Shaken-baby syndrome at center of Fairfax trial

By Tom Jackman
Washington Post Staff Writer
Tuesday, January 12, 2010

On April 20, Noah Whitmer started the day as a happy, healthy 4-month-old. By that afternoon, he was having seizures and bleeding from his brain. Doctors at Inova Fairfax Hospital suspected that Noah had been violently shaken, and police soon arrested his day-care provider and charged her with felony child abuse.

Now the trial could become a crucial test in the emerging debate over shaken-baby syndrome. In recent years, a group of neurologists has challenged the idea that shaking an infant can cause brain bleeding.

In Wisconsin, a woman who served 11 years in prison for allegedly killing a 7-month-old girl was released in 2008 after an appeals court ruled that the science behind shaken-baby syndrome was debatable, and prosecutors declined to retry her.

The theory behind the syndrome is that shaking a baby fiercely can cause the brain to smash against the skull, resulting in a subdural hematoma, or blood clot, in the space between the brain and the skull, which is indicated by bleeding in the eyes. But critics say it is impossible to shake a baby hard enough to cause that kind of trauma without causing noticeable trauma to the child's neck as well.

Fairfax County prosecutors and the attorneys for Trudy E. Munoz Rueda, a licensed day-care provider in Franconia, have lined up nationally recognized experts to testify in the trial, which began Monday.

For the prosecution, Craig Futterman, a pediatrician at Inova Fairfax Hospital and president of the national Shaken Baby Alliance, is expected to testify. The defense is planning to call Ronald H. Uscinski, a pediatric neurosurgeon and professor at Georgetown University's school of medicine and one of the chief critics of shaken-baby syndrome.

Outside the courtroom, both sides have posted detailed, emotional blogs about the case. Noah's parents, Michael and Erin Whitmer, launched "Noah's Road" while their baby was in the hospital and have detailed his progress to an audience that has posted comments from around the world.

On the other side, Munoz's family launched "Trudy's Defense" after Munoz was jailed and then held without bond. After almost seven months in the Fairfax jail, the Peruvian national was released with the assistance of the Peruvian consulate, and her case has attracted extensive media attention in South America.

After 18 days in the hospital, Noah survived his brain trauma, but prosecutors said he continues to have seizures and might be partially blind. His mother said she must take him to physical and occupational therapy three times a week.

Munoz, 45, is a mother of two girls and had run a licensed day-care center in her home for five years, her attorneys said. Erin Whitmer, pregnant with her second child, testified that she found Munoz on Craigslist, interviewed her and other providers, and began taking Noah to her last March.

Then she got a phone call from Munoz's daughter, who said that Noah wasn't breathing, and her life changed. So did Noah's, she said. After he was released from the hospital, "he screamed a lot," Whitmer said. "Fussier. . . . We don't think he is the baby he would've been."

In his opening statement, Assistant Commonwealth's Attorney Gregory O. Holt said that when police went to ask Munoz what happened to Noah, she said that "he was drinking milk, he choked on the milk and he went limp." Homicide detectives were brought in because it was feared that Noah would die. Munoz repeated the same story.

But the next day, a Fairfax child sex abuse detective and a child protective services worker interviewed Munoz for hours. Holt said Munoz said that "maybe I grabbed him too hard. . . . I shook him three or four times. Not hard."

Guillermo Uriarte, one of Munoz's attorneys, said she had a long record of excellent, patient child care. He said Munoz was eager to cooperate with police, went step-by-step through Noah's day and "never admitted to shaking the baby."

Uriarte said, "There is not one scintilla of reliable scientific evidence that Mrs. Munoz shook Noah on the day in question." He told the jury that "new research has suggested there are other, alternative medical explanations why a child has retinal bleeding and subdural hematoma that has absolutely nothing to do with shaking a baby."

Uscinski has written that brain injuries can occur during the tight squeeze of birth and that hematomas can continue to bleed weeks or months later. He also said impact from falls as short as three feet can create a hematoma in soft-skulled babies.

In a 2006 medical paper, Uscinski said that studies of the force needed to shake an infant into brain bleeding would create injury in the infant's neck "before it is seen in the head," as well as the spinal cord and brainstem.

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