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Information on the latest vitamin D news and research.

Find out more information on deficiency, supplementation, sun exposure, and how vitamin D relates to your health.

Dear Dr Cannell: Shaken baby syndrome

Dear Dr Cannell:

My family was recently torn apart by allegations of shaken baby syndrome of my 29 month old son. I found out today from my second opinion doctor that he has a vitamin D deficiency. I’m not sure if you are interested. But what I can tell you is that I’m innocent. And the way the hospital, social workers, and police have handled my case has now grabbed the Innocence Project of Washington’s attention. I’d be happy to give you more info if this saves other families from going through what my family and I are currently going through.

Thanks.

Cathy, Washington

Dear Cathy:

Shaken baby syndrome is a triad of three medical findings: bleeding over the surface of the brain (subdural hematoma), bleeding in the eye (retinal hemorrhage), and brain swelling (cerebral edema). It is the only crime where evidence of a crime is obtained from expert testimony. That is, it is experts who say a crime has been committed, and they do so by inference, reasoning that only shaking the baby could cause these symptoms.

However, in the vast majority of cases there is no visible sign of external trauma. Exactly how then, can one shake a baby hard enough to cause brain damage without leaving a bruise?

The entire diagnosis of shaken baby syndrome is being upended at its very roots. Widespread doubt about the diagnosis was raised in a 2011 New York Times article.

Bazelon E. Shaken-Baby Syndrome Faces New Questions in Court. New York Times February 2, 2011

I’m glad the Innocence Project in your state has taken your case. The widely regarded national Innocence Project has taken the issue head on, trying to free falsely incarcerated parents, contending the diagnosis is faulty, and the cause of the syndrome, despite its name, is actually unknown.

Tuerkheimer D. The Next Innocence Project: Shaken Baby Syndrome and the Criminal Courts. 87 Wash. U. L. Rev. 1 (2009)

Back in 2005, a scientist pointed out that cervical (neck) spine injuries are always seen when baby monkeys are shaken hard enough to cause brain damage. However, cervical spine injuries are almost never seen in human shaken baby syndrome. How can this be?

Bandak FA. Shaken baby syndrome: a biomechanics analysis of injury mechanisms. Forensic Sci Int. 2005 Jun 30;151(1):71-9.

Two of the three signs of shaken baby syndrome are bleeding abnormalities. Almost 20 years ago, a clear seasonality was seen in another infantile bleeding disorder called hemorrhagic disease of the newborn.

Douglas AS. Seasonality of hip fracture and haemorrhagic disease of the newborn. Scott Med J. 1993 Apr;38(2):37-40.

Also, about 20% of the babies with shaken baby syndrome die, and sudden infant death syndrome is highly seasonal.

Osmond C, Murphy M. Seasonality in the sudden infant death syndrome. Paediatr Perinat Epidemiol. 1988 Oct;2(4):337-45.

Douglas AS, Helms PJ, Jolliffe IT. Seasonality of sudden infant death syndrome (SIDS) by age at death. Acta Paediatr. 1998 Oct;87(10):1033-8.

The only link I know of between shaken baby syndrome and vitamin D is this seasonality effect. Shaken baby syndrome is more common in the winter than the summer but that, by itself, proves nothing.

Daly SE, Connor SM. Seasonal variations in the incidence of suspected shaken baby syndrome. Int J Trauma Nurs. 2001 Oct-Dec;7(4):124-8.

However, it turns out one leg of the triad on the diagnosis of shaken baby syndrome, retinal hemorrhages, are very common in normal newborns; about one-fourth of all normal newborns have such hemorrhages.

Watts P, Maguire S, Kwok T, Talabani B, Mann M, Wiener J, Lawson Z, Kemp A. Newborn retinal hemorrhages: A systematic review. J AAPOS. 2013 Feb;17(1):70-8

Likewise, another leg of the triad of shaken baby syndrome, intracranial bleeding, occurs in almost one-half of all normal newborns.

Rooks VJ, Eaton JP, Ruess L, Petermann GW, Keck-Wherley J, Pedersen RC. Prevalence and evolution of intracranial hemorrhage in asymptomatic term infants. AJNR Am J Neuroradiol. 2008 Jun;29(6):1082-9.

In 2011, a brave physician in California questioned the diagnosis.

Gabaeff SC. Challenging the Pathophysiologic Connection between Subdural Hematoma, Retinal Hemorrhage and Shaken Baby Syndrome. West J Emerg Med. 2011 May;12(2):144-58.

He said,

“According to the evidence presented here, the “prognostic” relationship between shaking and retinal hemorrhage is seriously called into question. It appears that shaken baby syndrome does not stand up to an evidenced-based analysis. Furthermore, children with perinatal subdural hematoma, or pre-existing subdural hematoma of any cause, are prone to re-bleed, resulting in episodes of increased intracranial pressure, new retinal hemorrhage and more symptoms, which may occur with minimal force applied to the head or with normal handling.”

Furthermore, additional doubt has been raised by two Wright State University researchers who found an unexplained higher percentage of male infants being diagnosed with shaken baby syndrome; they concluded that shaken baby syndrome was actually caused from recurrent bleeding due to a traumatic birth.

Miller R, Miller M. Overrepresentation of males in traumatic brain injury of infancy and in infants with macrocephaly: further evidence that questions the existence of shaken baby syndrome. Am J Forensic Med Pathol. 2010 Jun;31(2):165-73.

The authors concluded,

“We believe that many infants who have been diagnosed with shaken baby syndrome have been given incorrect diagnoses of child abuse. Rather, their subdural hematoma may occur as a result of a small subdural hematoma from the birthing process that enlarges during early infancy, a short fall, or from macrocephaly.”

So, Cathy, I am glad the Innocence Project has taken up your case. No one has ever adequately explained the motives in these crimes; all they do is to get the expert to say that someone must have lost their temper and shaken the baby. So not only is it the only crime where experts, and not the police, establish that a crime has been committed, those same experts are the ones who give evidence of motive, and that evidence is simply inferred by the diagnosis.

Nor has it ever made any sense to me grabbing hold of a baby and shaking it hard enough to cause brain damage will leave no bruises. Also, if you have ever handled an infant, you know how weak and floppy their necks are; how can you shake a baby hard enough to damage their brain but not their neck? How can those things be? It is about time that common sense was applied to the near hysteria surrounding shaken baby syndrome. In my opinion, the actual cause of the syndrome is yet to be discovered (it may or may not have something to do with vitamin D, which would explain the seasonality of the diagnosis) and when it is, the scale of the past injustice will be revealed.

John Cannell, MD

  About: John Cannell, MD

Dr. John Cannell is founder of the Vitamin D Council. He has written many peer-reviewed papers on vitamin D and speaks frequently across the United States on the subject. Dr. Cannell holds an M.D. and has served the medical field as a general practitioner, emergency physician, and psychiatrist.
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