Elsevier

Child Abuse & Neglect

Volume 35, Issue 1, January 2011, Pages 74-77
Child Abuse & Neglect

Abusive head trauma: A perpetrator confesses

https://doi.org/10.1016/j.chiabu.2010.11.001Get rights and content

Abstract

Objectives

To present a detailed confession from a perpetrator of Shaken Baby syndrome.

Methods

Case study.

Results

We present a confession of Shaken Baby syndrome describing how the perpetrator severely injured a 3 year old with repeated bursts of acceleration–deceleration (shaking). The child sustained retinal and intracranial hemorrhage. Details of the confession and circumstances by which it was obtained lead us to believe its accuracy.

Conclusions

Accurate perpetrator confessions offer useful windows into realities and pathophysiology of abusive head trauma.

Introduction

Shaken Baby syndrome is a form of abusive head trauma (AHT) that results from violent repetitive acceleration–deceleration forces with or without impact (Shaken Impact syndrome) producing characteristic head and ocular injuries. Other terminology has been suggested including Inflicted Traumatic Brain Injury (Bellemare, 2007). Subdural hemorrhage and cerebral edema are the head injuries most often associated with AHT. Hemorrhagic retinopathy is present in approximately 85% of victims (Lancon et al., 1998, Levin, 2000). The victim is usually less than 1 year old but may be up to 3 years old (Levin, 2000), and there have been reported cases in older children (Mierisch, Frasier, Braddock, Giangiacomo, & Berkenbosch, 2004) as well as adults (Carrigan et al., 2000, Pounder, 1997). In confessed cases of AHT the abuser often reports that crying was the precipitating event that led to the abuse (Barr et al., 2006, Lee et al., 2007).

That shaking is associated with a characteristic pattern of brain (e.g., subdural hemorrhage, subarachnoid hemorrhage), eye (retinal hemorrhage), and bone injury (e.g., rib and limb metaphyseal fractures when present) is well recognized in the world's literature including that published by the American Academy of Pediatrics (American Academy of Pediatrics Committee on Child Abuse and Neglect, 2001, Duhaime et al., 1998, Reece and Nicholson, 2003). One can garner useful additional information about such events through detailed confessions in which the concern about truth telling by the perpetrator is lessened. We present the case of a man who confessed to severely injuring his girlfriend's 3 year old daughter by shaking. He was not the biologic father. The confession was obtained under unusual circumstances that lead us to believe that the description given by the perpetrator is accurate.

Section snippets

Case report

One of the authors (AVL) was scheduled to testify in the criminal trial of a 6 foot tall, 82 kg man who was accused of assaulting a 3 year old, 15 kg child. The reported history from the accused was that the child had fallen in the bathtub from a standing position. The victim had a hematoma on the left side of her head when she presented to the hospital but the defendant recalls there being no blood in the tub. When medical help arrived, she was severely obtunded with a heart rate of 45.

Discussion

Abusive head trauma is rarely witnessed and most perpetrators do not confess to physicians caring for the child. Researchers have proposed biomechanical models to replicate these events, and no suitable animal model has been found. Accurate confessions assist researchers and clinicians in understanding the mechanics and cause of this kind of abuse. We had the unique opportunity to obtain a confession from a man who severely injured his girlfriend's 3 year old daughter. The confession occurred

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    However, it is important to emphasize that there is no consensus in the literature regarding whether only shaking the baby can cause the observed brain lesions, or whether the impact of the child's head on some kind of surface is necessary,12–14 and what force would be necessary to inflict the injuries on the baby.14,15 When AHT occurs as a result of violent shaking, a characteristic pattern of injury can be observed, which can include retinal hemorrhage, fractures, especially in the ribs and the extremity of long bones, and recognized patterns of brain injury.13,16–19 In accordance with the Joint Statement on Shaken Baby Syndrome,16 whenever there is the impact of the baby's head against some object, there may be additional injuries such as bruises, lacerations, and fractures.16

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    Studies examining perpetrator admissions also reveal accounts of shaking and/or blunt force trauma in reaction to infant crying. Accounts from perpetrators indicate that infants may be harmed multiple times in various ways, suggesting that the pattern of maltreatment became a “learned” behavior to quell crying.9-12 As highlighted in the above case study, reaching a diagnosis of AHT in infants and toddlers can be quite complicated.

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Funded in part by Brandan's Eye Research Fund and Foerderer Fund.

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