Shaken by an infant's injuries

'Days in intensive care went by, days with no good news, only a bedside vigil over a scrap of person whose head was hugely swollen with fluid'
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Every parent knows that there are few babyhoods that pass without a few knocks and tumbles, and even the occasional resounding biff on the head. Usually such accidents serve as nothing more than a reminder that one can't be too careful, as well as a comforting piece of evidence that though babies are certainly vulnerable, they're also, thankfully, astoundingly tough.

That's why, when a couple of months ago the infant of some friends rolled off a bed and banged his head, the resulting injury seemed so bitterly unjust. This baby had cried at first when he fell, but had quickly, in the phrase dreaded by all parents, "gone floppy". An ambulance was immediately called, and the child was rushed to hospital. There, the news was awful. This seven-month-old had a subdural haemorrhage ­ a blood clot on his brain ­ and needed an immediate operation if his life was to be saved.

And even if his life were saved, it would be days or months before the extent of the damage to his brain could be assessed. Days in intensive care went by, days of complication and unconsciousness, days with no good news, only a bedside vigil over a tiny scrap of person, whose head was hugely swollen with fluid, who was having trouble breathing without assistance, and who showed barely a sign of life.

Only the unspeakable could be worse for any parent. But in the tension of that time it seemed to all the friends of this family that this particular crisis was more than usually grotesque in its cruelty. This baby had from birth been so alert, so pretty, and so joyous and smiley. He slept through the night, he hardly ever cried, and his older sister, who'd been more than a little miffed at his arrival had, preternaturally quickly, come to adore him. He was the second baby that this happy, committed, and close-knit family, these wonderful parents, deserved.

Silly, of course. No baby is more or less deserving of such an awful fate, no normal parents, more or less deserving of such agony. Nevertheless, when the baby was moved to a paediatric ward, when he began to eat and thrive and behave just like his jolly self, it felt like natural justice. All was well with the world again, and soon this family would be back at home where they belonged.

Which was why it was so utterly surreal when the phone call came. There was the mother on the end of the line, saying words that were ungraspable: "They're taking my baby away from me. They won't let him come home with us."

The hospital's medical evidence suggested to them that this baby's injuries could not be the result of a fall, or at least not only the result of a fall. Even if the accident had occurred just as the father had described it, retinal haemorrhaging detected in the baby's eyes suggested that the baby had been shaken as well. The police had been informed and would be making an investigation. Social services were handling the case. The baby would not be released from hospital into the care of his parents. He would only, for his own safety, be released into foster care.

The retinal haemorrhaging, one consultant at the hospital estimated, might have taken place at any time in the month before the admission to hospital, and could only have been caused by violent and extended shaking. In this time, baby had been left alone twice with carers other than his parents. Both would be questioned by the police. The best possible hope at this time was that one of them would admit to having shaken the baby, unaware of the damage that such an action could cause. Often, when shaking is admitted, it is looked upon sympathetically. Sometimes it is not. But in any case, a confession from a carer would be a solution that made some sense.

Anyway, there was some dispute over the time-frame of the alleged incident. Another heavyweight medical opinion held that these eye injuries could only have been inflicted while the child was in the care of one of his parents, in the 12 hours before admission.

Instead, as the pendulum of blame swung wildly, so did the attitudes of the parents. At times when it seemed that the carers were implicated, the parents were acquiescent to the diagnosis of Shaken Baby Syndrome, and wanted desperately to find out what had happened to their son. At other times, when the full force of suspicion fell on them, the only logical explanation, for them, was that this diagnosis was simply wrong.

It would not, sadly, be the first time such a thing has happened. If one is not closely involved with a situation such as this, it seems sensible to accept that in the battle to protect children from abuse, it is best to err on the side of caution. Innocent people under suspicion must accept that they are unfortunate casualties of a system that has absolutely the best interests at heart. But Shaken Baby Syndrome is a fairly new diagnosis, and not quite as tried and tested as it might be wished. How can tests be done? By shaking babies?

All of the information given to new parents now stresses that a baby can be injured much more by shaking than by hitting. Many stressed parents understand that in a moment of loss of control, there can be a temptation to shake rather than hit a baby, in the belief that it will not hurt them as much. All should be aware that they give in to this urge at their baby's peril. Injuries from shaking are devastating because babies cannot support their heads. Their brains ­ and their retinas ­ simply bounce around in their large skulls with great force, and can cause serious brain damage, blindness or death.

Even so, there are usually other injuries associated with SBS that show themselves in conjunction with haemorrhaging, be it retinal or subdural. These include injuries to the neck and spine as the head waves violently and thumbnail bruising where the baby has been held tightly as it has been shaken. No such injuries were found on this baby.

And even retinal haemorrhaging, the presence of which is the only symptom that led to doubt over the parental explanation for this baby's injury, is not the cast-iron indicator it is conventionally held to be. The Institute of Ophthalmologists held a conference last year warning that too much emphasis might be being placed on retinal haemorrhage as a sure sign of shaking.

Other experts are also beginning to suggest that the syndrome might be being over-diagnosed. That would certainly seem to be the case. My friends are not the only people who have found themselves in this situation. A pressure group, which calls itself the 5 Per Centers, represents many parents who insist that they have been falsely accused of inflicting SBS. The name comes from the assertion that 5 per cent of those accused of this crime ­ which can lead to charges of grievous bodily harm, or murder ­ are innocent. The woman who set up the group has, after a lengthy struggle, proven her innocence.

Meanwhile, for my friends, life has become a long round of case conferences and court hearings, as they fight to get their son back home. The baby is in voluntary care, which means he is living with a friend of the family who has been vetted by social services and has undertaken to allow the parents access to their son only at prescribed times, and never alone.

The only consolation must be that these procedures do save many children from harm. In the case of my friends though, it is unlikely that the truth about these eye injuries, and how they were acquired, will ever be known. For now, though, it is stalemate.

Nevertheless, there is hope. The consummate well-being of their other child has not been taken into account, so far, in the decisions that are being taken about her brother's future. Paradoxically, of course, her own world has been shaken by recent events in a manner completely unknown to her before. She finds it terribly strange that her little brother lives somewhere else now, and never comes home. Like all children of her age, she longs for routine to be re-established. But even when ­ or, too horrible to contemplate for too long, if ­ the baby comes home, things will not, for a long, long time, be quite the same again.