Swedish Review Declares Shaken Baby Theory Unproven

sbuheaderSwedish agency charged with assessing health technology and social services has published a review of the shaken baby literature declaring the scientific evidence for shaking theory “weak” and noting that a number of other medical conditions can cause the findings typically used to diagnose shaking injury.

The posted report from the SBU (Statens Feredning för Medicinsk Och Social Utvärdering) is in Swedish, so I am relying on a Google translation and private email exchanges with native Swedish speakers for this summary.

Feb. 2017 update: The report is now available in English

babySilhouetteThe SBU team looked only at cases of pure shaking, without evidence of impact, in children younger than 12 months, and they set standards regarding sample size, study design, and more.  Their literature search strategies yielded 3,773 abstracts, and they screened 1,065 of the articles in full text. Only 30 of the papers met their reliability guidelines. The authors ranked two of those papers as medium quality, designating 28 of them low quality and none of them high quality.

The report identifies the recurring problems with the published research, especially the circular reasoning introduced when shaken infants are identified by the criteria being studied. The two papers that passed the quality review are both from France, Vinchon 2010 and Adamsbaum 2010:

  • Vinchon M, de Foort­Dhellemmes S, Desurmont M, Delestret I. “Confessed abuse versus witnessed accidents in infants: comparison of clinical, radiological, and ophthalmological data in corroborated cases.” Childs Nerv Syst 2010;26:637­45
  • Adamsbaum C, Grabar S, Mejean N, Rey­Salmon C. “Abusive head trauma: judicial admissions highlight violent and repetitive shaking.” Pediatrics 2010;126:546­55

Both papers used confessions to identify abused children—the report noted that neither paper provided details of the circumstances in which the confessions were obtained.

The SBU report follows a Swedish Supreme Court decision last year that overturned the conviction of a father with the observation (from the English translation of the decision):

It can be concluded that, in general terms, the scientific evidence for the diagnosis of violent shaking has turned out to be uncertain.

This week’s report, which confirms the court’s conclusion, has made a splash in the Swedish press, with headlines like “Shaky support [skakig bevisning] för shaken-baby-syndrome.” Google translates the introductory paragraph of that piece as:

The diagnosis of “shaken baby syndrome” has previously been questioned both medically and legally. Now comes the SBU and Smers investigative report argues that the evidence of [shaking violence] not measure up.

Mats Hellberg, a board member of the Swedish group RFFR (Riksförbundet För Famijers Råttigheter, or National Association for the Rights of Families), reports that the Swedish child protection teams are objecting that the SBU’s conclusions will make it harder for them to protect children in the future. “Positions are extremely polarized and group thinking is strong,” he wrote.

In addition to criticizing the existing literature, the report suggests the kinds of research that would help resolve the ongoing debate about shaking theory. I hope the SBU analysis, which I’m told is now being translated into English, will trigger more reflection, more rigorous research, and more clear thinking about shaken baby theory.

Oct. 29 update:  With thanks to readers who alerted me:  The American Academy of Pediatrics (AAP), the Society for Pediatric Radiology, and a number of other professional organizations approached the SBU earlier this month, asking for input on the final report before it was published. These letters were published in the Swedish periodical Expressen, which presented them as an attempt to interfere with the independent Swedish review. There is a translation tool at the top of their on-line treatment, which includes close-ups on the letters in the photo collection. An excerpt from the AAP letter:

“Medical and biomechanical research, clinical and pathologic experience, and radiologic evidence have confirmed the understanding of the range of mechanism that contribute to brain injury from these forms of abuse.

“Because a report from the SBU could have global medical, public health, and legal ramifications, we respectfully request that you allow international peer review by AAP experts on child abuse, pediatric radiology, neurological surgery, and that you consider their feedback in the final report. In addition, we request that you promptly provide us with the draft report so that we can evaluate your  methods, sources, conclusions, and review processes and prepare a timely response if appropriate.”

I think it’s fair to assume the AAP is now working on a rebuttal.

If you are unfamiliar with the debate about shaken baby syndrome, please see the home page of this blog.

copyright 2016, Sue Luttner

15 Comments

Filed under abusive head trauma, AHT, SBS, shaken baby, shaken baby syndrome

15 responses to “Swedish Review Declares Shaken Baby Theory Unproven

  1. John Henry Browne

    Great!!! John

    Sent from my iPhone

    >

  2. I have a question, does water boil at 100*C at 1 Atm pressure? Its an easy experiment to perform, replicable and can be accomplished anywhere. We all know the answer is yes. This is how Science is supposed to work.

    If you repeat the boiling water experiment in Ireland, USA, Sweden or Timbuktu the outcome is always the same (at 1 Atm).

    My question is why does shaking a baby in Sweden not result in the Triad?

    Any thoughts? Should the Lloyd Study be translated into every language? Should the study be translated into a language that people other than 4th year Engineers (ie: Doctors) that everyone can understand?

    This story is of course great news, it would be even better if it were covered by the Washington Post or the New York Times.

    • There is already a lot of material in English that should give the experts pause about shaken baby theory, but we do have to keep chipping away at the enormous institutional inertia that’s resulted from 30 years of convictions.

      Thank you for your own tireless efforts to get the word out through comments on news stories.

    • Irene Scheimberg

      Joe the answer is that shaking a baby without impact does not produce the triad in Sweden, Ireland, the USA or Timbuktu. As the Swedish experts noticed, most of the papers that support the theory that shaking alone can cause the triad are based on circular reasoning. They first decide that the triad means shaking and then find that all the cases with the triad are shaking. The circularity or the reasoning, the fact that scientific experiments can’t reproduce the theory and that there are many other causes in young children that result in the same led many doctors and scientist to question this flawed theory

  3. rattsprocess

    Thank you so much for sending this. Thank heavens for today’s fast media to speed thé Good news… SBU has already started the translation into English. Very important. In Swedish media all the pushing, almost threatening, letters to SBU have been published. AAP for one. Biased and dogmatic, as Waney said. They lost all respect and confidence! The air is much healthier already.

    Skickat från min Samsung Galaxy-smartphone.

  4. Susan

    Good to see some serious literature review.

  5. Expressen has now published the letters from the AAP, among other pediatric organizations, who attempted to influence the findings of the SBU.
    http://www.expressen.se/nyheter/har-ar-lakarnas-brev-for-att-tysta-experterna/

    I have to believe this is where the Canadian Goudge Inquiry fell apart. Once they yielded to the pressure from American “child abuse experts,” the findings of the Inquiry all but evaporated.

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  10. Suzanne Loveridge

    I hope one day this research and more like it can be rammed down the throats of the narcissistic expert neuroradiologist from Bristol and the paediatrician from Cardiff responsible for a horrific miscarriage of justice because they refused to challenge or request any further investigations that could possibly show any other cause that would undoubtably point to the real culprits, the delivery midwife and several other NHS staff during invasive procedures in the first 4 weeks of my grand daughters life -preferring to protect NHS staff and side with SS to blame the parents. How many others are these two and their many colleagues responsible for? More innocents than they will admit, to appease SS and their quest for adoptees. If I were not a nurse myself- I could not know the injuries were caused by the NHS staff from birth. What makes this worse for us is that the parents’ Legal team refused to fight for independent experts who would risk challenging the SBS status quo that lines so many experts’ pockets

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