CHICAGO -- Pediatricians need to be prepared to fight the "denialism" of shaken baby syndrome that has cropped up in both the media and among the general public, and do all they can to be aware and educate their patient population about the problem, a speaker said here.
Shaken baby syndrome exists, but the diagnosis is continually challenged by the court system, as well as various well-meaning groups like the Innocence Project, said Sandeep Narang, MD, of Ann & Robert H. Lurie Children's Hospital in Chicago, in a talk at the (AAP) annual meeting.
"There is, just like in any other denialism topic -- like anti-vaxxers or climate change -- a denialism that still exists about shaken baby syndrome and it's impacting court proceedings," Narang told 51˶.
Narang said that this "denialism" can be seen in both the medical literature, with "editorials or commentaries" by people who have a "philosophical bias against it." He added that the lack of quality filtration mechanism does not preclude these views from getting into court, and it has impacted court cases and child protection proceedings, giving these views a "misperception of validity."
Moreover, the Innocence Project, who looks to get wrongfully convicted criminals acquitted, has taken on denial of shaken baby syndrome as a "second mantle," Narang said, and claimed that it's an invalid diagnosis that wrongfully imprisons people.
"It's a clever marketing technique -- they get prominent newspapers to take on the mantle of it because from a media perspective, the angle of being wrongfully convicted and oppressed by the system is a narrative that's obviously interesting to look into," he argued.
However, shaken baby syndrome can be extremely difficult for clinicians to diagnose. Narang said that the symptoms -- such as vomiting or irritability or even a mild bruise -- can be easy to dismiss, because the child gives no indication that their brain is being repeatedly injured and "we don't know how to pick up on that clinically."
He said that in the literature, around 30% of kids who died from shaken baby syndrome had clear findings that clinicians didn't act on.
"It's our natural bias not to want to see it," Narang said. "But we have to fight that bias and be more vigilant clinically and not be afraid to do a little extra testing when we suspect something might be wrong."
Narang also advised vigilance in terms of identifying potential patients they're concerned about in "high-risk scenarios" for shaken baby syndrome and address their parents and caregivers to let them know it is a real medical diagnosis. It's also important to ask if they have enough support at home. He said that if clinicians are aware that it's there, and if they can see the risk factors, they can educate those parents and caregivers about those potential situations.
"Make sure they can understand it's okay to put the baby down if they get into a frustration event," he added.
For his part, Narang is trying to raise awareness about the issue, so that pediatricians can advocate for it on both a national and local level. He is involved in revising the AAP policy statement on abusive head trauma to include prevention strategies for shaken baby syndrome.
He said that he wanted to come up with a "cool acronym" to try to advise clinicians about shaken baby syndrome.
"I came up with the three As -- be aware, advocate and educate spelled with an A," Narang said. "But clinicians need to be aware that this is there and they need to act and do something about it."
Primary Source
American Academy of Pediatrics
Narang S "Shaken baby syndrome: Science vs myth" AAP 2017; Session P4051.