Elsevier

Legal Medicine

Volume 18, January 2016, Pages 90-97
Legal Medicine

Exploring the controversy in child abuse pediatrics and false accusations of abuse

https://doi.org/10.1016/j.legalmed.2015.12.004Get rights and content
Under a Creative Commons license
open access

Highlights

  • There is a controversy regarding the fund of knowledge in child abuse pediatrics.

  • An unproven hypothesis (SDH & RH = abuse) is in use to prosecute innocent caregivers.

  • Challenges to establishment thinking, and doubt regarding its validity, have increased.

  • Child abuse MDs continue to reject old and new science to maintain the status quo.

  • Efforts to eliminate false accusations (iatrogenic child abuse) should be expanded.

Abstract

There is a controversy in child abuse pediatrics between an established corps of child abuse pediatricians aligned with hospital colleagues and law enforcement, and a multi-specialty challenger group of doctors and other medical professionals working with public interest lawyers. The latter group questions the scientific validity of the core beliefs of child abuse pediatricians and believes that there are a substantial number of false accusations of abuse occurring. An unproven primary hypothesis, crafted around 1975 by a small group of pediatricians with an interest in child abuse, lies at the foundation of child abuse pediatrics. With no scientific study, it was hypothesized that subdural hemorrhage (SDH) and retinal hemorrhage (RH) were diagnostic of shaking abuse. That hypothesis became the so-called “shaken baby syndrome.” Through the period 1975–1985, in a coordinated manner, these child abuse specialists coalesced under the American Academy of Pediatrics and began working with district attorneys and social workers, informing them of the ways in which their hypothesis could be applied to prosecutions of child abuse and life-altering social service interventions. In a legal context, using then-prevailing evidentiary rules which treated scientific expert testimony as valid if it was “generally accepted” in the field, they represented falsely that there was general acceptance of their hypothesis and therefore it was valid science. As the ability to convict based on this unproven prime hypothesis (SDH and RH equals abuse) increased, some defense attorneys were professionally compelled by their own doubts to reach out to experts from other fields with experience with SDH and RH, trauma, and biomechanics, for second opinions. Medical and legal challenges to the established thinking soon emerged, based on both old and new evidenced-based literature. As the intensity of the controversy increased, the probability of false accusation became more apparent and the need to address the issue more pressing. Since false accusations of child abuse are themselves abusive, efforts to eliminate such false accusations must continue.

Keywords

Child abuse pediatrics
Controversy in child abuse pediatrics
Shaken baby syndrome
False accusations of abuse
False allegations of abuse
Child abuse

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