Barbara Almond, M.D.

Barbara Almond M.D.

Maternal Ambivalence

Don't Shake That Baby

It isn't always the caretaker's fault.

Posted Mar 04, 2011

The cover of the New York Times Magazine for February 6, 2011 reads "Has a Flawed Diagnosis Put Innocent People In Prison?" The ensuing story, written by Emily Bazelon is subtitled "A Re-examination of Shaken-Baby Syndrome."

The simultaneous finding of subdural hemorrhage, retinal hemorrhage and brain swelling in a baby, who was previously well, has been titled the "shaken baby" syndrome, and has also been considered evidence of rough handling on the part of someone, usually a caretaker. The penalty for such a charge, if it comes in guilty, is often many years in prison.

The Times chronicles several such cases. The effects on the baby, the parents and the caretaker are serious and disturbing. What is more disturbing is, that as evidence about the syndrome mounts, it seems as if this condition can occur in circumstances where the baby has not been shaken. Often the baby was already ill (with an infection) before the putative "shaking" has taken place. Sometimes the baby has a clotting disorder that first manifests as a bleed into the brain. How can we know for sure?

This article caught my notice because of my interest in the manifestations of maternal ambivalence. Prior to the 20th century, children (especially poor children) were pretty much knocked about at the whim of indifferent or cruel caretakers, including parents. Nowadays, such behavior can lead to arrest and prison sentence, and sometimes deservedly.

My problem is with the swing of the pendulum—that perhaps adult caretakers sometimes take the blame (where there may be no blame) because of the over-protectiveness of modern parents and their fear of being accused of being inadequate, themselves. Years of productive life may be lost, hostage to the hysteria of some contemporary parents who cannot bear the possibility that their children were born with a flaw that manifested early, as a cerebral bleed. This blog is not written to excuse the ill treatment of children by poorly trained and questionably motivated caretakers, but rather to caution both parents and the legal system that sometimes, unfortunately for all concerned, nobody is to blame.

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