A new look at childhood head injuries
Impacts caused by falls may be mistakenly branded as child abuse, expert says

By Robert Sanders, Public Affairs

05 December 2001 | Mechanical engineer Werner Goldsmith is on a mission to reform the way doctors and prosecutors view the thousands of suspected cases of shaken baby syndrome each year.

An often-fatal set of symptoms caused by violent shaking of an infant or young child, shaken baby syndrome can be difficult to diagnose because frequently there are no external signs of abuse. Most of the damage is in the brain.

Backed by decades of research on the effects of head impacts, and as author of the only book on the subject of impacts, Goldsmith sees a rush by pediatricians, social workers and prosecutors to brand many parents and caregivers as child abusers when the injuries were more likely caused by a fall.

"Anyone who abuses a child deserves the full fury of the law," said Goldsmith, a professor of the Graduate School. "But people should know the truth. The brain injuries that lead many prosecutors to file charges of child abuse can also be caused by falls or even result from chronic bleeding in the brain."

To get his message out, Goldsmith is traveling around the country educating the medical community, lawyers and child welfare caseworkers about the complexities of establishing a cause of child brain damage. He also counsels numerous lawyers and testifies as an expert on head impacts at trials, where he sees firsthand the rush to judgement.

"A child in someone's care dies by natural causes or accident and the district attorney files charges claiming shaken baby syndrome," he said. "Suddenly, the caregiver is faced with life in prison."

His message to doctors and lawyers is not to assume automatically that a child with bleeding in the brain and the eye is the victim of child abuse. Doctors typically look for these symptoms, plus brain swelling or edema.

Such symptoms could result from an accident or, under certain circumstances, from a chronic condition. Doctors and medical examiners need to look for other signs of abuse, in particular, neck damage, he argues.

"I am absolutely convinced that in order to do serious or fatal damage to an infant by shaking, you have to have soft tissue neck damage," Goldsmith said. "Yet, in 95 percent of cases, medical examiners do not look at the neck in autopsy."

Very little research has been done on the effects of head impacts in infants and small children. Within a few months, however, Goldsmith will embark on a preliminary study with UCSF neurosurgeon Geoffrey Manley, using professional crash test dummies, to measure the types of forces an infant would sustain during shaking and other types of abuse.

"I have a very strong feeling that, given how little we really know about the mechanical issues involved in head injury, there may be people who are convicted of crimes they are not guilty of," said Manley, chief of neurotrauma at UCSF.

Said Goldsmith: "Well over 50,000 people die from head injuries each year. Finding out the causes and procedures is very difficult, but essential."