Correction to This Article
This article misstated Craig Futterman's position at Inova Fairfax Hospital. He is an intensive-care pediatrician, not an emergency room pediatrician. The article also oversimplified a statement by William Young, a pediatric neurologist, in explaining a quotation. Young was referring to subfalcine hemorrhage in particular, and not brain hemorrhage in general, when he testified that "I can't find any other reason in the literature that [causes] hemorrhages, absent shaking." A subfalcine hemorrhage is one below the falx cerebri, which separates the two hemispheres of the cerebrum.

Shaken baby syndrome itself is put on trial in Fairfax court

By Tom Jackman
Washington Post Staff Writer
Tuesday, January 19, 2010

As a criminal trial in Fairfax County tries to determine who, or what, caused 4-month-old Noah Whitmer's brain hemorrhage, the debate over whether "shaken baby syndrome" exists has erupted into a national battle of the experts.

Most criminal trials focus on what the defendant did and didn't do. But in this case, the complicated matter of what's humanly possible is at center stage.

Already on the jury's plate:

Craig Futterman, a Fairfax pediatrician and president of the national Shaken Baby Alliance, testified that 50 Gs of force -- 50 times the force of gravity -- are required to shake an infant's brain and cause serious damage. Kirk L. Thibault, a biomechanical engineer from Philadelphia, responded for the defense that tests conducted with adult humans found that a very strong man could generate 20 Gs of force by shaking a crash-test dummy the size of a 6-month-old child.

Fairfax pediatrician William E. Hauda II said that Noah's bleeding brain was caused by rapid acceleration and deceleration and that there has "got to be rotation there to cause these injuries." But Georgetown University neurosurgeon Ronald H. Uscinski said brain scans showed that the infant's bleeding continued long after he had been hospitalized, when no trauma was occurring, and "this condition was not caused by shaking."

The trial of licensed day-care provider Trudy E. Muñoz Rueda, 45, recessed Thursday after four days of testimony. She is charged with felony child abuse and child endangerment and has already spent seven months in jail. The trial will resume Wednesday, and Muñoz Rueda is expected to testify that she never harmed Noah, as she told police on the day he collapsed in her arms.

But the next day, April 21, Muñoz allegedly told a Spanish-speaking social worker that "I imagine I shook him about three times, but I'm not sure." The defense claims the social worker misinterpreted the Spanish verb "sacudir," and that Munoz made the comment as she demonstrated holding Noah with one hand on his bottom and one hand on his back. That presumably would not generate enough force to inflict both a subdural hematoma on the brain and retinal hemorrhages in the eye, typically seen as indicators of shaken baby syndrome, the defense says.

Fairfax prosecutors anticipated the defense attack on the concept of shaken baby syndrome -- "There is no science," Uscinski testified -- and called its own phalanx of physicians.

Emergency room pediatrician Dawn M. Thornton testified that "a child this age with blood on the brain is typically an abuse case until proven otherwise." Pediatric neurologist William Young testified that "I can't find any other reason in the [scientific] literature that [causes brain] hemorrhages, absent shaking."

And Amy Jeffrey, a pediatric ophthalmologist, said that "vigorous shaking" can cause retinal bleeding, but "retinal hemorrhages [are] not related to intracranial pressure," as the defense would soon claim.

The true battle, though, was between Futterman and Uscinski, who have faced off before. Futterman, an emergency room pediatrician at Inova Fairfax Hospital for 22 years, said he'd seen between 50 and 100 cases of shaken baby syndrome. "This child was shaken, or shaken and slammed against something," he said of Noah, who might be partially blind and still suffers seizures. He suffered numerous seizures beginning at Muñoz's home on April 20.

Futterman acknowledged that there were no neck or torso injuries to the baby, and that 50 Gs of force is eight times what a jet pilot experiences. But he said the neck is the pivot point, not the recipient of the force, and is supple enough to withstand it.


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