Читать книгу Losing Patience - James Peinkofer - Страница 10
Оглавление“A father was arrested and charged Wednesday with reckless homicide in the July shaking death of his infant daughter,” the South Bend Tribune reported. “Steve Edward Gill, 21, was arrested after an Elkhart County Circuit Court grand jury returned an indictment late Tuesday, according to the Elkhart County prosecutor’s office…His daughter, Patience Gill…, died July 30 at Memorial Hospital in South Bend at the age of seven weeks, according to the death notice published at the time…The grand jury met all day Tuesday and heard testimony from many witnesses before returning the indictment.”1
It was a perfect storm that came together in July 2000 at the Gill home: A young father, who fit the profile of a caregiver most at risk to use shaking as a method of controlling an out-of-control situation. An infant, whose own victimology placed her in harm’s way, through no fault of her own. Patience was communicating a need. At seven weeks of age, she was on the cusp of using crying as her primary method of that communication. But her father didn’t speak the same language. He couldn’t tell what she wanted and became more and more frustrated by her screams, which would escalate, as would his anxiety. He had no one to turn to in order to give him support or a break from the constant crying. He may have used one or two methods to attempt to soothe his daughter, but they failed. He didn’t want to fail. He wanted to be viewed as a father who could handle any situation. He was the one left to take care of her. Leaving the house for a half-hour wasn’t an option. What would people think if he did that? He’d be a failure as a caregiver, as a father. Instead, he took his daughter into his hands to control the situation, to make the crying stop.
Final Diagnosis of Patience Gill
1. Craniocerebral trauma:
a. Left cheek contusions
b. Subscalpular contusions, posterior (occipital) and left parietal skull
c. No skull or facial bone fractures
d. Diffuse subdural hemorrhage
e. Scattered subarachnoid hemorrhages
f. Marked cerebral edema
g. Bilateral optic nerve hemorrhages
h. Diffuse axonal injury
i. Retinal hemorrhages
j. Deep posterior neck hemorrhage, small
2. No other injuries identified.
Cause of Death:
Craniocerebral trauma
Manner of Death:
Homicide
Every year, thousands of infants and children are shaken by parents and caregivers. The exact numbers are unknown, as there is no database of Shaken Baby Syndrome (SBS) cases, but cases are estimated to fall between 1,000 and 1,500 cases in the U.S. alone. Since many cases are missed diagnoses or are less traumatic, the actual numbers are most likely in the thousands. The missed cases may be ones that are not ruled as abusive or a child was shaken but not hospitalized, etc. So the estimated number is just a best guess. In 2003, Heather T. Keenan and her associates calculated that approximately three hundered children in the U.S. died from being shaken, which correlates with previous estimates of SBS deaths.
How can a child be injured so seriously by being shaken? A baby’s head is larger than an adult’s. It takes up approximately 25 percent of an infant’s body weight. The head also tends to be floppy, since a baby does not initially have strong neck muscles. These muscles develop and strengthen over time. A large, floppy head makes the forces of shaking severe. It also affects the forces of impact (if impact occurs after shaking).
The damage of shaking occurs within the fragile organs of a child. Shaking tears apart an infant’s developing brain, which is soft and rapidly growing. Across the brain, the connective bridging veins are loosely attached, so when a whipping motion occurs during shaking, the resultant combination is very destructive and potentially lethal for an infant or child. Another injury that occurs from violent shaking is retinal hemorrhage. The eye nestles as a globe within the socket and shaking causes a pulling at the back of the eye, which is where the retina is. This extreme pulling causes tiny hemorrhages throughout the entire retina. These widespread hemorrhages cannot be seen with the naked eye; a trained ophthalmologist is needed for an examination. The physiology of the brain and eye will be explained in greater detail in the next chapter.
Who is shaken? Sixty percent of the victims are male. It is presumed that the reason for this is the perpetrator believes a male child should not cry—even though the child is simply communicating a need. Crying is the number one trigger to initiate a shaking event. For toddlers, the trigger is typically a behavioral one, such as toilet training or temper tantrums. The average age of victims is six months. In the victimology chapter, I will explain the reasons why certain children are targeted to be shaken.
In terms of injury from shaking, only 20 percent come out of the shaking with a “positive” outcome. Approximately 60 percent have lifelong physical consequences—blindness, mental retardation, paralysis and permanent disability. There is a 20 to 25 percent death rate. Male perpetrators have been found to be more lethal shakers.
Besides intracranial bleeding and retinal hemorrhages, shaking an infant or young child can cause cerebral edema, body fractures and other injuries. Research has not shown how severe the shaking must be to cause these injuries, so in prevention efforts, parents are cautioned to not shake babies at all. Perpetrator accounts and comparison studies to accidental injuries put the common injuries found in SBS in the violent to severe shaking arena. Light tossing, play, sudden movements, jostling and light shaking (captured in abuse videos) have been shown not to cause the high-level injuries diagnosed by clinicians.
Child abuse statistics for many parts of the world, including the United States, are indicative of worldwide trends. One study that captured what SBS is all about and that signalled the seriousness of the condition was a recent one from 2013. Thomas Niederkrotenthaler and his group found that shaking injuries were much more severe and more lethal than accidental head injuries. Using the new Centers for Disease Control and Prevention definition for abusive head trauma (AHT), they searched a children’s hospital inpatient database and found the national rates for AHT were 39.8 per 100,000 population for children less than one year old and 6.8 per 100,000 population for children one year old. They reported the demographics of AHT as being: more often less than one year of age, male, enrolled in Medicaid, hospitalized longer, died during hospitalization, seen at children’s hospitals and hospitals outside the Northeast.
The researchers recommended targeting socioeconomically disadvantaged families with children less than a year old who live in the South, Midwest and West for prevention purposes. The authors proposed that a more concentrated study of hospitals and hospital regions would be significant in reporting AHT injury.
Why do parents and caregivers shake children? There are multiple reasons, but ultimately it comes down to control as well as a lack thereof. It is a double-edged sword—a crying child who can’t be soothed effectively and an out-of-control parent or caregiver. It is a punishment inflicted on someone who is completely vulnerable. Some individuals just don’t care for infants and children and they are placed in a situation where they are alone with one without support. That can become very dangerous.
In taking the steps to charge and bring a perpetrator of SBS to court, there first needs to be a medical diagnosis. This can be a problem because doctors can come up with wrong diagnoses. Dr. Carol Jenny looked at missed diagnoses of SBS in the 1990s and found that ER and doctor’s office visits missed signs that a baby had been shaken 30 percent of the time, especially if an infant had a moderate shaking event and was not in dire need of medical attention, but rather was fussy, irritable, vomiting, etc. These symptoms can be confused with a virus or other ailment, especially without the use of a CT scan to rule out head injury. Subsequent shakings in the home may cause more dramatic injuries because the abuser may dangerously assume that the baby wasn’t really harmed by the initial shaking and he or she wasn’t blamed for the abuse, so the baby is shaken again and the shaking is usually harder.
SBS is a tragedy that can be prevented. There are a plenty of ways to soothe a crying infant, just as there are signs of potential danger that parents can perceive when leaving their child with a caregiver. The chapters that follow will not only describe the history and physiology of SBS, but also how we are all affected legally, socially and emotionally by this deadly form of child abuse.
Elijah Fisher
My name is Emily Bodily and I am the Parent Spokesperson for the National Center on Shaken Baby Syndrome. My son was shaken in 1998 and, after putting up a valiant fight for four days, my precious son, Elijah, lost the fight and passed away.
The story begins when my son Elijah was sixteen months old and went for a visit with his biological father, Jason, for the weekend of December 19. My nightmare began with a phone call from Jason on the morning of Monday, December 21. He told me Elijah had fallen off the bed and stopped breathing, and the paramedics wanted to know which hospital to take Elijah to.
I went to the hospital and eventually was told my son had been shaken and would most likely not live. I have found this is the way most parents are thrown into the SBS abyss. Elijah struggled for four days, putting up a fight that looked promising to the outside world; however, in my heart, as his mother, I knew he was losing the fight and I was losing all strength to go on day after day and watching his little body only struggle more and more. On December 24, 1998, I told the doctors to take my son off life support and I knew he would not be able to take one single breath for himself.
I believe to this day that Jason loved Elijah, but what I did not and still don’t understand is how he could have gotten so angry with such a precious little boy and use so much force on him. Jason told investigators he could not stop Elijah from crying and that became overwhelming and frustrating to him so he shook him.
In 1998, and currently, the National Center on Shaken Baby Syndrome tracks cases of SBS victims, especially local ones. When my child’s case occurred, they came to offer support at the hearings and eventually asked if I would be interested in making a documentary that would be used to help educate parents and caregivers on the dangers of Shaken Baby Syndrome. We started filming the documentary in 1999, while the court hearings for Jason were still proceeding. I felt that the film was a way I could help the community and the world understand what happens with SBS victims, family members and so many more who are thrown into a world they knew nothing about and have no desire to learn about. The debut of Elijah’s Story was in September of 2000 at the National Conference on Shaken Baby Syndrome. It was at that time I found that this video was going to be a very effective tool to use in the fight for shaken baby victims and families everywhere.
Whether your child survived this awful abuse or passed away, we as parents and family members go down paths that we never want to wish upon anyone. If your child did not survive, you are in mourning of all the wonderful things you will miss through the years. You have to somehow stay strong for the many trial dates you have and come up with the money to pay all different kinds of expenses for the funeral cost and medical bills. If your child survived, you will need to learn many medical procedures and keep a record of all medical issues going on with your child. You will more than likely become his personal nurse and have your days filled with doctor appointments. You will also mourn for the child you have lost, but rejoice in the smallest accomplishments.
If you are a parent or other family member reading this, I am not going to be able to tell you how you should feel or what to expect around any corner you may turn, because each victim, whether they survive or not, is different, and each family member or friend who must go through this deals with something different each time.
In my particular case, Elijah’s father, Jason, ended up pleading guilty to a first-degree murder charge and was sentenced to twenty-five years to life in Utah State Prison. In his plea agreement he will be required to serve a minimum of twelve years. It is a sad thing to have to say, considering the other sentences that I have heard of, that I feel fortunate to have him in there for that length of time.
One of the things that has helped me get through this hell is that I had to come to grips regarding my anger towards Jason. I was not okay for many years, hating Jason the way I did. However, now coming up on the sixth anniversary of Elijah’s death and expecting my first child since then, I now can say I don’t hate Jason; I am very angry with Jason because in a matter of minutes he took so much away from me. But what is very important, which it took me at least two years after my son’s death to realize, was that I am okay with being angry. I do not let it rule my life nor do I ever want to forget it all or “just get over it.”
I invite you to explore our website, www.dontshake.org. You will find two other letters, one from a grandparent who is raising her granddaughter and one from a mother whose child was shaken by a daycare provider. I hope that each of these letters will help comfort you and give you some inspiration.
Nothing can change what has happened to you and it will take a long time to sort out your feelings about it all and find a way to move on in a positive way. My hope for any parent or family member experiencing this is that the anger will not rule your life. I have been able to find some positive ways to deal with my situation and anger by helping other parents and talking publicly about my personal experience.
—Emily Bodily
SBS CASE HOT SPOTS IN THE UNITED STATES
In November 2013, the Medill Justice Project published their study of U.S. counties that had the highest rates of shaken baby syndrome cases. These include: Douglas, Nebraska; Richmond, Georgia; Sarpy, Nebraska; Summit, Ohio and Weber, Utah. These counties were adjusted for population and found to have significantly higher rates than other U.S. counties. When looking at a statewide level, Nebraska ranked number one with the most SBS cases per 100,000 people, followed by Utah, Oklahoma, Wisconsin and Ohio.
Why do these particular counties in the U.S. have higher incidence rates than others? This is an unanswered question, but the report proposes that either some counties are better at identifying SBS cases and charging perpetrators or alternatively that there is a high number of caregivers who are violently shaking infants in those areas.
SBS AROUND THE WORLD
Over the past eleven years, the National Center on Shaken Baby Syndrome has hosted biannual conferences in countries including Australia, Japan, Canada, Scotland and France. Twenty years ago, SBS was recognized primarily in the U.S., Canada, Australia and the UK. Since then, recognition that shaking is used as a means of discipline has grown in terms of awareness in many more countries. There has been an increasing number of prevention initiatives around the world.
In 1999, the World Health Organization (WHO) estimated that 40 million children were subject to abuse and neglect. WHO does not separate SBS into its own entity; thus, countries are left to address or ignore shaking children as a problem. Recently, India has started to address SBS as a matter of concern. In a 2013 article, SH Subba and his associates rang the alarm bell of child abuse: “…The culture of corporal punishment is still viewed as normal and, when that crosses the line and becomes child battery, is not watched closely by any agency.”
Child abuse is a rare occurrence in Sweden due to the ban on corporal punishment since the 1970s. A national survey of parents from 2011 found that 3 percent of the parents beat their children during the previous year, nine out of ten parents expressed negativity about corporal punishment of children and no parent of a child below one year of age claims to have shaken his or her child. In recent years, there were several cases where infants have been severely injured after being shaken by their parents, but this has led to special efforts being made to inform parents of the serious consequences shaking can have on children.
In 2001, the Canadian government developed a joint statement on SBS and proposed a population-based surveillance to establish the incidence of SBS and address risk factors for shaking. They also recommended prevention strategies for the general community, as well as those who are most vulnerable (this includes child development information, parenting programs and anger management).
Japan’s incidence of SBS was recently highlighted in a journal article by K. Mori and his team. They found that Japan’s most recent SBS trends had similar characteristics to their Western counterparts in terms of age of incidence, perpetrator (an increasing number of fathers) and birth defects as a trigger for SBS.
As the concept of Shaken Baby Syndrome continues to spread across the globe, hopefully prevention strategies will increase as well. Such programs need to be supported on a government level in order for increased awareness to be instilled in the general populace.
