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SBS --Dr. Buttram's 'Rebuttal' article
Sun, 25 Nov 2001 16:02:52 -0800

A Rebuttal to the Joint Statement on Shaken Baby Syndrome, Minister of Public Works and Government Services, Ottawa, 2001.

Harold E Buttram, M.D.

November 27, 2001


At the present time there is a concerted international campaign to train and mobilize health services, child welfare, police services, justice, education, social services, and other organizations in the identification of child abuse under the general term of shaken baby syndrome, the frequent end result being the accusation and conviction of parent or caretaker of this crime through the court systems. The Joint Statement on Shaken Baby Syndrome (SBS), cited above, is a typical example of this campaign. These accusations and convictions are largely centered in the United Kingdom, Australia, Canada, and America, where they are being seen with increasing frequency.

Very tragically, child abuse does occur and deserves appropriate punishment. However, it is equally tragic when a family, already grieving over death or injury of their infant, finds a father or mother unjustly accused, convicted, and imprisoned for murder or injury of the infant, a murder of which he or she is innocent. In most instances these families are not only devastated emotionally but ruined financially so that their defense falls upon public defenders, which very often seals their fate regardless of the merits of the case.

Personally I am a late-comer to this field following in the footsteps of two pioneers, both Australians, Viera Scheibner, Ph.D. and Archivedes Kalokerinos, a medical physician. Based on personal communication, Dr. Scheibner has written reviews of 56 cases and testified in defense of parents in some of them, all of whom she feels were innocent of charges of SBS. Dr. Kalokerinos has worked in defense of 33 cases. In virtually all of these cases there was a time-related onset of signs and symptoms following vaccines. Other doctors have almost always dismissed this association as coincidental, but this is not reasonable. By their inherent nature, coincidental occurrences may be expected occasionally but not with an incidence approaching 100 % as has been observed by Drs Scheibner, Kalokerinos, and the relatively few in which I have been involved.

If a large portion of accusations and convictions of SBS are the result of misdiagnosis, as we believe, then we are witnessing a rapidly growing reign of terror against the families of English-speaking countries.

As described in the medical literature, SBS commonly describes a combination of subdural hematoma (brain hemorrhages), retinal hemorrhages, and diffuse axonal injury (diffuse injury of nerve cells in brain and/or spinal cord) as the triad of diagnostic criteria. In some, the presence of rib or other fractures is also taken as a sign of child abuse. (1-4) These basic concepts of SBS, which originated approximately 30 years ago, remain a basis for most SBS accusations and convictions today in spite of newer scientific publications which promise to revolutionize these older concepts. The following paper will address a general review with comparison of older and newer concepts, showing that many of the premises and claims on which SBS accusations and convictions are being made are flawed and erroneous.

In order to maintain simplicity and avoid cumbersome length from repetition, this paper includes several appendices to which the reader will be referred when appropriate.

Premises and Claims Involved in SBS Accusations and Convictions:

In the joint statement on SBS from Canada, one finds the following statements:

"Injuries that characterize Shaken Baby Syndrome are intracranial haemorrhage (bleeding in and around the brain); retinal hemorrhage (bleeding in the retina of the eye); and fractures of the ribs and at the long ends of bones. Impact trauma may produce additional injuries such as bruises, lacerations or other fractures. Shaken Baby Syndrome is a condition that occurs when an infant or young child is SHAKEN VIOLENTLY (emphasis ours)....

"Shaken Baby Syndrome may be severely underestimated due to missed diagnosis and underreporting....

"Shaken Baby Syndrome can occur at any age but occurs most frequently in infants less than one year of age...

"The severity of the shaking force required to produce injury is such that it cannot occur in any normal activity such as play, the motions of daily living or a resuscitation attempt. The act of shaking that results in injury to the child is so violent that untrained observers would immediately recognize it as dangerous..."

"Violent shaking has its most serious effect on the infant's head, causing it to whip backward and forward and to undergo rotational forces. The shaking causes the shearing of blood vessels around the brain, leading to a subdural haematoma (a haemorrhage around the brain). The brain itself may be injured as it smashes against the skull during shaking. Nerve cells in the shaken brain may be damaged or destroyed."


Five of the above-statements will be quoted below and used as examples of common claims regarding the Shaken Baby Syndrome, to be followed by rebuttals:

Claim 1: "Shaken Baby Syndrome (SBS) is a condition that occurs when an infant or young child is shaken violently.".. "It cannot occur in any normal activity such as play, the motions of daily living, or a resuscitation attempt." (In the courts today it is becoming common if not universal to accept the findings of retinal hemorrhages and subdural bleeding as diagnostic of SBS and child abuse if found in the absence of known accidental cause or illness).

Rebuttal: In an article by Jennian F Geddes, a neuropathologist at Royal London Hospital, and colleagues, Geddes's team studied the brains of 53 children suspected of dying from deliberate injury. (5) Of the 53 children, 37 were less than a year old.

In the past, brain damage in such circumstances has been blamed on the brain banging against the skull as a baby is violently shaken or struck. It has been thought that this direct assault causes a characteristic kind of damage to the axons of nerves known as diffuse axonal injury (DAI). However, the researchers found evidence of DAI in only two of the 37 babies. Instead they found that three-quarters of the 37 babies had died because they stopped breathing as a result of previously unseen and undescribed pathology that was focused on the cranio-cervical junction, the point where the brain meets the spinal cord, where a (non-violent) rocking motion can damage the vital part of the spinal cord that controls breathing. When babies stop breathing as a result of this injury, subsequent lack of oxygen causes the brain to swell dramatically, which in turn causes hemorrhagic complications and brain damage formerly attributed to violent shaking or blows.

The cranio-cervical junction is uniquely vulnerable in very young babies, the authors explained, because their neck muscles are weak and their heads relatively large and heavy.

The researchers found subdural hemorrhages in 72% of the 53 cases, although most were too superficial to cause death. Also, retinal hemorrhages were found in 71% of the 38 cases in which eyes were examined, but the authors felt that these resulted from a lack of oxygen to the brain (and the brain edema or swelling) rather than trauma.

In a news interview about her study, Geddes said that such injuries could not happen just by bouncing a child on your knee or in normal every day interactions between mother and child.

"They would have to involve vigorous unsupported movement of the head." She believes most people would realize that this would be dangerous, "but you could imagine scenarios that might produce the damage without it being deliberately inflicted," Geddes stated. (6)

Also commenting on these findings, John Binns, a criminal defense solicitor with Victor Lissack & Roscoe of London, stated:

"Unless it is certain that injuries were caused by gross injuries or worse, the judge will direct the jury to acquit. On the basis of these findings it is impossible to imagine a prosecution succeeding in anything but the clearest cases." (6)

Pursuing the issue of the retinal hemorrhages, experience has shown that some courts hold retinal hemorrhages alone as diagnostic of SBS, in the absence of any other finding usually associated with the SBS diagnosis. This is very difficult to understand. In none of the original articles on SBS (1-4) was it stated or inferred that child abuse could be diagnosed on basis of retinal hemorrhages alone. John Plunkett, M.D. pointed out this fallacy in the American Journal of Forensic Medicine and Pathology in which he says:

"I do not understand the 'retinal hemorrhage' litmus test for shaken infant. No one knows what causes retinal hemorrhage, although it is highly correlated with rotational deceleration injury/subdural hemorrhage in children, but retinal hemorrhage indistinguishable from that found in rotational deceleration may be found in association with ruptured vascular malformations, arachnoid cysts, and CNS (central nervous system) infections." (7)

There are other causes of retinal hemorrhages. In the text, Ocular Differential Diagnosis, by Frederick Hampton Roy, M.D., increased papilledema and increased intracranial pressure (from any cause) are listed as possible causes of retinal hemorrhages, as well as the DPT, polio, and MMR vaccines. (8) Retinal hemorrhages have been caused by occlusion of the central retinal vein following a hepatitis B vaccine, (9) and childhood resuscitation following events other than trauma. (10-12)

Claim 2: "Shaken Baby Syndrome may be severely underestimated due to missed diagnosis and underreporting."

Rebuttal: In an article entitled "The Mistaken Diagnosis of Child Abuse," Kirschner and Stein made the following comments:

"The suspected diagnosis of child abuse may prove to be unfounded. Reports in the literature have focused on unusual diseases and folk medicine practices that may mimic abuse. We report ten cases where allegations of abuse were lodged against parents because the treating physicians in the emergency room mistook life-threatening illness or postmortem artifacts for inflicted injury...Although the histories related by the parents were in all cases truthful and consistent with the results of physical examinations of the child, the involved physicians failed to make a correct diagnosis. Not only a lack of experience with severe childhood illness and death but also an attitude of suspicion and/or hostility probably contributed to these misdiagnoses." (13)

Along a similar vein, in a letter to the British Medical Journal, English and Sutliff expressed their concerns about injudicious questioning of parents by emergency room doctors when accidentally injured children are brought in for care. They state:

"Many parents are insecure and uncertain anyway, especially those with known predisposing factors in their case histories, such as being young, having had children in special care units, multiple births, and abnormal children. While the doctor's primary aim is rightly to protect the child from non-accidental injury it must be remembered that this is achieved only by giving insecure families more support, and that the alienation achieved by what is perceived as a witch hunt is strongly counterproductive. Arguably, the deterioration in relations between parents and health service personnel we have observed may actually lead to more rather than less non-accidental injury." (14)

Claim 3: "Shaken Baby Syndrome can occur at any age but occurs most frequently in infants less than one year of age..."

Answer: This statement is entirely correct. The great majority of cases where parents are accused of SBS occur in infants below one year age, most during the first six months of life. It is included here as an introduction into a highly pertinent survey in this controversial area.

This survey concerns an unpublished series of 25 cases involving accusations or convictions for the SBS, largely collected by attorney and jury counselor Toni Blake of San Diego, California (personal communication 2000), which have the following features: 1) All occurred in fragile infants born from complicated pregnancies. Problems included prematurity, low birth weights, drug/alcohol problems, diabetic mothers, or other maternal complications. 2) All infants were 6 months of age or younger. 3) Onset of signs and symptoms occurred at about 2, 4, or 6 months age, within 12 days of vaccines. 4) All infants had subdural hematomas. 5) Some had multiple fractures.

It is my understanding that this series is now much larger than the original 25 cases and will in due time be made public. When this does occur, it may prove to be of invaluable aid for embattled parents and caretakers accused and/or convicted of SBS.

Claim 4: "Violent shaking has its most serious effect on the infant's head, causing it to whip backward and forward and to undergo rotational forces. The shaking causes the shearing of blood vessels around the brain, leading to a subdural haemotoma. The brain itself may be injured as it smashes against the skull during shaking..."

Rebuttal: It is true that violent trauma, either accidental or non-accidental, can result in the pathologic changes described above. However, the study of Dr. Jennian Geddes and colleagues previously reviewed showed that, in a large majority of babies examined, death had come about by an entirely different mechanism in which violent trauma played no role. Also, as will be reviewed below, there are valid grounds for believing that, in many of these cases, the brain edema (swelling) with inflammation and hemorrhages may be the consequence of vaccine reactions.

Claim 5: "Injuries that characterize the Shaken Baby Syndrome are...fractures of the ribs and ends of the long bones." (In courts the presence of fractures are generally accepted as pathognomonic, or diagnostic of child abuse, in the absence of known accidental trauma. This simplistic view lacks an acknowledgement, or even an awareness, that there are a number of metabolic causes predisposing to spontaneous fractures or to fractures from minimal trauma during infancy. Infants born from problem pregnancies, as in the previously mentioned series of attorney Toni Blake, are especially prone to such bone disorders. Some of these will be outlined in the following):

Rebuttal: In instances where rib fractures of unknown cause are found in infants, prosecutors often use the fractures as evidence of child abuse. In this regard there are two situations in which spontaneous fractures are prone to take place: temporary brittle bone disease (TBBD) and scurvy, both of which are characterized by imperfect connective tissue formation in fetal or infant skeletal tissue. In 26 infants with multiple fractures that fit the criteria of TBBD, (15-16) there was a striking association between TBBD and decreased fetal movement during pregnancy, which might occur in extreme prematurity, multiple birth pregnancies, and chronic oligohydramnios (deficiency of amniotic fluid) as a result of inadequate uterine space for fetal movement.

Vitamin C deficiency may contribute to inadequate connective tissue formation in the bones before birth, making them susceptible to green-stick fractures and/or metaphyseal plate (costochondral junction) slippages in utero or during the mechanical stresses of childbirth. Dr. A Kalokerinos quoted from an older text dealing with scurvy that states:

"Scurvy disrupts these areas, the bone breaks down, and the ribs may over-ride, forming in typical cases 'beads.' Then the healing commences with new bone formation looking just like true healing fractures. Furthermore, not all the ribs will be involved in this process, and the changes will not all occur at the same time - giving the appearance of multiple fractures of different ages." (17)

A study of children at the Royal Children's Hospital, Victoria, Australia has cast doubt on the acceptance of multiple metaphyseal plate fractures as definite roentgenologic (X-ray) evidence of battering. This type of fracture occurs in scurvy without undue trauma to the child. (18)

Vaccines, Scurvy, and Hemorrhagic Diatheses:

Physicians and the lay-public alike generally think of scurvy as an historical disease of the days of wooden sailing ships, which was eliminated by the introduction of limes or other citrus fruit into the diet. However, in a generation of young people and their families increasingly turning to commercially processed "fast foods" as a major part of their diets, subtle forms of scurvy may be returning, and being subtle or "sub-clinical," it is seldom recognized for its true nature. As indicated by the following story, it is not only possible but probable that vaccines may in some instances be escalating scurvy from a smoldering to a fulminating phase, which is then misinterpreted as Shaken Baby Syndrome:

In the 1970s Dr. Archivedes Kalokerinos, than stationed as a medical physician among the Australian aborigines, was trouble by a very high child mortality rate, in some areas approaching 50%. Dr. Kalokerinos recognized signs of scurvy among the children, whose diets were very poor. Observing that the children frequently died following immunizations, especially if they had colds, he recognized that there might have been a connection between vitamin C deficiency and the vaccines. With improved nutrition, oral vitamin C supplementation, injectable vitamin C during acute crises, and avoiding immunizations during minor illnesses, infant mortality was virtually abolished. (19) As a result of this work he was awarded the Australian Medal of Merit in 1978.

One of the primary roles of vitamin C in the body being that of producing and maintaining connective tissue, Dr. Kalokerinos hypothesized that with minor viral infections further depleting an already marginal store of vitamin C, the administration of endotoxin-bearing vaccines would sweep away the residual traces of vitamin C provoking fulminating scurvy with hemorrhagic complications from the of weakening of blood vessels.

Childhood Vaccines and Shaken Baby Syndrome:

General Background: Basic Science Deficiencies in Vaccine Testing:

As a result of deficiencies in original pre-licensing safety testing of current vaccines, large numbers of vaccine reactions may be taking place unrecognized, especially reactions of a delayed nature. (See appendix 2)

As a general statement, scientific evidence does not support the safety of immunizations in that safety studies on vaccinations are limited to short periods only: several days to several weeks. There are no long-term (months or years) safety studies on any childhood vaccine in use today. In addition, there are very few before-and-after published studies on the effects of vaccines on immune parameters and brain function of babies, studies which are indispensable in formation of a basic science for the vaccines. Inadequate consideration has been given to the additive or synergistic adverse effects of multiple simultaneous vaccines, although in cases of toxic chemicals, two chemicals together may be 10 times more toxic than either separately, or 3 chemicals 100 times more toxic. (20-22)

Two examples of before-and-after studies from older medical literature will be cited as examples of these deficiencies. In 1955 AL Low of Chicago published a study in which he did encephalograms (EEGs) on 83 children before and after pertussis immunization. (23) In two of the children he found that the EEGs turned abnormal following the immunizations without other signs or symptoms of abnormal reactions. In his report he commented,

"This study suggests that mild but possibly significant (emphasis mine) cerebral reactions may occur in addition to the reported very severe neurological changes."

Comment: During a time when neurobehavioral problems have become epidemic among American children, this test suggest that unrecognized brain injury from vaccines may be far more frequent than officially recognized. One would think that a preliminary study of this nature would have been repeated, but a careful search of the literature has disclosed only one other similar study, one from Japan in which it was found that 61 children with epilepsy or a history of febrile seizures showed significant increases in "epileptic spikes" on EEGs following DTP, DT, or BCG vaccines. (24)

The second example involves the testing of T-lymphocyte subpopulations (white blood cells which help to govern the immune system) in eleven healthy adults before and after routine tetanus immunizations. The results showed a significant though temporary drop in T-helper lymphocytes. Special concern rests in the fact that in 4 of the subjects the T-helper cells dropped to levels found in active AIDS patients. (25)

Comment: If this was the result of a single vaccine in healthy adults, it is sobering to think of the consequences of a series of multiple vaccines given to infants with their immature and vulnerable immune systems.

With a poverty of basic science in current childhood vaccines, as indicated by these two studies which have never had adequate follow up, it is probable that many vaccine reactions are taking place unrecognized as to their true nature. Signs and symptoms mimicking the Shaken Baby Syndrome may be among these.

DTaP/DTP Vaccines and Shaken Baby Syndrome:

In medical research it is standard procedure to develop an animal model of a disease for experimentation before proceeding into human studies. In the case of Shaken Baby Syndrome, these animal models already exist in publications involving pertussis endotoxin, studies showing reactions to pertussis which match each and every feature of brain injuries now represented in courts by prosecutors as proof of the Shaken Baby Syndrome.

Studies by Iwasa stressed the finding of brain edema as a feature of pertussis-induced encephalopathy. (26) It is of interest to point out that there are anecdotal human reports of infants which developed increased intracranial pressure with bulging fontanelles following DTP immunizations, which tend to support these animal findings. (27-29) In addition, in 1972 Galazka reviewed a series of autopsies on children whose deaths followed the pertussis vaccine. Although limited in number, findings included brain edema, hyperemia, and soft meninges. (30) As shown in the study of J Geddes as well as other sources previously quoted, brain edema in and of itself may result in both retinal and brain hemorrhages.

Munoz in turn conducted mice studies with pertussigen, an endotoxin derivative of the pertussis bacteria, in which he found (inflammatory) infiltrates of lymphocytes surrounding blood vessels in the brain and spinal cord, findings compatible with an autoimmune encephalitis. (31)

It is noteworthy that vaccines such as pertussis have been used to induce allergic encephalomyelitis in laboratory animals since 1973, (32) characterized by brain swelling and hemorrhages similar to that caused by mechanical injuries.

Allergic Sensitization by Vaccines:

Among the components and combinations of vaccines routinely given to infants during the first six months of life, the period during which most complications attributed to SBS take place, those which have been reported as causing hypersensitivity reactions include pertussis, (33-34), Hemophilus influenza (Hib), (35) aluminum, (36) the mercury adjunct thimerosal, (37) and tetanus (38). Depending on the agent, reactions may be either of an anaphylactic and/or autoimmune nature.

The Controversy of the Latent Period:

According to current guidelines of the Congressional Childhood Vaccine Injury Act of 1986, the onset of signs and symptoms of encephalitis must take place within certain time limits following vaccination in order to qualify for compensation under this act. The current time limit for the DTP/DTaP vaccines is 3 days, any event taking place beyond this time limit not being accepted as vaccine-related.

In clinical practice as well as the courts, this time limit has become accepted as the medical-legal standard. However, there are strong grounds for believing that this time limit represents human artifact and not the realities of what is taking place with vaccine reactions. This subject is too lengthy to include here but is reviewed in Appendix (2).

Hepatitis B Vaccine and the Shaken Baby Sydrome:

In 1994 a special committee of the National Academy of Sciences (Institute of Medicine) published a comprehensive review of the safety of the hepatitis B vaccine. When the committee, which carried the responsibility for determining the safety of vaccines by Congressional mandate, investigated five possible and plausible adverse effects, they were unable to come to conclusions for four of them because they found that relevant safety research had not been done. Furthermore, they found that serious "gaps and limitations" exist in both the knowledge and infrastructure (basic science) needed to study vaccine adverse events. Among the 76 types of vaccine adverse events reviewed by the IOM, the basic scientific evidence was inadequate to assess definitive vaccine causality for 50 (66%). The IOM also noted that,

"If research.(is) not improved, future reviews of vaccine safety will be similarly handicapped." (39)

A scattering of reports suggest that the hepatitis B vaccine may play a major role, as yet largely unrecognized, in hemorrhagic complications from vaccines. One especially poignant case involves a mother whose quadruplets each suffered subdural hemorrhages or bloody spinal fluid following hepatitis B vaccines. The mother of these children has been sentenced to 172.5 years in prison.

Among the 109 references provided in Appendix 3 involving reports of adverse reactions from hepatitis B vaccine, various forms of vasculitis (inflammation of blood vessels) appear with special frequency along with a variety of autoimmune neurologic, rheumatoid disorders, and thrombocytopenia (reduction in blood platelets). Inflammation of blood vessels, in turn, implies greater fragility and friability of blood vessels with greater tendency for hemorrhages. In a report of 18 deaths of neonates following the hepatitis B vaccine by the Vaccine Adverse Event Reporting System, 1991-1998, hemorrhagic phenomena were common, including two patients with cerebral hemorrhages, four with pulmonary bleeding, one with bloody diarrhea, and several with blood in the upper airway passages. (40) A report in Postgraduate Medicine on acute hemorrhagic encephalitis cites vaccines as one of the possible causes. (41) Hypersensitivity vasculitis with swelling and bruising, diagnosed by biopsy, has been mistaken for child abuse. (42)

Thimerosal; the Mercury Issue: Prior to 1999 most brands of DTP/DTaP, hepatitis B, and Hib vaccines, (all of which have been given routinely at ages 2, 4, and 6 months age for a number of years) contained ethyl mercury in the form of thimerosal, added to the vaccines as a preservative and an adjuvant to increase the potency of the vaccine. If one adds 25 micrograms mercury in a DTP/DTaP vaccine, 12.5 micrograms in hepatitis B, and 25 micrograms in the Hib vaccine (Hemophilus influenza), it is theoretically possible that some infants were receiving over 50 or even a 100 times more than the allowable safe dose according to current U.S. Environmental Protection Agency (EPA), which limits safe exposure to a maximum of 0.1 micrograms mercury per kilogram of weight per day. (43)

Since 1999 thimerosal has been removed from some vaccines but remains in others. Tables of vaccines with and with thimerosal are provided for the U.S. Center for Disease Control. (44)

For over 200 years mercury has been known as a potent neural (brain) toxin and one of the most toxic of the heavy metals. A possible mechanism for this toxicity has been disclosed in a recent animal study in which mercury vapor exposures resulted in retrograde degeneration of neuronal (brain) membranes, producing molecular lesions similar to those seen in the brains of patients dying with Alzheimer's disease. (45)

Since August, 1999 a series of Congressional hearings have been taking place addressing issues of vaccine safety, headed by Congressman Dan Burton, Chairman of the U.S. House Government Reform Committee. More recent hearings have focused in part on the thimerosal (mercury) content of vaccines. Apparently as an off-shoot of these hearings, the Institute of Medicine, a scientific board usually assigned to evaluate controversial issues, issued a report on October 1, 2001 entitled, "Thimerosal-Containing Vaccines and Neurodevelopmental Outcomes." The IOM report states:

Page 10: "The committee concludes that although the hypothesis that exposure to thimerosal-containing vaccines could be associated with neurodevelopmental disorders is not established and rests on indirect and incomplete information, primarily from analogies with methylmercury and levels of maximum mercury exposure from vaccines given in children, the hypothesis is biologically plausible." (Emphasis mine)...Page 11: "The committee recommends the use of thimerosal-free DTaP, Hib, hepatitis B vaccines in the United States, despite the fact that there might be remaining supplies of thimerosal-containing vaccines available."

The IOM is now on record stating that it is "biologically plausible" that thimerosal-containing vaccines may be causally related to the current increases in the childhood neurodevelopemental problems such as autism, ADHD, speech delays, and other conditions. In my opinion, this list should include vaccine reactions that are mistakenly diagnosed as Shaken Baby Syndrome.


As a conclusion I would like to draw a hypothetical composite picture of a number of babies diagnosed with the Shaken Baby Syndrome, based on personal experience as well as the experiences of others with which I am familiar:

Let us assume that a baby was born prematurely in early 1999, the product of a complicated pregnancy with maternal diabetes, recurrent urinary tract infections, and constant nausea which resulted in limited weight gain during the pregnancy. Diminished fetal movements were noted by the mother during the latter part of the pregnancy. Labor was induced at 36 weeks because of oligohydramnios (deficiency in amniotic fluid). Birth weight was 5 pounds.

The neonatal period was complicated by prolonged jaundice, feeding problems, nasal congestion, colic, fussiness, and constipation. Just prior to the routine two-month pediatric visit the baby acquired a head cold, although there was no fever. At the two-month visit routine childhood vaccines were administered which included the DTaP, Hepatitis B, Hemophilus influenza (Hib), and injectable polio. (In 1999 the hepatitis B vaccine would have contained 12.5 micrograms of thimerosal (ethyl mercury), and most brands of DTaP would have held 25 micrograms, most brands Hib 25 micrograms) Calculated on basis of 0.1 micrograms per day per kilogram body weight of the infant, the 62.5 micrograms of ethyl mercury would have been over 100 times the allowable amount of mercury in a given day according to U.S. Environmental Protection Agency standards for an average weight baby, even more so for a low birth weight baby born prematurely.

Let us assume further that the baby developed a high fever within hours of receiving the vaccine along with high-pitched inconsolable crying, at times accompanied by an arching of the baby's back. The fever and constant crying did subside after about two days, after which the baby alternated between somnolence and fretfulness. The parents traded off nights with the baby and became exhausted. One of these nights, twelve days following the vaccines, the mother was pacing the floor and rocking the baby. She was nearly stupefied with fatigue. She later recalled that, in an unguarded moment, she may have left the head unguarded and unsupported while rocking the baby so that the head may have flopped back and forth several times. Several hours later in checking on the baby in its crib, the parents found that the baby was not breathing. They attempted artificial resuscitation, called 911, and the child was rushed to the hospital in an ambulance. Resuscitation was successful in the hospital emergency room and the baby admitted to a critical care unit. Initial examinations and tests revealed retinal and brain hemorrhages as well as evidence of two old rib fractures. Life-support measures were removed three days following hospital admission when it was determined that the baby was brain dead. Autopsy confirmed the findings of retinal/brain hemorrhages and rib fractures along with the finding of massive cerebral edema (brain swelling).

Following the baby's death the mother remained numb with fatigue and grief. While in this state a group of people approached her and informed her that the autopsy findings were suggestive of the Shaken Baby Syndrome. Since she was the last person to handle the baby, she was to be held in custody on suspicion of murdering her baby.

In my opinion, criminal proceedings in such cases, where there is no conclusive evidence or history of child abuse, perform a gross miscarriage of justice. If there must be criminal proceedings, as some insist, I for one believe the charges should be directed elsewhere and not on the heads of the parents (in this case the hypothetical mother). Perhaps the only final answer to this dilemma will come when parents are granted freedom of choice to accept or reject vaccines for their children based on informed consent. This will give parents the power to compel adequate vaccine safety testing and surveillance based on the power of the free market, the ultimate system of checks and balances.


(1) Buttram HE, Shaken Baby Syndrome or vaccine-induced encephalitis?, Medical Sentinel, Fall, 2001, 6(3): 83-89.

(2) "The Controversy of the Latent Period," (unpublished article).

(3) List of 109 publications reporting on Hepatitis B vaccine reactions.


(1) Weston IT, The pathology of child abuse, in: Heifer RE, Kempe CH, editors, The Battered Child, University of Chicago Press, 1968: 77-100.

(2) Guthkelch AN, Infantile subdural hematoma and its relationship to whiplash injury, British Med J, 1971; 11: 430-431.

(3) Caffey J, On the theory and practice of shaking infants; its potential residual effects of permanent brain damage and mental retardation, Am J Dis Child, 1972; 124:161-169.

(4) David TJ, Shaken baby (shaken impact) syndrome: non-accidental head injury in infancy, Royal Soc Med, Nov., 1999; 99:556-561.

(5) Geddes JF, Hackshaw AK, Vowles GH et al, Neuropathology of inflicted head injury in children, I. Patterns of brain damage, Brain, July, 2001; 124(7); 1290-1298.

(6) Andy Coghlan & Michael LePage, "Gently Does It," New Scientist Daily News, London, June 13, 2001.

(7) Plunkett J, Shaken baby syndrome and other mysteries, Am J Forens Med Path, Letter submitted spring, 1998.

(8) Ocular Differential Diagnosis, Sixth Edition, Frederick Hampton Roy, Williams & Wilkins Publ., Philad., 1997: 527-532.

(9) Devin F et al, Occlusion of central retinal vein after hepatitis B vaccination, Lancet, 1996; 347:1626.

(10) Weeden VW et al, Retinal hemorrhage in an infant after cardiopulmonary resuscitation, Am J Forens Med Path, 1990; 11:79-82.

(11) Kirschner RH, Stein RJ, The mistaken diagnosis of child abuse, Am J Dis Child, 1985; 139:873-875.

(12) Kramer K, Goldstein B, Retinal hemorrhage following CPR, Clin Pediatr, 1993; 32:366-368.

(13) Kirschner RH, Stein RJ, The mistaken diagnosis of child abuse, a form of medical abuse?, AJDC, Sept., 1985; 139:873-875.

(14) English JM, Sutliff PA, British Med J, Oct. 20, 1979: page 1003.

(15) Miller ME, Temporary brittle bone disease, a true entity?, Seminars in Perinatology, 1999, 23:174-182.

(16) Miller ME, Hangartner TN, Temporary brittle bone disease associated with decreased fetal movement and osteopenia, Calcified Tissue Int, 1999, 64:137-143.

(17) Hess AF, Scurvy, Past and Present, Philadelphia, J.B. Lippincott Co., 1920.

(18) Hiller HG, Battered or not - a reappraisal of metaphyseal fragility, Am J Roentgenology, Radiotherapy, & Nuclear Medicine, 1972; 114:241-246.

(19) Kalokerinos A, Every Second Child, Thomas Nelson, Australia 1974.

(20) Chester AC, Levine PH, Concurrent sick-building syndrome and chronic fatigue syndrome: epidemic neuromyasthenia revisited, Clin Infect Dis, (Suppl 1), 1996;18:S43-S48.

(21) Arnold SF et al, Synergistic activation of estrogen receptor with combinations of environmental chemicals, Science, 1996; 272:1489-1492.

(22) Abou-Donia AB et al, Neurotoxicity resulting from exposure to pyridostigmine bromide, DEET, and permitrin; implications of Gulf War chemical exposures, J Tox & Environ Health, 1996; 48:35-56.

(23) Low AL, Electroencephalographic studies following pertussis immunization, J Pediatrics, 1955; 47:35-39.

(24) Nouno S et al, Adverse effects on EEG and clinical condition after immunizing children with convulsive disorders, Acta Paediatr Japan, August, 1990; 32(4):357-360.

(25) Eibl M et al, Abnormal T-lymphocyte subpopulations in healthy subjects after tetanus booster immunization (letter), New Engl J Med, 1984310(3):198-199.

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