Protecting the child but not punishing the innocent, a diagnosis that is still controversial

It’s a complex debate where drama is never far away. In France, the subject of Shaken Baby Syndrome is causing a stir. Some believe that the procedure recommended by the High Health Authority for suspected cases risks putting innocent people in jail and separating newborns from their parents who have done nothing. Others counter that protecting babies in danger of death remains a priority. In celebration of National Shaken Baby Syndrome Day this Tuesday, April 5th, 20 minutes try to see it clearer

Three lesions indicate Shaken Baby Syndrome

Shaken Baby Syndrome affects approximately 300 children under one year old each year, 75% of whom are under six months old. More than 10% die, and three quarters of those who survive have lifelong consequences: cognitive impairment, behavioral problems, attention problems, vision problems, hemiplegia, epilepsy, etc.

How do you recognize a child sacrifice? The HAS recommendations, published in 2011 and refined in 2017, describe three distinctive lesions: “a very particular multifocal subdural hematoma that only occurs in certain very violent accidents; retinal hemorrhage; and rupture of the bridging veins,” lists Anne Laurent-Vannier, neurologist and president of the HAS working group. For them, a shock after a fall or a game should not be confused with these extremely rare and serious injuries. HAS has therefore endeavored to define criteria that are as objective as possible. Most importantly, the medical team must look for possible medical causes before reporting the parents, as these lesions can also be linked to meningitis, leukemia, a coagulation disease, etc.

“90% of my clients have no criminal record”

But from the affected families comes a completely different echo. Grégoire Etrillard, a lawyer specializing in these cases of shaking trauma, regrets that we are too quick to associate subdural hematoma with the shaking trauma. “Either the baby dies and it’s almost certain that one of the parents will go to prison,” he summarizes. Either he makes it, and often 90% of the time he is placed for a year or more. I’ve specialized in shaking babies for ten years and I’ve never seen a parent’s confession. However, there are confessions of domestic violence, rape. In addition, 90% of my clients have no criminal record. We can get excited about a toddler, but here we are talking about a parent shaking a baby like a plum tree. »

Complicated all of this to rule out the abuse hypothesis when a doctor receives an apathetic baby in the emergency room, with broken bones and bleeding from the skull. “Of course there are people who shake the children,” annoys Grégoire Etrillard. But the purpose of the investigations is not to verify the existence of a tremor, but to blame someone for it.”

“Only after the multidisciplinary team has performed a medical check with fundus, whole skeletal radiography and scanner can we say with certainty whether we are facing shake head syndrome,” replies the neurologist. Also, it is based on the story told by the adults. When a child falls out of a high chair, adults always tell the same story. But associated with a shaken baby, it is often changeable, absent, or inconsistent with the severity of the lesions. But the lawyer points out shortcomings. “The research is not thorough enough, the parents’ explanations are swept away. No one knows all the explanations for a subdural hematoma. »

“We fall from the clouds”

Another problem: falling as an explanation for the lesions often seems impossible. As the story of François and Aline* shows, clients of Grégoire Etrillard. Her twins were born prematurely in Necker in September 2018. “In June 2019, our pediatrician noticed that one of the two was stiff, he would not sit down,” explains the mother. This is confirmed by a psychomotor therapist. Then the couple’s life changed on August 21, 2019. “I was at home with my cleaner. My son tries to climb on my back, he loses his balance and falls backwards, the mother continues. »

In Necker, the doctors don’t seem to be worried. But the next day, the neuropsychiatrist accuses them of abuse. “We fall from the clouds,” remembers the mother. Necker’s social welfare office is skeptical. The police too. We pass three interviews with the Child Welfare Office, who recommend that the child return home. But the report triggers his placement in kindergarten. It’s the shock! »

The hospital will keep their son for two weeks before he is taken to his grandparents with his brother. “We could see them, but not alone and without sleeping with them. Six months later, the judge ends the placement but extends the education measure. “We’re finally going home and we can take care of our children,” breathes François. And in March 2021, the judge stops the follow-up and tells us that the file is empty. But there will be criminal prosecution. We live with a sword of Damocles for something we’ve never done. “Especially since her son had neither an operation nor any sequelae. “And his pediatrician says it’s known that preterm babies are at risk for intracranial hemorrhage.” »

An illustration of terrible errors in this kind of files. “The HAS recommendations are overconfident where the science is doubtful,” regrets François. The precautionary principle takes precedence over the principle of innocence. The tested father draws a positive conclusion: “Our son was saved, others are less fortunate. Both of our children are doing well now. »

“We can become suspicious, but remain rational”

“The debate is global, assures Grégoire Etrillard. One can become suspicious, but stay reasonable. » « When in doubt, what can we do other than place the child? replies Anne Laurent-Vanier. He insists: “We’re talking about a provisional accommodation order here, not systematically. And in many trials, the alleged perpetrators of this violence have not served a day in prison. »

She admits some anger. “HAS’s work was carried out by a hundred professionals after studying hundreds of articles and received no scientific criticism. My goal is not that people are condemned, but that the violence is identified. In 2022 or 2023, HAS plans to refine its recommendations. But definitely not back. »

*Names have been changed.

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