28 T H E W A R R I O R • F a l l 2 0 0 4

E L A I N E W H I T F I E L D S H A R P , T L C ‘ 9 8

Evil events are rarely committed to paper. The history of child abuse inherent-

ly involves pain inflicted in the dark and behind closed doors, providing us with

only the barest of facts. We know that royal children were poisoned and mur-

dered for convenience or for their crowns and that the ancient Greeks dis-

posed of handicapped children at birth. We hear words like “beaten,” “burned,”

“raped,” and “exploited,” but these do little to reveal the enormous tragedies

for which they are mere codes.

Today, there is a vast infrastructure of child protective services (CPS) in America.

It is funded by billions of federal and state tax dollars. History has been turned

on its head. Instead of children being ‘seen and not heard,’ or having no right

of survival at birth, children are now revered as precious, as our modern day

mocking birds. The entire ‘village’ is involved in their protection and welfare.

This is part of a book currently being written by Elaine Whitfield Sharp. Copyright byElaine Whitfield Sharp, July 2004. Permission to publish given to The Warrior.

T H E W A R R I O R • F a l l 2 0 0 4 29

Dwelling in the village are child protective services (CPS)professionals, pediatricians and others committed tostomping out child abuse. The history of child abuse

plays a valuable role in helping to form the professional self-images of CPS and medical professionals. History helps themidentify the demons and mobilize for the mission. An apprecia-tion of the present comes through the prism of the past and fos-ters camaraderie between colleagues who share the vision. It isthe grist of the CPS culture.

But, there’s a dark side to this culture. The multi-billion dollarannual budget keeping this community alive also encouragesoverzealous investigation and, with that, millions of false reportsand accusations of child abuse every year. Powering the ‘indus-try’ of false accusation are mandatory reporting laws requiringprofessionals who regularly come into contact with children toreport suspected abuse. And the standard for ‘suspicion’ or even‘reasonable cause’ is low. False accusations are particularly preva-lent in cases of so-called shaken baby syndrome (SBS). The listof professionals now legislatively mandated to report hasexpanded. Failure to report suspected abuse may put a person inthe dock and subject them to civil liability.

Money, another familiar villain, also lurks on the landscape.Some professionals may be encouraged to find ‘abuse’ becausethey have government grants to look for it. The result is thatalleged child abuse, especially of the SBS variety, may be not themost probable diagnosis, but instead the most profitable.

What follows are some snap shots from the world of child abuserecognition and prevention professionals. Understanding theroots of this culture is one way to prepare for cross-examinationof child protection and medical witnesses who were part of amedical emergency that has evolved into a criminal childabuse case.

THE PRISM OF THE PAST:THE ALARMING HISTORY OF CHILD ABUSE

Read between the lines of the Florence phone book and you willfind the human face of child abuse: Hundreds of people withthe last name, “Innocenti.” The name means “innocents” and itwas given to each child who was rescued in one of the early bat-tles to fight the war against child abuse.

In the 1500’s, liberal-minded, Florentine men helped them-selves to the local slave women—mostly from Africa—andfathered hundreds of unwanted children. The babies were rou-tinely murdered at birth because the mothers could not care forthem.

As a humanitarian alternative to this local wave of infanticide,in 1491 the wealthy Florentine Medici family (of Vatican fame)sponsored an orphanage for the newborns. A mother who couldnot keep her baby now had a choice. Typically, a mother dis-guised her baby as a bundle of laundry and took it at darkthrough the narrow, winding streets of Florence to the House ofthe Innocents. There she placed the child on a ‘wheel’ that wasmuch like a lazy Susan—half inside the sanctuary behind asmall door and half outside the building. This wheel served asthe method of anonymous delivery. A mother signaled thearrival of the baby with a knock on the door before fleeing intothe night. On hearing the knock, the sisters religious, who ranthe orphanage, turned the wheel around 180 degrees, took thebaby in, raised and educated the boy or girl, and arranged foreach child to be trained in one of the many trades then bur-geoning in Florence.

Each child took as its surname “Innocenti.” Today, there are sev-eral pages of “Innocenti’s” in the Florence phone book, alldescendants of that great humanistic experiment more than halfa millennium ago. The babies had been saved by an act of social

Florence Phone Book: Hundreds of children were saved by a humanitarian experiment in Florence, Italy duringthe Renaissance. Beginning in 1491, instead of being murdered at birth, newborns were taken to the House of the

Innocents where they were raised by the sisters religious and taught a trade. Today, hundreds of the orphans’ descendantslive in Florence where their names can be found in the city’s telephone book.

30 T H E W A R R I O R • F a l l 2 0 0 4

reform from the ultimate act of childabuse: murder.

But this type of Renaissance humanitari-an idealism was slow to spread.Infanticide and other forms of physical,sexual and emotional abuse had beengoing on since the advent of Man. Nolaws or programs would or will ever putan end to this. The ancient Egyptiansused to punish mothers who murderedtheir newborns by making them hug thecorpse for 72 hours. In 1917, of 5,000illegitimate children born in Chicago,1,000 disappeared without a trace. TheVictorians stuffed their babies down sew-ers, clogging the city’s system. Today, thenews of war and conflict is punctuated bystories of dead babies left in public toilets,garbage cans and dumpsters.

The lessons of history are used in childmaltreatment books as case studies ofwhat to look for today. Wrote the editorsof one such text:

“The historical perspective allows us

to stand back from theeveryday experience ofconfronting the batteredor neglected child and toreflect on the wider issuesof what has been present-ed to us as a single inci-dent in time.”1

We rejoin history at thework-houses of VictorianEngland. These were a per-version of institutions likethe House of the Innocents.Orphaned children weresent to these Hell holes.Moved by the stories of chil-dren who were starved andbeaten in these places,Charles Dickens created astorm of indignation andoutrage when, based on thelives of real boys, he wrotestories like “Oliver Twist.”Orphaned at birth, Twistwas put into a work-housewith other boys where hewas forced to work. Mealsconsisted of one small bowlof gruel, and no more.

The emaciated boys beganto plot a rebellion of sortsand drew straws for who

would ask for more at the next meal. Theshort straw fell to Oliver and so, the nextday, he approached thework-house master anduttered what is perhaps themost famous of Dickens’lines: “Please, sir, I wantsome more!”

Oliver was severely beaten,cast out and sold by thework-house to a localundertaker for five Englishpounds. Beatings and star-vation continued thereuntil, one night, Oliverstole into the darkness—only to fall into the handsof the Artful Dodger.(You’ll have to read thebook to find out whatbecomes of Oliver.)

Dickens’ stories were mile-stones in raising social con-sciousness about child mal-

treatment. A loyal champion of all boys,his descriptions of maltreated childrenstemmed from a desire to remedy evilsthat he had found in London and its sub-urbs. Dickens’ gave these victims oftyranny and oppression a voice in hisnovels. On hearing this voice, Londonerswere deeply affected and were stirred to astorm of indignation and protest.Schools, work-houses, and other publicinstitutions were subjected to rigorousexamination, resulting in several closingsand tremendous improvements.Although Dickens’ goal was partlyaccomplished, the war against child abusehad a long road ahead.

Meanwhile, across the Atlantic, thou-sands of homeless children scraped outgrim existences and often died on thestreets of New York and other cities. By1850, in New York City, alone, therewere an estimated 30,000 orphans on thestreets. In response in 1853 CharlesLoring Brace, a young, Yale-educated the-ologian, formed the Children’s AidSociety (CAS). In what was to becomethe beginning of the modern-day fostermovement in the U.S., the CAS shippedsome 120,000 children out of the city on“Orphan Trains,” initially to farmingfamilies in the Midwest and West and, asthe Orphan Train Movement grew, to 45states, Canada and Mexico. Even so,America’s homeless orphans and abusedchildren remained mostly voiceless and

House of the Innocents terra cotta and glazed medallion:A child symbolically seeks the charity of Florence’s rich in thismedallion by Andrea della Robbia. From 1463-66, Robbiamade 10 such medallions to decorate the arches of the House

of the Innocents, (Ospedale degli Innocenti), built byBrunelleschi and funded by the Medici family as a refuge fornewborns who were abandoned there in lieu of being killed.

Oliver Twist: "Please, sir, I want some more!" This is perhapsthe most famous of Charles Dickens’ lines. The author’s descrip-tions of boy life in Victorian England caused a wave of protestagainst, and reform of the miserable conditions in which young

children were forced to live.

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T H E W A R R I O R • F a l l 2 0 0 4 31

largely ignored by mainstream, middle-class America for the next two decades.

Fast-forward to 1874 when child abuseissues briefly took center stage in theAmerican media. The plight of MaryEllen Wilson, a crusade-inspiring casein New York City, sparked the creationof the early child protection movementin the United States.

Mary Ellen, a nine-year-old orphan,was regularly beaten and berated by herfoster mother. A charity worker whowas boarding in the same house wantedto help Mary Ellen escape her misery,but there were no government agenciesto intervene. The charity worker turnedto the American Society for thePrevention of Cruelty to Animals(ASPCA) which, based on the premisethat a child was part of the animal king-dom, sought and obtained a writ ofhabeas corpus removing Mary Ellenfrom the abuser’s home. Mary Ellen’sfoster mother was convicted of assaultand battery and sentenced to one year ofhard labor.

Outrage over Mary Ellen’s case resultedin the organization of the New YorkSociety for the Prevention of Cruelty toChildren in 1874. In 1875, the NewYork state legislature enacted a statutethat “authorized cruelty societies to filecomplaints for the violation of any lawsaffecting children and required lawenforcement and court officials to aidagents of the societies in the enforcementof these laws.” In doing so, that state leg-islature created the first statutory childprotective services system in the UnitedStates.

By 1905, there were more than 400 pri-vate charitable societies to prevent crueltyto children (SPCC’s). The SPCC’sassumed the primary role in handlingchild-abuse complaints that, if founded,they referred to the courts for action.

The Great Depression brought with it ashift in child-welfare priorities from pre-venting physical abuse to providing food,clothing and shelter for poor and father-less children. Supplying these necessitiesbecame the hot issue under the SocialSecurity Act of 1935. Through thisstatute, Congress attempted to create asocial welfare system for “the protectionand care of homeless, dependent and neg-

lected children in danger of becomingdelinquent.” Stomping out physicalabuse was to take second place behind theneed to fill bellies. As it did so, the role ofthe SPCC’s gradually diminished.

THE SPECTER OF INVISIBLE ABUSE:FROM MISSION TO MONSTER

Historically, the signs of physical crueltyto children were perceived as visible,only: bruises, burns, obviously brokenbones, or ‘pattern injuries,’ such as, beltbuckles and whip welts. But in 1956,radiologist John Caffey, M.D., believedhe had discovered a new form of ‘invisi-ble abuse’: whiplash shaking, later to becalled “shaken baby syndrome” (SBS).2 Itwas in that year that a nursemaid,Virginia Jaspers, confessed to shakingsome of the babies for whom she hadcared.

Japsers’ story made Newsweek and othernational media. Jaspers’ victims hadintracranial bleeding, that is, bleedingbetween the skull and the brain. Thistype of bleeding could only be seen with

newly-developing X-ray technology. Thedistinction between visible and invisibleinjuries had been created in the field ofchild abuse.

It is part of the alarming history of med-icine that Caffey assumed, without reli-able-scientific proof of causation, thatJaspers’ confession to shaking the babiesin her care was all that was needed to“prove” that the intracranial bleedingthey had was, in fact, caused by shaking,alone. Neither the medical examiners norCaffey excluded the possibility of impactor other possible causes of the bleeding inthe Jaspers’ baby cases.

Although it was to be shown in 1987,and again in 2003, that shaking, alone,could not cause intracranial injuries, theSBS diagnosis slowly became more preva-lent over the next three decades.3

The diagnosis received a lot of publicityfrom C. Henry Kempe, M.D., who in1962 published an article, “The BatteredChild Syndrome,” in the Journal of theAmerican Medical Association (JAMA).That article contributed to changing the

Orphan Trains: In 1850, there were some 30,000 orphaned, homeless and hungry children on thestreets of New York City. This emergency sparked the creation of the Children’s Aid Society (CAS) in

1853. Over the next few years, the CAS shipped some 120,000 of these children on ‘OrphanTrains’ to farming families in the Midwest, the West and to places as far away as Canada. Today,

descendants of the Orphan Train movement keep in touch by e-mail and the Internet.

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32 T H E W A R R I O R • F a l l 2 0 0 4

entire landscape of child protection.Harnessing the increasing institutionalpower of the American medical establish-ment, Kempe called for physicians tolook for and to report to child protectionauthorities the parents of “battered chil-dren”—those with intracranial bleedingand retinal hemorrhages—in order toprotect them from further injury. The sci-entifically-unreliable theory was that ifbleeding could be seen on an X-ray, thecause—violent shaking—could be identi-fied. (This is like saying that a psychiatristwho views the skull on an X-ray, or thebrain on CT, MRI or PET scans, candetermine the cause of mental illness evenin the absence of organic brain disease.)

Recognition of so-called SBS was—andstill is—part of the declared war againstchild abuse prevention. Kempe andCaffey theorized that when a child hadintracranial bleeding and bleeding behindthe eyes in the layers of the retina (retinalhemorrhages), this meant only one thing:they had been violently and intentionallyshaken. Their legacy persists. Fast forwardto a July 2004 TV news story, typical ofscores like it. The TV news reporter led:

Physical child abuse is hard to lookat. But what if a baby has no marks?What if they look perfectly healthy,but come into the doctor’s office,clinic or emergency room vomiting?Dr. Rachel Berger, Children’sHospital of Pittsburgh….

It could be that they have reflux, itcould be that they have the flu, but itcould be that they have a braininjury . . . . If you return a child toan environment where he or she wasinjured, there’s a high likelihood thatthe child will come back and be re-injured or be killed.4

Recognizing “shaken baby syndrome”and preventing it was the major focus ofthe child abuse protection communitydeveloped in response to the writings ofCaffey and Kempe. Beginning in 1962,several groups drafted model child-abuse-reporting statutes that mandated healthcare workers who see or suspect physicalabuse, such as so-called SBS, to report itto the authorities. By 1967, every statehad a statute.

In the following years, mandatory report-ing statutes cast their net far beyond

those who worked in the health care andchild protection fields. Other categoriesof professionals who regularly came intocontact with children—clergy, teachers,school nurses, dentists and more—became mandated reporters.

Shaking, alone, as a cause of child braininjury was not scientifically challengeduntil 1987. It was shown to be a falsehypothesis.5 But, in the climate of theearly 1970’s, many physicians eager toserve the legitimate cause of child abuseprevention, diagnosed scores of so-calledSBS cases.

Public awareness of intentionally inflictedchild head injury continued to increase asKempe, Caffey and others beat the drumsof this newly-discovered form of ‘invisi-ble’ child abuse. Even so, between the1960’s and early 1970’s, SBS was still acomparatively rare diagnosis. That wasabout to change.

AN EMPIRE IS BORN

In 1974, the federal government took aleadership position in child abuse whenCongress enacted the Child AbusePrevention and Treatment Act (CAPTA).6

Under CAPTA, “the term ‘child abuseand neglect’ means, at a minimum, anyrecent act or failure to act on the part ofa parent or caretaker, which results indeath, serious physical or emotionalharm, sexual abuse or exploitation, or anact or failure to act which presents animminent risk of serious harm.”7 Thatbroad definition pulls many withinits net.

The statute was designed to raise aware-ness about child abuse and to create anationwide child protective services sys-tem on a state-by-state basis. In the past30 years, Congress has used CAPTA asthe main funding vehicle to pump bil-lions of dollars annually into state coffersto build a child-protection-services infra-structure. It is now a mighty force withwhich to be reckoned.

THE MONSTER UNDER THE BED:MANDATORY REPORTING

In order to drink at CAPTA’s trough,states had a number of obligations,including a requirement that they enacttougher mandatory reporting statutes.With all that money at the end of the car-rot, they did. All 50 states now havestatutes that not only increase the states’power to intervene in cases where childabuse is suspected and remove childrenon an emergency basis, but which furtherbroaden the net of those who are man-dated to report and provide a broaderdefinition of child abuse.

In some states, mandated reporters whofail to report their suspicions of abusemay be criminally prosecuted.Mandatory reporting statutes in somestates, such as Alabama and California,authorize fines of up to $1,000 and up to

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Mary Ellen Wilson (before and after). Asrelated by the New York City Museum, “The

startling child abuse case of Mary Ellen Wilsonspawned the formation of the New YorkSociety for the Prevention of Cruelty to

Children (NYSPCC). Hearing of the plight ofa child living in the Hell's Kitchen area of

Manhattan, social worker Etta Angell Wheelerenlisted the assistance of Henry Bergh (of the

American Society for the Prevention of Crueltyto Animals -- NYSPCA), who acted in the

belief that children should be afforded the sameprotection as animals.” The NYSPCA

obtained a writ of habeas corpus to rescueMary Ellen from her cruel stepmother who was

later sentenced to one year of jail and hardlabor. (Photo from NYSPCC.)

T H E W A R R I O R • F a l l 2 0 0 4 33

six months in jail for those who fail toreport. Failure to report may also subjecta mandated reporter to civil liability.

Predictably, with a larger number of peo-ple now mandated to report, a broaderdefinition of child abuse, large amountsof funding at stake, coupled in somestates with the fear of criminal prosecu-tion and/or civil liability, reports of childabuse have more than quadrupled since1974.

MANDATORY REPORTING

MEETS JUNK SCIENCE

Almost three million reports of suspectedchild abuse were made in 1999. Of those,1.8 million were investigated and of thoseless than half were substantiated.8 Whilethe protection of those unfortunate chil-dren who had been abused or neglectedwas necessary, the flip side of those num-bers tell another sorry story. A good por-tion of more than half of the peopleinvestigated for child abuse and/or neg-lect were falsely or mistakenly accused.With a population of about 280 million,this means that in 1999, alone, as manyas one in 300 people in America mayhave been the victim of false accusationsof child abuse and/or neglect.

It is one of those modern facts ofOrwellian life that mandatory reportingof ‘invisible’ abuse still occurs eventhough that form of alleged abuse—SBSwithout spinal cord injury—has been sci-entifically refuted.

It is another fact of Orwellian life that theright hand of the government does notknow what the left hand is doing.9 Forexample, the National Institutes ofHealth (NIH), under HHS, defines“shaken baby syndrome” as resultingspecifically in “TBI [Traumatic braininjury] and spinal cord injury.”10 Eventhough a scientific experiment has provedSDH’s cannot be caused by shaking,alone, and even though NIH’s officialposition is that real cases of SBS includespinal cord injuries, those who are trainedand paid by the government to find SBScases, and those who are under the gun toreport it, are not taking any chances. Themajority of SBS cases reported in themedical literature or currently being pros-ecuted do not involve spinal cord injury.In the absence of spinal cord injury or

any other physical evidence of shaking,most of the 5,000 to 6,000 peoplecharged with causing SBS every yearmust surely be in the group of those whoare falsely accused.11

THE VILLAGE

The oldest federal agency dedicated tofighting child abuse is the Children’sBureau. It is part of the Department ofHealth and Human Services (HHS),under the Administration for Childrenand Families, Administration onChildren, Youth and Families.

The Children’s Bureau budget for FiscalYear (FY) 2004 was $6.7 billion. Of that,a whopping $2.5 billion was funneled tothe states in grants for various child abuseprograms for protection and prevention,which includes recognition. Many, manymillions of that go directly to a vastbureaucracy of programs focused on onetarget: finding child abuse. In 2002, forexample, in just one genre of grants, some$81 million was awarded to states forchild abuse “recognition.” And, wehaven’t even begun to talk about themandated state matching requirements.

As has been the pattern over the last 30years, many of the federally funded stateand local programs organized to recog-nize child abuse heavily emphasize find-ing cases of so-called SBS.12

Every year, each state matches multi-mil-lion-dollar federal funding in partnershipbudgets for preventive and primary careof children. For example, in FY 2002,

Alabama spent more than $65 m ($12 min federal dollars). California spent $1.3billion ($42 m federal). Florida spent$329 m ($19 m federal). Massachusettsspent more than $101 m ($11 m federal).Wyoming spent almost $4 m ($1.3 mfederal).

The Children’s Bureau also awards grantson behalf of the Department of Justice(DOJ) that administers the Children’sJustice Act. The awards are made, forexample, not only for research to recog-nize child abuse, but also to state andcounty prosecutors for the training ofassistant attorneys general and districtattorneys in how to effectively prosecuteaccused child abusers, including cases ofalleged SBS. Funding is also awarded tohire expert witnesses to testify against theaccused, including SBS experts.

The National Clearing House on ChildAbuse and Neglect which along with theChildren’s Bureau is under the HHS’Administration for Children andFamilies, provides guides on how to getgrant money to CPS and medical profes-sionals, “community-based organiza-tions” “public and non-profit agencies,”“universities,” “service providers,” “train-ers” and “researchers helping to protectchildren.”

Regularly announcements are made inthe Federal Register that the Children’sBureau is seeking grant proposals frompublic or private agencies to study how torecognize child abuse. Grants are avail-able to departments within state CPS

Children During Great Depression: Feeding, clothing and sheltering children were at the topof the child abuse agenda during the Great Depression. Child abuse issues were mostly put

on the back burner until the 1960’s.

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34 T H E W A R R I O R • F a l l 2 0 0 4

agencies, to private child advocacy organ-izations, or to individuals studying fortheir doctorates. The types of grantsavailable and the organizations to whichthey are awarded are limited only by theimagination—and the Children’sBureau’s stated “research agenda.”

In any given case of so-called SBS, it’simportant to get as much information aspossible about the background of theState’s medical and child protective serv-ices witnesses, especially those whoplayed a role in the evolution of the med-ical case into a criminal case.

Naturally, physicians and child protectiveservices professionals testifying in crimi-nal child abuse cases are dedicated tostomping out child abuse. But, if thesewitnesses have been involved in trainingand/or research that manifests a clear biasin favor of the existence of SBS (withoutspinal cord injury) as a real diagnosis, andif they also failed to seek to study orunderstand any of the known mecha-nisms of head injury, then it’s importantto get that information for cross-exami-nation to demonstrate the bias that maybe the only reason your client is in thedock. This is where research on theInternet and requests under state and fed-eral freedom of information acts can helpyou find facts that you can use for cross-examination. q

Next Issue: Every year the federal,state and local governments pumpbillions of dollars into programsdesigned to help an army of socialworkers and doctors find childabuse. Inasmuch as the prospect ofmoney may encourage somephysicians and some who work inthe child-abuse-prevention com-munity to find what they are look-ing for to justify continued fund-ing or to study the area to obtaininitial funding, it is useful to sup-plement criminal or civil discoverywith information obtained underthe federal and/or state freedom ofinformation acts (FOIA) and theInternet to get a fuller picture ofwitnesses’ backgrounds and likelyorientations. Knowing where tosend FOIA requests and what toask for requires an understandingof the basic federal, state and localfunding trees and the types ofgrants and awards that are avail-able. The sequel to this article willcover that topic.

ENDNOTES

1 Hobbs, CJ, Hanks, HGI, Wynne,JM, Child Abuse and Neglect , AClinician’s Handbook, Churchill-Livingstone, Harcourt Brace, 1991(2nd ed).

2 Caffey first wrote about some cases ofchildren who had intracranialbleeding and broken bones in 1947.He continued to study and writeabout the topic throughout the1950’s and 1970’s.

3 In 1987, that assumption was provedfalse when a biomechanician experi-enced in the science of traumaticbrain injury (TBI) together with neu-rosurgeons created a model baby, putan accelerometer on its neck, and hadsome burly Penn State footballplayers shake the model as hard asthey could. The result was that the‘shakers’ were unable to create theforces needed to cause intracranialbleeding. The experiment alsoshowed that to cause intracranialbleeding, or what is medicallytermed, “subdural hematomas”(SDH’s) and “subarachnoid hemor-rhages” (SAH’s), there had to beimpact. Impact forces were found tobe 50 times greater than those ahuman being could generate byshaking the model. For a fuller dis-cussion of this study, see “TheElephant on the Moon,” Part I of thethree-part series published in TheWarrior. Virtually the same experi-ment was repeated and validatedagain in 2003, and in the March2004 issue of the Journal ofNeurosurgery, the lead neurosurgeryexperimenter from the 1987 model-baby-shaking experiment, agreed thatbecause the evidence for shaking isnot complete, that the term shouldnot be used to describe the cause ofintracranial injuries in babies. JNeurosurg. 100:574-75, March 2004,“Neurosurgical Forum,” “Letters tothe Editor,” regarding, “RotationalInjury,” Prange, MT, Coats, B,Duhaime AC, et al,“Anthropomorphic simulations offalls, shakes and inflicted impacts ininfants,” J Neurosurg., 99:143-150,July 2003.

4 Medical Reporter Marilyn Brooks,

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Penetrating X-rays Were Used to Find ‘Invisible Abuse’: The scientifically-unreliableclaim made by Caffey, Kempe and others was that if intracranial bleeding was seen with anX-ray, the cause of this bleeding – violent shaking – could be identified. This is like sayingthat if a psychiatrist views a patient’s skull on an X-ray, or the brain on CT, MRI or PET

scans, they can determine the cause of mental illness or insanity.Copyright by Sidney Harris, 2004. Reprinted with Permission.

T H E W A R R I O R • F a l l 2 0 0 4 35

The Pittsburgh Channel, ActionNews, “Healthcast,” WTAE-TV,Channel 4, July 22, 2004, 5 PM. Thenews story also discusses the develop-ment of a blood test to detect braininjury.

5 Fn 4, Id.

6 42 USC § 5102, et seq., as amended.

7 42 USC § 5106g(B)(2).

8 Opening Statement of Rep. PeterHoekstra (D-Mich), Chairman of theSubcommittee on Select Education,before the U.S. House ofRepresentatives, Committee onEducation and the Workforce,Subcommittee on Select Education,“CAPTA: Successes and Failures atPreventing Child Abuse andNeglect,” August 2, 2001.

9 Over reporting and over-zealousinvestigations are only half of thestory. The flip side is that some casesof alleged reported child abuse arenot properly investigated or followedup. Children who are in danger slipthrough the cracks and suffer terriblyas a result. The Keystone Kids inChicago were victims of the failure ofthe Illinois Department of Childrenand Family Services (DCFS). In thatcase, Chicago police officers enteredan apartment at 219 North Keystone

Avenue to investigate a tip that thepeople there were dealing drugs.They did not find any drugs, butthey did find nineteen children, mostunder five years old, all huddled onbare mattresses. The children werewearing little but soiled diapers anddirty underwear, and two of themshared meat off a bone with a dog.DCFS had received several com-plaints about the plight of theKeystone Kids and had failed toinvestigate. One might say theKeystone Kids were "lucky" After all,some children die as a result of CPSfailures to investigate. Doctors andCPS professionals are all too aware ofthese kinds of cases. Cases like thesecreate a systemic and, often, an indi-vidual tension. Physicians and CPSworkers are concerned not to falselyaccuse anyone and, in doing that, risktearing apart families they wouldrather help to preserve.

10 NIH Consensus Statements for theRehabilitation of Persons withTraumatic Brain Injuries, 1998, Oct.26-28; 16(1): 1-41, NIH ConsensusDevelopment Panel.

11 Given the magnitude of the problemof false accusations of child abuse,CAPTA amendments in the pastdecade require states to have in place

a procedure for speedy expungementof records of those who were accusedbut found to be without fault. But,once accused of SBS, because physi-cians and CPS workers believe it is areal diagnosis, there is no hope ofexpungement for that segment of thepopulation of the falsely accused.Although CAPTA’s amendmentsreflect sensitivity to the colossalproblem of false accusations of childabuse, there are no correspondinggrants for criminal defendantsaccused of SBS (or any other form ofchild abuse). So much for one ofCAPTA’s stated purposes—to keepfamilies together.

12 Also high on the list are cases ofsexual abuse and MunchausenSyndrome by Proxy. In this claimed“factitious” disorder, parents are saidto make their children sick to getattention for themselves.

Thanks is due to Susan Kelly, author of “TheBoston Stranglers,” for her incredibly aggressiveand thorough research which helped me getstarted on the funding trail, to Jan E. Leestma,M.D., for his balanced view of child abuse pre-vention culture and its problems of under-reporting and over-reporting, and most of all toAyub K. Ommaya, M.D., for first inspiring meto write about the topic of SBS.

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Money Matters: Expert witnesses testify in 2003 before a Congressional subcommittee to sustain and increase the huge federal budg-et for child abuse protection and prevention. The Children’s Bureau is the main federal agency that signs the checks to the states andto a long list of private child protective services organizations under the amended 1974 Child Abuse Prevention and Protection Act(CAPTA). The annual budget of the agency was $6.7 billion in 2004.

Over the past 30 years, and to date, a significant portion of that has gone and still goes to programs to train and encourage childprotective services and medical professionals to recognize child abuse, including so-called “shaken baby syndrome” (SBS). This cre-ates the risk that SBS may sometimes be diagnosed not because it is probable, but because it is profitable. Some people believe thatthis financial incentive compounds the problems already caused by mandatory reporting of suspected child abuse by contributing tothe more than one million unsubstantiated child abuse reports and the large number of false child abuse accusations every year.