp, A. M., Stoodley, N., Cobley, C., Coles, L., & Kemp, K. W. (2003). Apnoea and brain swelling in non-accidental head injury. Archives of Disease in Childhood, 88, 472–476. Lantz, P. E., Sinal, S. H., Stanton, C. A., & Weaver, R. G. (2004). Perimacular retinal folds from childhood head trauma. British Medical Journal, 328(7442), 754–756. Leestma, J. E. (2006). “Shaken baby syndrome”: Do confessions by alleged perpetrators validate the concept? Journal of American Physicians and Surgeons, 11(1), 14–16. Levin, A. V. (1990). Ocular manifestations of child abuse. Ophthalmology Clinics of North America, 3, 249–264. Levin, A. V. (1998). The ocular findings in child abuse. Focal Points: Clinical Modules for Ophthalmologists, 16(7), 1–14. Looney, C. B., Smith, J. K., Merck, L. H., Wolfe, H. M., Chescheir, N. C., Hamer, R. M., et al. (2007). Intracranial hemorrhage in asymptomatic neonates: Prevalence on MR images and relationship to obstetric and neonatal risk factors. Radiology, 242(2), 535–541. Minns, R. A., & Busuttil, A. (2004). Patterns of presentation of the shaken baby syndrome: Four types of inflicted brain injury predominate. British Medical Journal, 328(7442), 766. Office of Juvenile Justice and Delinquency Prevention (OJJDP). (1996). Recognizing when a child’s injury or illness is caused by abuse: Portable guides to investigating child abuse. (NCJ-160938). Washington, D.C.: U.S. Department of Justice, Office of Justice Programs. Omaya, A. K., Goldsmith, W., & Thibault, L. (2002). Biomechanics and neuropathology of adult and paediatric head injury. British Journal of Neurosurgery, 16(3), 220–242. Pinheiro, P. S. (2006). World Report on Violence against Children. Geneva, Switzerland: UN Secretary-General’s Study on Violence. Plunkett, J. (2001). Fatal pediatric head injuries caused by short-distance falls. American Journal of Forensic Medicine and Pathology, 22(1), 1–12. Reece, R. M., & Sege, R. (2000). Childhood head injuries: Accidental or inflicted? Archives of Pediatric and Adolescent Medicine, 154(1), 11–15. Rutty, G. N., Smith, C. M., & Malia, R. G. (1999). Late-form hemorrhagic disease of the newborn. American Journal of Forensic Medicine and Pathology, 20(1), 48–51. Sato, Y., Yuh, W. T., Smith, W. L, Alexander, R. C., Kao, S. C., & Ellerbroek, C. J. (1989). Head injury in child abuse: Evaluation with MR imaging. Radiology, 173(3), 653–657. United States Advisory Board on Child Abuse and Neglect (USABCAN). (1995). A nation’s shame: Fatal child abuse and neglect in the United States. (Report No. 5).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.”
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