EvidenceProf Blog

Editor: Colin Miller
Univ. of South Carolina School of Law

Monday, April 25, 2016

Is Shaken Baby Syndrome Junk Science?

The case of Trudy Muñoz Rueda is a tragic one, no matter how you slice it. Munoz ran a daycare in Fairfax, Virginia. "At a widely watched trial, 45-year-old Trudy Muñoz Rueda was accused of violently shaking a 5-month-old in her home day care in 2009, causing serious brain injuries." The

doctors who examined the child found three things: blood under his skin, bleeding inside the eyes and swelling of the brain.  Those symptoms have – for years – prompted a diagnosis of shaken baby syndrome.

At trial,

Defense attorneys had argued that Trudy E. Munoz Rueda had not shaken the baby and that the concept of "shaken baby syndrome" was "junk science" that has not been proven by scientific evidence. The lawyers on both sides of the courtroom launched a battle of national experts on the issue, with the jury taking only five hours to side with those who say it is certainly possible to severely injure an infant merely by shaking the child.

But are those experts right?

The UVA Innocence Project, which was featured on the Serial Podcast, has taken on the case.

“Genetic abnormalities, clotting disorders, some of the retinal hemorrhaging is even caused by efforts to resuscitate a child,” says  Deirdre Enright, Director of the Innocence Project at the University of Virginia.  She fears doctors are often ignoring things that could lead to another diagnosis.

“Blood work that looks unusual or the presence of an infection is ignored by doctors in favor of, ‘We have these three things.  We’re calling this trauma.’”

Pediatric neuroradiologist Patrick Barnes, who used to testify for the prosecution in baby shaking cases, agrees. 

Barnes, a professor at the Stanford University School of Medicine, looked at scans of the baby's head at the request of defense attorneys and came to a different conclusion: The baby had likely suffered from an infection that caused blood clots in the brain, leading to a series of strokes.

"All of the treating physicians simply assumed trauma and stopped looking for alternative explanations," Barnes wrote in a 2012 affidavit. "That is not sound science and cannot be the basis of a reliable prosecution." 

Barnes is not alone. 

Other doctors have also stepped forward to defend parents and caregivers, including George Nichols, the former state medical examiner of Kentucky, who made a surprising offer at a meeting for public defenders shortly after he retired in 1997. 

"I said if they had a case in which I had testified that somebody had died as a result of Shaken Baby Syndrome alone, that they were to contact me and that I would now testify for a reversal," Nichols said. "Shaken Baby Syndrome is a belief system rather than an exercise in modern-day science."

Muñoz Rueda's fate will soon be in the hands of the Governor of Virginia, with the UVA Innocence Project planning to ask him for clemency. Last year the United States District Court for the Eastern District of Virginia denied Muñoz Rueda's claim that she received ineffective assistance of counsel,  decision upheld by the Fourth Circuit, with the Supreme Court subsequently declining to grant cert.



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I think it is wrong to think of Shaken Baby Syndrome (SBS) as "junk science"; it is better to think of it as not science at all. What I mean by that is that Shaken Baby Syndrome is just a label invented by lawyers to cover a range of traumatic deaths. The problem becomes, as the article points out, is that soon doctors began treating SBS as a real medical event. So then medical professionals begin to see what they want to see.

This is isn't a scientific problem as such, it's a cognitive one. "Shaken Baby Syndrome is a belief system rather than an exercise in modern-day science." That's the right way to think about it.

Posted by: Daniel | Apr 25, 2016 4:20:03 PM

My question is: If someone does shake a baby violently, do these same type of injuries result? If so, then it's not junk science, it's just not always the cause.

Posted by: CeeJay | Apr 26, 2016 5:31:32 AM

It is not junk science, it is valid. Investigations need to be more thorough to rule out any other causes first. That is what needs to change.

Posted by: NavyMom | Apr 26, 2016 8:43:20 AM

The problem is two-fold: First, such testimony is not science-based; it is a broad-based assumption derived from others' anecdotal assumptions about how non-specific medical findings were inflicted. Second, criminal defense lawyers have failed to adequately object to the admission of such opinion in the first instance. Even forensic pathologists do not opine that a gunshot wound was "intentionally" inflicted. But gunshot wounds are clearly not natural, and they are _only_ created by gunshots. The same cannot be said of the nonspecific medical findings observed in so-called Shaken Baby cases. Yet, we as attorneys have let some clinical pediatricians testify (without objection) that they are experts in diagnosing crime ("child abuse"). We let them testify (without objection) from these nonspecific medical findings that there was a criminal act, that it was done with criminal intent, and let them speculate in the guise of an opinion about the supposed manner of infliction even where there are no independent facts to support that? Unbelievable.

Posted by: Angie K | Apr 26, 2016 10:14:52 AM

Shaken baby syndrome is a fascinating study in how sincere but unproven medical opinion became apparent courtroom fact. While infant battering can cause the intracranial bleeding and swelling that define shaken baby syndrome, doctors outside the child abuse community now recognize a long and growing list of non-abusive causes, including bleeding and metabolic disorders, birth trauma, stroke, vitamin deficiency, congenital malformations, some kinds of infections, and accidental injury. For the story of a family torn apart when their son's metabolic disorder was misdiagnosed as shaking injury, please see https://onsbs.com/prologue/

Posted by: Sue Luttner | Apr 26, 2016 10:18:16 AM

Sue - there was a case here, in the UK, where a woman was convicted of murdering the toddler son of her neighbours, while she was babysitting. The Crown Prosecution Service made the case that she'd held him by his feet, and swung him at either some banisters, or a wall. She was found guilty and imprisoned.

A few years passed, and after reexamination it was incredibly apparent (I mean to anyone with eyes, just seeing a photograph of her "victim"!) that this child was not the bouncing, neurologically robust baby that he'd been painted as. This child was grossly neurologically abnormal, had almost certainly been suffering from seizures since birth, and had died of injuries and bleeding of the brain sustained during a seizure, and could not (as his parents had repeatedly stated) have been in "perfectly good health" when they'd last seen him.

The neighbour was ultimately acquitted, but her life had been shattered.

The problem is that a diagnosis of SBS is, all too often, made basely solely on the pathology of the brain, without any corresponding injuries to the ribs, limbs, or neck. Absent those bodily injuries, another cause is likely the culprit.

Posted by: Squatch | Apr 26, 2016 8:46:32 PM

The question is not whether it is safe to shake babies. It is not. The question is not whether people violently shake and abuse infants. They do. The question is whether doctors can conclude, beyond a reasonable doubt, based on physical symptoms alone, that a child has been violently shaken by the last person with him / her. They cannot. While shaking may lead to certain symptoms, those symptoms do not necessarily prove shaking, especially not beyond a reasonable doubt. One judge called Shaken Baby Syndrome more an "article of faith" than established science. That is the case.

Posted by: Susan | Apr 26, 2016 8:51:24 PM

The words "forensic" and "science" generally don't deserve to be intermingled.

Science refers to the scientific method, and the peer review within a field until a consensus best current model can emerge.

With the exception of DNA, pretty much no forensic specialties have any science whatsoever involved with getting them to where they are today.

Posted by: Paul | Apr 26, 2016 11:49:02 PM

It is not "junk science" that we should be concerned with, but rather "junk scientists". Most of the analytical uncertainties typically associated with "junk science" is known, and the cautious forensic scientist will acknowledge those uncertainties when creating reports or testimony. It is the "junk scientist" who does not know or refuses to accept (or is forced/enticed to deny) those uncertainties which lead to a wrong analysis.
It is the "junk scientist" who should be named and held accountable for their erroneous conclusions.

@Paul - Even DNA analysis can be considered junk if the person performing the task is a "junk scientist". See also, mixed DNA interpretation.

Posted by: zoe | Apr 27, 2016 7:10:36 AM

Two posters write, " If someone does shake a baby violently, do these same type of injuries result? If so, then it's not junk science, it's just not always the cause."

"Investigations need to be more thorough to rule out any other causes first. That is what needs to change."

The problem here, as Susan points out, is that this is not scientifically possible. The medical professional doesn't know what caused the trauma, he just knows it is there. This is a very common confusion. Doctors are healers, not lawyers or scientists: they only need the facts necessary to create a solution to the problem before them. It is a complete waste of their time to "investigate all other causes first". That simply isn't their job.

Posted by: Daniel | Apr 29, 2016 2:48:01 PM

Whether or not something is right isn't the determining factor as to whether or not it's based on junk science. What makes it junk science is it's based on untested assumptions. Shaken Baby Syndrome is very much junk science.

Posted by: bacchys | May 1, 2016 6:47:31 PM

The real motivation for the anti-shaken baby testimony is money. Any criminal defendant willing to pay enough can hire witness with a lot of degrees to testify in a manner which appears on the surface to exonerate them. I'm glad the jury saw through this. Congratulations to the hard-working prosecutors who cross-examined these witnesses.

Posted by: David Soukup | May 2, 2016 8:58:43 AM

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