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Editorial-Shaking the baby. . .

November 20, 1997

Have you heard all that you ever wanted to hear about the trial of Louise Woodward, the 19-year-old British au pair accused of shaking an 8-month-old infant to death?

As editorial page editor of The Herald-Mail, I've read scores of commentaries, most of which focused on the legal issues raised at the trial, and the possibility that her sentence was reduced to time served because she was a young woman with a child's face and a charming English accent.

Almost none of the coverage has dealt with the most important part of the case - the danger of shaking infants in an attempt to quiet them.

To find out how dangerous shaking infants is, I talked to Dr. Lavdena Orr, director of the Child Abuse Team at the Children's National Medical Center in Washington, D.C. Depending on the type of injury a child comes to the hospital with, her team may make further inquiries into what happened.

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They see about five cases a year of what is called "shaken baby syndrome," a condition Dr. Orr said is very difficult to diagnose because of the way the injuries take place.

Imagine for a moment, she said, that the linings of the human brain are like the skin of an orange. First there's a hard outer layer like the orange's outer covering. Underneath that is another layer, like the white that adheres to the inside of the orange peel. Finally, there's a third layer, which is almost invisible.

Imagine the blood vessels running up through these layers, like an immensely tall tree might run through several layers of low-lying clouds. When the shaking occurs, Dr. Orr said, it's not the bony ridges inside the skull that damage the brain, but the breaking of these vessels. When that happens, blood that should be circulating all through the body begins to pool up in the brain, eventually causing severe damage and death.

Infants are particularly susceptible to this injury because their heads are disproportionately large, and because their neck muscles haven't developed to the point where they can hold their heads steady without help.

A baby should never be shaken, Dr. Orr said, because there's no way of telling which child's blood vessels are so fragile than even a slight trauma might cause them to break and bleed.

Certain combinations of injuries trigger suspicion that a baby has been shaken, but in other cases, Dr. Orr said, "there's a child dead, and who knows why."

For more information, Dr. Orr referred me to Dr. J.C. Showers, who wrote the executive summary for the National Conference on Shaken Baby Syndrome.

Showers told me she spent four years in the early 1980s studying 20 years of child abuse cases that ended in fatalities. She found, to her dismay, that shaking a baby to death was relatively easy to get away with, in part because even some health practicioners didn't know how harmful it could be.

In one case, for example, Showers said she found practicioners treating infants for sleep apnea were telling parents to shake children to get them wide awake. Some others who taught cardiopulmonary resuscitation were also routinely shaking babies as part of their resuscitation attempts.

It became her mission to get the word out, she said, because she wanted the dangers to become common knowledge. Once that happened, she said, it would be more difficult for perpetrators to use ignorance as an excuse to avoid prosecution.

She even did some work with Johns Hopkins University Hospital, and seemed a bit frustrated when I told her I wasn't aware that there had been a regional push to get the word out about this problem.

After I began making phone calls on this issue, 50 doctors who specialize in treating victims of child abuse issued a letter saying that the medical evidence presented at the Woodward trial was inaccurate and unscientific.

"Infants simply do not suffer massive head injury, show no significant symptoms for days, then suddenly collapse and die," the letter said.

The young au pair's last statement was that she would continue appealing the case until she obtained "total vindication," and a recent trip to the supermarket indicates that the tabloids are tying up her story like a holiday turkey, for consumption by those who like to make a meal out of celebrity gossip.

Read that if you must, but don't forget that when you've had a bad day and the baby won't stop crying, shaking will only make things worse. And if the urge to do something like that seems uncontrollable at times, help is available through the local Parent-Child Center, at (301) 791-2224.

Bob Maginnis is editorial page editor of The Herald-Mail Company.

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