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What Does Nanny Case Reversal Say About Shaken Baby Syndrome?

This article is more than 5 years old.

You read about the striking reversal in the latest Boston nanny case and you wonder: How does this happen? How could a medical examiner first say a baby died of "complications from blunt force head injuries" and then, two years after the baby's Irish nanny is accused of murder, decide that the cause of death is "undetermined"?

The medical examiner's report has not been publicly released, but the Middlesex district attorney's press release does cite a major review process that included "expert witness reports from the defense and prosecution, additional transcripts of police interviews, transcripts of grand jury testimony, additional medical records, DCF reports, and additional laboratory testing."

On Radio Boston today, co-host Anthony Brooks spoke with Dr. Robert Sege, a member of the American Academy of Pediatrics' committee on child abuse and neglect, and vice president at Health Resources in Action, a public health policy organization. Here's an excerpt of that conversation, lightly edited:

Anthony Brooks: This is the second time in a year that the Massachusetts medical examiner has reversed its finding in a baby's death, and we've been reading that in the United States, 16 convictions have been overturned since 2001, including three last year. So does this raise questions about the diagnosis of shaken baby syndrome? What are your thoughts on that?

Dr. Robert Sege: To me, it doesn't raise the question at all. If you think about it, there are people who are falsely accused of murder, robberies, all kinds of things and the justice system is not perfect. So in a situation where we have hundreds and perhaps a thousand infants a year who experience shaken baby syndrome, the fact that 16 convictions over a multi-year period were overturned lets me know that the justice system worked, and that people get a fair shot at getting their story told...

I'm very happy that we live in a country with a judicial system that looks at things skeptically and tries to make sure that justice is done. It doesn't change anything about whether or not shaken baby syndrome or abusive head trauma exists. Sadly, it does.

I want to read you one quote from Gregory Davis, the chief medical examiner in Birmingham, Alabama, and board chair of the National Association of Medical Examiners. He told the Washington Post:

"You can’t necessarily prove [shaken baby syndrome] one way or another ... Neither side can point to compelling evidence and say, 'We're right and the other side is wrong.' So instead, it goes to trial."

Do you disagree with that?

I actually do, and I think part of the issue is that many cases of abusive head trauma never make it to trial, sometimes because the police and the prosecutors can't figure out who the perpetrator was, but often — and I've certainly seen this — because someone confesses. It's a very sad situation, but frequently a person just reaches the end of their rope. They're frustrated, the infant won't shut up, they don't mean to cause harm or death but they just can't stand it anymore.

So I think that with all due respect to the medical examiner, most of these cases don't make it to trial. So I don't think that — as opposed to someone like me, a child-abuse pediatrician who actually sees these babies — I don't think the medical examiner has the broadest possible experience and can say something like that.

So despite what we're reading about this particular case, this idea of shaken baby syndrome or abusive head trauma, it's based on pretty good empirical research, it sounds like...

Yes, there are hundreds of articles in the medical literature by radiologists, pathologists, medical examiners, pediatricians, ophthalmologists, social workers — all describing this and describing all the details that you might want to know about it. But this has been seen so often and there are so many articles about it that it's very difficult for anyone to say that this syndrome doesn't exist.

Based on your experience, how common are infant deaths as a result of abusive head trauma?

There are kind of two answers to that. One is that they're uncommon and that's great, because although babies can be frustrating, most adults can control themselves and that's not a problem. But having said that, it's one of the leading causes of death for infants after things like birth defects. It's unfortunately way more common than it should be. And we're doing a lot at the American Academy of Pediatrics and elsewhere to try to help parents so they don't get to that point of just frustration that seems to lead to this.

When people talk about why they shook a baby or did this, most commonly the baby was crying. So we spend a lot of time talking with families and with the media about what to do when a baby cries. And babies never die from crying. Put the baby down in a safe place, make yourself a cup of tea, call a friend, do whatever you need to do and just let it wash over you. Every moment of being a parent is not always joyous. There's other stuff that happens too, particularly when babies are young and they cry and most parents are exhausted. It is preventable and I think we're doing a pretty good job of trying to reduce the number of abusive head trauma cases, and that's what I think we have to concentrate on.

Listen to the full conversation here:


Carey Goldberg Twitter Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth section.


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