A child trauma specialist called for an interdisciplinary approach to help stem the rising tide of infant abuse and death known as Shaken Baby Syndrome (SBS).
SBS occurs when an adult violently shakes an infant or child, and can result from as little as five seconds of shaking, said Edward E. Conway Jr., M.D., GSAS ’80, on Nov. 17 at the Lincoln Center campus.
Conway, the chairman of the Milton and Bernice Stern Department of Pediatrics and chief of Pediatric Critical Care Medicine at Beth Israel Medical Center, has devoted his career to investigating the causes and effects of SBS.
Death rates for abused children under the age of four years have hit an “all time high” in the United States, reaching approximately 2,000 fatalities per year, he said. Of those fatalities, 50 percent of those occur in infants one year of age or under.
“We are talking about the most vulnerable and the most susceptible,” said Conway, who presented the Fall Gannon Lecture, “Shaken Baby Syndrome: Medical, Legal and Social Issues.”
“I would argue that, at 5 or 6 children per day, we have a silent epidemic.”
The crime is especially hard to prove against a perpetrator in a court of law because there is often no external sign of trauma on the child’s body.
What happens inside the brain, however, is a different story.
Because of the amount of force, the size of a baby’s head and the consistency of the infant brain itself, violent shaking can cause the head to oscillate and the loose matter to “go to and fro, twisting on itself.” The result, said Conway, is that veins in the infant brain’s neural network may break and begin to bleed, unseen, within the subdural area—possibly even in the retina.
In an emergency room, often the infant appears lethargic, won’t eat, has seizures or slips into a coma. Common excuses from perpetrators, said Conway, include, “The baby fell,” “A sibling did it,” or “The child was choking so I shook it.”
“In a courtroom, we have to be able to refute all of these,” Conway said. “There is absolute medical certainty out there where we can say something did or didn’t happen.”
Conway also addressed the societal causes of SBS.
The leading trigger for an incident of SBS, he said, is when an infant cries. On average, perpetrators are younger, less educated, unmarried and evenly split between men and women. In addition, recent research shows that with each 1 percent increase in unemployment, there is a .5 per 1,000 increase in child maltreatment reports annually.
“It is a perfect storm,” said Conway. “You have a susceptible infant, a susceptible perpetrator and then you add a major stressor—unemployment and the recession.”
And yet, he said, SBS is totally preventable.
“Studies have shown that 80 percent of the population know that shaking is bad,” Conway said. “What nobody knows is, ‘What can I do instead of shaking my baby when my baby is crying horribly?’”
What is needed, he said, is for psychologists, doctors, educators, law enforcement and legal experts to work together. This includes better sharing of medical records through a multicenter database, more research on the biomechanics of pediatric injury, and more educational outreach to schools and high-risk parents.
“Nobody is comfortable talking about [SBS] and hearing the details,” he said. “But it is essential that we get it out there. It is a loss of self-control for probably 10 to 20 seconds, which will invariably destroy the life of an infant, parents, grandparents and family.
“Everyone here has to be an advocate for children,” he said. “We always have to remember the vulnerability of these infants.”
A recipient of the Leon M. Davidoff Certificate of Distinction for teaching of medical students and a Lewis M. Fraad Scholar in Child Health, Conway is a professor of clinical pediatrics at Albert Einstein College of Medicine and a member of the Graduate School of Arts and Sciences (GSAS) Advisory Board at Fordham.
The Gannon Lecture, held twice a year, brings distinguished individuals to Fordham to speak on topics of their expertise. It is named in honor of Robert I. Gannon, S.J., president of Fordham from 1936 to 1949. It is sponsored by GSAS.
