zlacker

The worst part here is: He spent months researching 500 medical papers to even realize this was a problem. No way in hell will a single defense lawyer get someone to be able to research enough to figure this out. As stated, how many people are in jail or lost their kids due to something that didn't actually happen. And how many people don't know that a minor bump in the head for a baby could be life threatening, but we just mark it as SIDS. And even worse, no medical doctor will go this hard trying to figure out how to defend a person they believe murdered a baby.

It is the perfect combination of crap.

Cyrille Rossant may save a lot of lives, in both parents and children, if this becomes common knowledge.

>>Justsi+(OP)
I’ve heard credible rumors that SIDS is the “parent accidentally killed their child but we won’t tell them that” polite fiction.

>>bombca+T1
Who have you heard these rumors from?

How did you determine them to be credible?

My assumption is that any citation to a rumor should be totally dismissed if these questions can’t be answered.

>>bombca+T1
This article is entirely about debunking rumors and looking at actual scientific evidence to correct people's misconceptions -- misconceptions among doctors and law enforcement that have ruined people's lives.

So please don't bring "rumors" into a discussion here. That's exactly the kind of harmful behavior the article is trying to fight against.

>>ncalla+y4
It seems to me that this rumor is just an alternate framing of the original commenter's assertion that "a minor bump in the head for a baby could be life threatening, but we just mark it as SIDS". I think it's fair to be skeptical of both, but it's worth reflecting on how the same factual assertions can come across as either "science-informed speculation" or "crazy unsubstantiated rumor" depending on how you say them.

>>bombca+T1
Don’t say horrible things like that unless you can really back them up. Think of how a grief stricken parent might feel after reading that.

>>bombca+T1
That's the whole point here, isn't it: that 'what you've heard' isn't credible at all. There is no 'polite fiction' here, what there is is people looking for culprits when there are none. Does that meant that all such cases are accidents? No, because we know for a fact that some people really do hurt infants for whatever reason. But the evidence is apparently such that a large fraction of the cases that were thought to be criminal in actuality were not. So don't go on rumors or polite fictions when lives are at stake. Do the legwork before ruining people's lives.

>>SpicyL+m5
Exactly. And imagine you’re a doctor, and you have a dead child in front of you, crying parents, and a form to fill out. No possible way of filling out the form brings the child back to life, and one way makes it as easy as possible for everyone, and another results in potentially up to jail time.

Now do this repeatedly during your long and illustrious career.

>>SpicyL+m5
> or "crazy unsubstantiated rumor" depending on how you say them.

“How it was said” was literally presented as unsubstantiated rumor. It’s not worth reflecting that when someone says “I heard a rumor that X…” it sounds like an unsubstantiated rumor. It’s just the basic structure of English language.

>>slashd+p5
SIDS most likely does not exist. "Unknown cause of death" should be preferred.[1] If you review the literature, there has been a definite increase in pushback against "SIDS" instead trying to assign causes of death with known mechanisms. I can't find a great reference but there is one out there that proposes with evidence that the most prevalent actual cause of death labeled "SIDS" is accidental suffocation.

It is so emotionally charged though that there is and has been great hesitation to assign this cause of death because of the emotional effect on the parents.

[1] https://pubmed.ncbi.nlm.nih.gov/10571752/

>>colech+Wc
One of my children had a serious problem right after birth with breathing (central apnea). He'd stop breathing suddenly while sleeping. If this had happened at home he likely would not have made it, but the hospital was very alert to it and after two weeks with many such episodes it suddenly clicked and then it never happened again.

If we had taken him home without knowing about the condition I'm pretty sure a 'SIDS' cause of death would have been one of the possible outcomes regardless of the actual cause (which would have been very hard to determine after the fact).

>>bombca+j7
My wife is a pediatric ER doctor. That’s not how that works. If suspected SIDS case/unexplained death comes in, it would be handed over to the child abuse team and the medical examiner would determine cause of death. The medical examiner is detached from crying parents.

What you’re talking about would require a lot more than just one well meaning doctor.

>>Justsi+(OP)
> No way in hell will a single defense lawyer get someone to be able to research enough to figure this out.

Why would we have to? We can just hire M. Rossant.

>>Justsi+(OP)
Similar case in Denmark/Romania where a baby was taken from his romanian parents because of the shaken baby syndrome, parents spent time in jail, but the hemorage continued over time so they had to concede it wasn't the shaken baby syndromd.

>>Justsi+(OP)
Try that in a court which doesn’t recognise the reliability of evidence provided by an “expert” witness.

>>single+OL
I wish, unfortunately I'm not a criminal defense lawyer nor a medical doctor! And I don't intend to be one anytime soon. ;)

I think the most productive thing I can at least try to do is to raise awareness among lawyers, doctors, and all professionals involved. No one has the time to dig into it as much as I did, but perhaps I can organize and present our current knowledge as clearly as possible. The book is one little step in this direction.

>>raducu+GU
The trouble is: shaken baby syndrome is real and well documented. Because the crime is so abhorrent, people strongly want to believe the diagnostic tools to be much more sensitive and accurate than they really seem to be.

It's the classic "N guilty men" problem, aka Blackstone's ratio: if you risk putting one innocent person in jail, how many guilty people you need to catch to make it morally justifiable? 5, 10? 100?

You have to pick a number, or else no kind of criminal justice can exist.

>>cornho+c41
In the article it clearly states that shaking does not cause the hemorrhage that's currently considered "shaken baby syndrome". It literally says there aren't documented cases where the shaking was captured on tape/testified and the symptoms present at the same time.

It's more likely that a fall (or being thrown) would cause the symptoms.

>>Fire-D+471
I read it as no cases where shaking caused ONLY the retinal/subdural haemorrhage, without any other trauma.

>>hoseja+f91
That's indeed what I said, but I was cautious. I'd have to dig into the latest literature to be sure, but I don't remember seeing even 1 case where shaking with no impact was independently witnessed or videotaped, and was shown to cause retinal/subdural haemorrhage, with or without any other form of trauma.

In any case, these situations are extremely rare, much more than those involving any kind of head impact.

>>raducu+GU
Even if the kids hemorrhaging continued, it was brought to the ER initially with fractures in the right side of the skull.

>>Fire-D+471
You need to work on your comprehension

>>Justsi+(OP)
The ironic thing here is that these sorts of innocuous bumps and minor traumas regularly lead to severe medical complications and deaths in older children & adults, too. The only difference here is that babies & toddlers are too young to be able to verbalize and advocate for themselves in ways that most adults recognize & respect.

>>tokai+vs1
I did not know this detail, I know the Danish state offered apologies, the charges were dropped and the child was returned to the parents.

>>raducu+GU1
Yeah, nobody know the exact parts of the case. As its semi-secret (to protect the child and parents I guess). While the parents were cleared, this case is definitely not appropriate to this discussion as it was definitely not only hemorrhaging that started it. If a hospital gets a toddler with fractures on their skull, society should damn well figure out how it got them and stop it from happening again.

>>rossan+g11
First: I'm very sad about your son and also about your experiences afterward.

If you have the requisite "knowledge, skill, experience, training, or education" you can testify as an expert. No need to be a lawyer, don't need to be a doctor.

You gave yourself that knowledge and your knowledge exceeds that of the typical "they shook the baby" expert. I'd go with you any day.

>>single+rX1
I had no idea that was possible. Thank you.

>>cornho+c41
The better way to think of what you said is:

If toyota cars unintentionally accelerate and kill people, but sometimes people mistakenly accelerate and kill people. If I am driving a toyota and accelerate and kill a person, if 100% of all cops/investigators believe the first case doesn't exist, and the second case is the only possible answer, I will be thrown in jail without a second thought; my life is destroyed, and it wasn't even my fault.

But more than that, we don't even know what the ratios are, is it 90% / 10%? is it 10% / 90%? is it 50/50? Because everyone believes it is 0%/100% we can't make the "N guilty men" decision at all, so we need a hard stop, evidence, and re-start.

I know you were downvoted, but I think your thoughts are exactly the problem I am trying to point out. So thank you for commenting on it.

>>tokai+vs1
> it was brought to the ER initially with fractures in the right side of the skull.

Just to defuse this a bit. My #4 used to collect skull fractures. He'd slip away in a nanosecond and would be 50' above us two heartbeats later. We put him in a padded helmet for a year or so. It stayed on sometimes.

As an adult he can still disappear in an empty room.

>>robbie+5y1
Please don't cross into personal attack. You can make your substantive points without that.

https://news.ycombinator.com/newsguidelines.html

>>tokai+MW1
> If a hospital gets a toddler with fractures on their skull, society should damn well figure out how it got them and stop it from happening again.

What a leap (the kind the article is calling out by the way). Do you really think all causes for toddler skull fractures are a societal problem?

>>jacque+Ik
Thank god the hospital caught it!

>>rossan+g11
It seems highly likely that you and your co authors are the some of the most expert people on the planet about this subject.

>>slashd+p73
They were really caught out by it themselves if not for an unrelated issue they would have sent us home. So luck played a huge part here. That's also two weeks that aged me a couple of years. But compared to what I saw some of the other parents there deal with we were the lucky ones in more ways than one.

>>tokai+MW1
As a toddler, my daughter fell out of her bed from a height of less than 18 inches and broke her collar-bone. It seems plausible to me that if she had landed on her head rather than her shoulder, she could have fractured her skull. I'm not sure that society needs to be in the business of preventing all falls from such a small height!

>>tokai+MW1
I fully understand where you are coming from, but have you had a toddler?

>>grog45+V63
I do.

If a child has a serious injury the circumstances should be examined, as it should be quite rare for children to have serious injuries.

That's why places have Child Death and Serious Injury Review Committees.

>>Justsi+(OP)
Since having a kid and reading a lot I've been bothered by how clearly a lot of what is labeled as "SIDS" is pretty clearly accidental suffocation. The conclusion is impossible to escape when you begin reading about measures that have "reduced SIDS." Yet I also wonder if continuing to observe this social fiction is just a way of keeping overzealous prosecutors and other crusaders from locking up and treating as depraved murderers grieving families for accidental deaths.

>>ameist+PA3
So in order to form an informed opinion we have to figure out the relative costs and benefits of various options. Lets start by examining assumptions. Here we have

Fractures among children: incidence and impact on daily activities

https://injuryprevention.bmj.com/content/4/3/194

wherein we discover that kids 0-12 break bones at an incidence of 128 per 10,000. Over 12 years that's more like 1536 or about 15% of kids if injuries were evenly distributed, although they probably aren't. Still in the right ballpark.

So serious injuries among kids are incredibly common.

If we launch investigations and get it right 95% of the time we will none the less fuck up millions of kids lives. We would probably be better off selectively investigating when there is at least some reason to believe something is afoot instead of every injury.

>>emoden+tK4
Not an expert but it seems to me you'd be making the same kind of error that the article denounces: attaching equal value to direct evidence on the one hand and inference to the best explanation on the other. If a physician does not observe tell-tale signs of suffocation in an infant, then it is not their role to say "Well, statistically speaking, or logically speaking, pretty good chance it's accidental suffocation isn't it? I'll jot this down as Accidental Suffocation Syndrome" or alternatively "I know in my heart that this is accidental suffocation but let's just call it SIDS for the benefit of the parents" but rather they should simply conclude "there's not enough evidence, therefore this death remains unexplained".

>>michae+YT4
First things first - 85% of the fractures you're talking about are arm and leg fractures. Skull fractures, which was what I was talking about, are a significantly smaller number.

But yes, we should investigate why the child broke their arm. Does that need to be an in-depth investigation? Not usually. But it's important to understand why these things happen; that's where the data for the study you cited comes from.

>>emoden+tK4
A tiny selection of the relevant literature:

[1] https://onlinelibrary.wiley.com/doi/abs/10.1002/(SICI)1099-0...

[2] https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1440-1754....

[3] https://link.springer.com/article/10.1007/s12024-014-9600-5

[4] https://publications.aap.org/pediatrics/article/143/5/e20183...

>>stdbro+Ol5
Some measures that reportedly reduce “SIDS” include assembling the crib properly and not putting soft objects that could smother the baby in the crib. Risk factors include lower parental educational attainment. You tell me if I’m being unreasonable attributing a death from the crib collapsing to suffocation and not a mysterious, poorly understood disease. When a baby dies in the crib it is rare for much investigation to be done that would conclusively suggest suffocation and it is usually just labeled SIDS.

>>rossan+lq5
These do bolster my point but it becomes more striking in resources intended for parents where one minute they’re telling you the mechanism of SIDS is poorly understood and the next they’re giving you advice that is clearly about removing suffocation risks from the sleeping environment. Though there is similarly strange advice about “preventing shaken baby syndrome” which turns out to be just anger management tips. I guess the sensitive nature of the topic makes frank discussion difficult.

>>emoden+806
I mean, I don't mind, you can attribute whatever to whatever and yeah, a crib full of plush toys doesn't seem like such a smart idea... but the question is what a doctor should do, how we want them to behave in the face of limited evidence.

>>stdbro+QD6
SIDS is intended as a diagnosis of last resort but is often used with little digging so it's not really any different than the case this article discusses, except with the opposite result. I never demanded that doctors start doing something different but I think it's pretty obvious we're just collectively leaving some stones unturned here.