Shaken Baby Syndrome: A Medicolegal Problem

Sir Thomas Barlow

Has infantile scurvy, or Barlow’s disease, really disappeared? Or is it now diagnosed as ‘shaken baby syndrome’, without any evidence that the infant was ever shaken?1,2 If so, we may be missing the mark in infant care and subjecting parents to a grave injustice.3,4

Even Caffey,5 in his original observations of ‘child abuse’, observed subperiosteal haemorrhages and long-bone fractures typical of infantile scurvy in his six infants with subdural haematomas.

We do not like to believe that scurvy could possibly occur today in the modern world. Yet, 6% of a consecutive sample of people attending a Health Maintenance Organization (HMO) clinic in Arizona were found to have deficient plasma vitamin C concentrations in 1998 (<11.4 micromols/L), and 30% had depleted levels (<28.4 micromols/L).6

Blood levels of vitamin C and histamine are inversely related, because L-ascorbic acid is essential for the removal of histamine by conversion to hydantoin-5-acetic acid. Thus, severe vitamin C deficiency can cause a 10-fold increase in the blood histamine concentration.7 Any further production of histamine by vaccinations, infections, and other stresses can give rise to toxic histaminaemia, which could be fatal.

We will not be able to solve the present-day medicolegal dilemma regarding shaken babies, until hospital laboratories are set up to provide accurate, same-day plasma ascorbic acid and whole blood histamine analyses for all sick infants.7–9

C Alan B Clemetson
Professor Emeritus
Tulane University School of Medicine
New Orleans, Louisiana, USA

References:

1. Fung ELW, Sung RYT, Nelson EAS, Poon WS. Unexplained subdural hematoma in young children. Is it always child abuse? Pediatrics International. 2002;44:37–42.
2. Donohoe M. Evidence-based medicine and shaken baby syndrome. Part 1: Literature Review, 1966-1998. Am J Forensic Med Pathol. 2003;24:239–42.
3. Geddes JF, Tasker RC, Hackshaw AK, et al. Dural haemorrhage in non-traumatic infant deaths; does it explain the bleeding in “shaken baby syndrome”? Neuropathol & Applied Neurobiology. 2003;29:14–22.
4. Clemetson CAB. Child abuse or Barlow’s disease? Pediatrics International. 2003;45:758.
5. Caffey J. Multiple fractures in the long bones of infants suffering from chronic subdural hematoma. Am J Roentgenol. 1946;56:163–73.
6. Johnston CS, Thompson LL. Vitamin C status of an outpatient population. J Amer Coll Nutr. 1998;17:366–70.
7. Clemetson CAB. Histamine and ascorbic acid in human blood. Journal of Nutrition. 1980;110:662–8.
8. Clemetson CAB. Barlow’s disease. Medical Hypotheses 2002;59:52–6.
9. Clemetson CAB. Capillary fragility as a cause of subdural hemorrhage in infants. Medical Hypotheses and Research. 2004;1:121-129.

Source:

The New Zealand Medical Journal 2004

http://www.nzma.org.nz/journal/117-1205/1160/