Researchers say criterion for diagnosing child abuse based on faulty evidence
WINSTON-SALEM, N.C. – At least one of the "definitive" criteria used to diagnose child abuse may be wrong, report researchers from Wake Forest University Baptist Medical Center in the current issue of the British Medical Journal.
"If you read the medical literature, certain eye findings have been considered diagnostic for shaken baby syndrome," says Patrick E. Lantz, M.D., a forensic pathologist at Wake Forest University Baptist Medical Center. "This isn't supported by objective scientific evidence and could result in innocent caregivers going to jail."
Lantz and colleagues researched published reports about perimacular retinal folds, which is a buckling of the retina, the light-sensitive membrane that lines the back of the eye. The injury has been reported in shaken baby syndrome, caused by vigorous shaking of an infant or young child. The shaking may cause bleeding around the brain and in the eyes, resulting in blindness, and can also result in brain damage leading to death.
"Statements in the medical literature indicate that perimacular retinal folds result from the movement of the gel within the eye when an infant or young child is shaken, and that they have no other cause in young children with head injuries," said Lantz. "But our literature review showed that this conclusion is not based on scientifically valid comparative or experimental studies." Lantz and colleagues researched the issue after being involved in the case of a 14-month-old-child who died with perimacular retinal folds and other injuries. The child's father reported that a television set had toppled over, landing on the child's head. However, because of the diagnosis of perimacular retinal folds and hemorrhages, Child Protective Services suspected child abuse and removed a sibling from the home.
"Our investigation found no indication of child abuse other than the eye findings," said Lantz.
A review of the current medical literature showed that the condition has been reported in cases of shaken baby syndrome. However, no studies have compared whether the condition is also present in similar accidental head injuries in young children.
"Some physicians observed perimacular retinal folds in diagnosed cases of shaken baby syndrome and jumped to conclusions," said Lantz. In the case of the 14-month-old child, an investigation by police, a child abuse specialist, and a medical examiner corroborated the father's report and the sibling was returned to the home.
"We found that the eye findings in this case were caused by an accident," said Lantz. "But when you read the current medical literature, the presence of perimacular retinal folds and hemorrhages in a young child with a serious head injury are considered diagnostic for shaken baby syndrome and cannot be from anything else. When physicians read that, they may stop investigating other potential causes, which could have serious consequences. Until good scientific evidence is available, we urge caution in interpreting eye finds out of context." Lantz said the 14-month-old child also had other eye injuries that some professionals consider diagnostic for child abuse. He said the evidence base for these assumptions has problems similar to the evidence surrounding perimacular retinal folds and could also lead to false allegations.
Lantz's co-researchers were Sara H. Sinal, M.D., pediatrician and child abuse expert, Constance A. Stanton, M.D., neuropathologist, and Richard G. Weaver, Jr., M.D., pediatric ophthalmologist, all with Wake Forest University Baptist Medical Center.
Source: Eurekalert & othersLast reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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