child abuse


Narrating Medicine: The Long Lasting Impact Of Child Abuse

One day when we were in first grade and sitting on a rickety wooden bench under a large oak tree in her backyard, my best friend’s mother called her to come inside.

A few minutes later, I heard wailing like an animal being gutted. Squinting my eyes and looking perplexed, I turned to my friend’s younger sister who was sitting beside me. She whispered, “She’s just getting beat.” Beat? What’s that, I wondered. She explained. Depending on the severity of their perceived wrongdoings, they were administered one of three levels of physical punishment: a stick, a belt or a big slab of wood. Their parents had moved from Ireland to our small suburb in New Jersey.

The Catholic schools the parents had attended as children in Ireland were very strict and the nuns reportedly beat them until their knuckles bled. Here, as parents in New Jersey, they told their daughters to strip naked and mercilessly receive corporal punishment. (I learned this from her sister, and over the years, from my friend.)

This was not a onetime event. These were repeated, deliberate acts. Continue reading

Bleeding Disorder? National Expert Discusses Questions Around Cambridge Baby’s Death

Aisling Brady McCarthy

Aisling Brady McCarthy watches as her attorney addresses the court during a status hearing at Middlesex Superior Court in Woburn in May. McCarthy, a nanny from Ireland, was accused of killing a 1-year-old Massachusetts girl in her care two years ago. (Charles Krupa/AP)

Aisling Brady McCarthy is back in her native Ireland now, after murder charges against her were dropped in the death of Rehma Sabir, a Cambridge infant in her care. But while the case is over, the mystery remains: How did Rehma die?

The Middlesex County district attorney’s office says a review of the case raised the question of whether 1-year-old Rehma had an undiagnosed blood disorder that could have caused her brain hemorrhage. A press release from the office cites these details from the medical examiner:

“Review of Rehma’s coagulation and hematology testing, her history of bruising, the NIH guidelines for diagnosis of von Willebrand disease, and literature on the subject suggest to me that Rehma’s low von Willebrand factor could have made her prone to easy bleeding with relatively minor trauma.

“Given these uncertainties, I am no longer convinced that the subdural hemorrhage in this case could only have been caused by abusive/inflicted head trauma, and I can no longer rule the manner of death as a homicide.  I believe that enough evidence has been presented to raise the possibility that the bleeding could have been related to an accidental injury in a child with a bleeding risk or possibly could have even been a result of an undefined natural disease.  As such I am amending the cause and manner of death to reflect this uncertainty.”

So, then, a bleeding disease might have caused a spontaneous hemorrhage? Or the combination of the disease and a minor head injury led to death? And if so, could it be that quite a few of the contested accusations of baby abuse in recent years could be thus explained away?

Dr. Shannon Carpenter (courtesy)

Dr. Shannon Carpenter (courtesy)

I turned to Dr. Shannon Carpenter, a bleeding disorders specialist who has done research and written American Academy of Pediatrics reports on checking children for bleeding disorders when there’s a question of abuse. She’s the chief of hematology at Children’s Mercy Hospital in Kansas City, Missouri, and the director of the Kansas City Regional Hemophilia Center.

Dr. Carpenter was not involved in the Cambridge case, but speaking generally she says that sadly, no, there’s no kinder explanation here: Abusive head trauma — a better term than “shaken baby syndrome” because abuse can involve more than shaking — is far more common than serious bleeding disorders, and even children with severe disorders are extremely unlikely to have fatal brain bleeds. Our conversation, lightly edited:

Dr. Carpenter, what are we to make of the medical examiner’s mention of Von Willebrand disease — a not-very-rare bleeding disorder — and the suggestion that death could have resulted from disease or “an accidental injury in a child with a bleeding risk”?

One thing I would say is, most patients with von Willebrand disease have a mild disorder, mostly manifested by nosebleeds, bruising, and gum bleeding, and do not seem to have an increased risk for intracranial hemorrhage. Research is ongoing in this area and I think there may be more information coming, but from a clinical perspective, when we see patients with the most common types of von Willebrand disease, we do not have a high concern for intracranial hemorrhage in those patients, certainly not spontaneously.

“Unfortunately, child abuse is more common than bleeding disorders.”

– Dr. Shannon Carpenter

The most severe forms of von Willebrand disease occur in about 1 percent of people with von Willebrand disease, probably less than that. And even in the most severe forms, the risk of having a bleed inside of the head is probably less than 2 percent. So it’s a very rare event. This would be an unusual presentation for von Willebrand disease. I don’t know the specifics of this patient’s case, and I don’t know what her actual von Willebrand factor level was, but even if she was low enough to be diagnosed with the most common form of von Willebrand disease, this kind of bleeding would not be typical for that kind of diagnosis.

But, I suppose, possible?

While anything is possible, you have to look at what’s probable and what other patients have experienced. And patients with bleeding disorders are not immune to trauma, whether it’s inflicted or non-inflicted. I would say if a child came to me with type 1 von Willebrand disease, the most common type, the mild form of von Willebrand disease, with a typical toddler head bump that would not otherwise cause someone to seek medical care, I would not worry about intracranial hemorrhage in that patient.

And if a child had a more severe form of von Willebrand disease?

Then I might be concerned.

But if it were a severe form, wouldn’t it have likely shown up by 1 year of age? Continue reading

Studies Show How Physical, Emotional Neglect Harms Children’s Brains

It’s not surprising but it is alarming: physical and emotional neglect has a harmful effect on children’s developing brains, new research shows.

(Southworth Sailor/flickr)

Children’s Hospital Boston’s blog Vector pulls together several studies that detail the various levels of damage that can be done to children’s brains when they are subject to trauma, neglect and social isolation:

Sheridan, Nelson and colleagues obtained brain MRIs from three groups of 8- to 11-year old children: 29 had been reared in an institution, 25 had left the institution for a high-quality foster home (where they spent 6 to 9 years), and 20 typically developing children who were never institutionalized served as controls.

The findings were mixed:

–Children who had spent their entire lives in an institution had significantly lower volumes of white matter—necessary for making connections in the brain—in the cortex of the brain than did the controls. But if they were transferred into foster care, their white matter volume became indistinguishable from that in controls. Continue reading

Study Finds Link Between Child Abuse And The Timing Of Menstruation

(Southworth Sailor/flickr)

Might childhood physical and sexual abuse be so profoundly traumatic that it actually disrupts a developing woman’s hormonal system years later?

Based on a new study out of Boston University, it sure looks that way.

Researchers have uncovered a connection between child abuse and disruptions in the timing of menarche, the final phase of puberty, when menstruation begins.

The new findings, published online in The Journal of Adolescent Health, suggest that a woman’s hormonal pathways can be derailed by trauma and stress; and the research underscores the importance of a comprehensive approach to treating abuse survivors in which the severity and specific type of violation is considered.

Renée Boynton-Jarrett, MD, assistant professor of pediatrics at the BU School of Medicine and the study’s lead author, reports a 49 percent increase in risk for early onset menarche (defined here as menstrual periods prior to age 11) among women who reported childhood sexual abuse compared to those who were not abused.

Abuse was also linked to girls getting their first period later than average. The researchers report a 50 percent increase in risk for late onset menarche (menstrual periods after age 15) among women who reported severe physical abuse in childhood. Continue reading

Study: Rise In Serious Child Abuse Linked To Mortgage Foreclosures

(Jeffery Turner/flickr)

Amidst all the troubling global and local economic news in recent months, this is particularly worrisome:

Researchers in Philadelphia report a strong link between rates of hospital admissions for serious child abuse and local mortgage foreclosures.

The new analysis from the PolicyLab at Children’s Hospital of Philadelphia stands in contrast to other national statistics that show child abuse overall has declined. It also raises red flags about how well social service agencies and others are protecting vulnerable children, particularly in regions hard-hit by the recession.

The study, which reviewed hospital data over a 10-year-period, from 2000-2009, included 11,822 admissions for physical abuse of children under 6 years old.

From the news release:

The study, published in the journal Pediatrics, found a strong relationship between the rate of child physical abuse and local mortgage foreclosures, which have been a hallmark of the recent recession. The CHOP findings, based on data from 38 children’s hospitals, contradict national child welfare data, which show a decline in child physical abuse over the same period…

According to the study, overall physical abuse increased by 0.79 percent, and traumatic brain injury increased by 3 percent per year between 2000 and 2009, while overall injury rates fell by 0.8 percent per year over the same time period. The researchers found that each 1 percent increase in 90-day mortgage delinquencies over a one-year period was associated with a 3 percent increase in hospital admissions due to child physical abuse and a 5 percent increase in admissions due to traumatic brain injury suspected to be child abuse. (My bold.)

Pediatrician Joanne Wood, the lead author of the study and an attending physician at CHOP said she and colleagues embarked on the study after hearing stories from other doctors around the country about increases in serious child abuse cases — including children with traumatic brain injuries, fractures and other injuries requiring hospitalization. Continue reading

‘Anatomy Of A Bad Confession’: The Medical Evidence

2008 photo of Nga Truong and Khyle

It’s all over the WBUR homepage today, but just in case that’s not on your usual online route, here’s an added signpost: Check out uber-reporter David Boeri’s frightening investigation into a young Worcester girl’s coerced confession that she had killed her baby, “Anatomy of a Bad Confession.”

My reaction: The only nightmare worse than losing a child is being accused of the child’s murder — and somehow confessing to an unthinkable crime you never committed. There’s a medical element as well — strong evidence that the baby could have died of natural causes. David writes:

That videotape was of crucial significance to the case. The police had no other evidence other than the confession. There were no witnesses, the autopsy report was inconclusive, and the 13-month-old boy, Khyle, had strep throat, tracheobronchitis, indications of a fever and a history of respiratory problems, including asthma, at the time of his death. When the judge, Janet Kenton-Walker, threw out Truong’s statements to police, she wrote that Truong “was a frightened, meek, emotionally compromised teenager who never understood the implications of her statements [to police].”


Pageau knows, as he will later testify, that at the time of this interrogation the manner of Khyle’s death is “undetermined.” The medical examiner who conducted the autopsy just a few hours earlier has stated no cause of death. The child has shown no sign of injuries and his elevated body temperature after death (101 degrees Fahrenheit one hour after being declared dead) indicates, as Truong said, that her baby had a fever. And Khyle had a history of asthma. But in the box, the detectives betray no doubt.

When Child Death Cases Are Mishandled

An investigation into the death of Isis Vas (above) raises questions about how the case was handled

A joint investigation between NPR, ProPublica and Frontline finds a troubling number of botched cases in which caretakers may have been wrongly charged and convicted of killing or assaulting children.

The piece on NPR today, The Child Cases: Guilty Until Proved Innocent, begins with the heartbreaking story of a little girl from Texas:

Her name was Isis Charm Vas and at 6 months old she was a slight child – fifth percentile in height and weight.

Isis Vas was just six months old when she died.

When the ambulance sped her to Northwest Texas Hospital in Amarillo on a Saturday morning in October 2000, doctors and nurses feared that someone had done something awful to her.

A constellation of bruises stretched across her pale skin. CT scans showed blood pooling on her brain and swelling. Blood was found in her vagina. The damage was so severe that her body’s vital organs were shutting down.

Less than 24 hours later, Isis died.

An autopsy bolstered the initial suspicions that she’d been abused. Joni McClain, a forensic pathologist, ruled Isis’ death a homicide and said the baby had been sexually violated. McClain would later describe it as a “classic” case of blunt force trauma, the type of damage often done by a beating.

The police investigation that followed was constructed almost entirely from medical evidence. In the end, prosecutors indicted one of the child’s babysitters: Ernie Lopez.

Today, Lopez is serving a 60-year prison term for sexual assault and is still facing capital murder charges.

The problem with the case again Lopez, the story reveals, is that it may have been terribly mishandled.

…a growing body of evidence has emerged suggesting that McClain and the hospital staffers were wrong about what happened to Isis — and that her death was not the result of a criminal attack.

If Lopez is ultimately exonerated, his case will not be unique. An investigation by NPR, ProPublica and PBS Frontline has found that medical examiners and coroners have repeatedly mishandled cases of infant and child deaths, helping to put innocent people behind bars.

The piece raises hard questions about the way some of these horrific cases were investigated. But in many ways, it feels like a recap of a recent magazine piece in The New York Times, which posed doubts about the diagnosis and science behind shaken baby syndrome. (The NYT piece mentions CommonHealth, by the way, and when we posted about shaken baby syndrome, we had an overwhelming response from a number of medical and legal experts who asserted, powerfully, that the science behind the syndrome remains sound.

Class Action: Ex-Children’s Hospital Doc Charged With Sex Abuse Of Patients

A class action lawsuit filed this morning against former Children’s Hospital doctor Melvin Levine alleges that he sexually abused young patients under his care, The Boston Globe reports.

The suit, filed by attorney Carmen Durso, alleges that Dr. Melvin D. Levine committed medical malpractice and sexual abuse and the hospital was negligent in failing to properly supervise him in more than 40 cases over 20 years. According to the lawsuit, those plaintiffs have alleged that Levine performed genital examinations on them that were not medically indicated.
The suit, filed in Suffolk Superior Court, also said it sought to represent the entire group of children examined by Levine during the period 1966 through 1985, estimating that he treated approximately 5,000 boys during that period.

See the complaint here.

Tuerkheimer Responds To Criticism On Shaken Baby Syndrome

CommonHealth asked professor Deborah Tuerkheimer to comment on all of the impassioned responses (mostly negative) we got after linking to her op-ed piece in The New York Times. (The piece, called “Anatomy of a Misdiagnosis,” said that experts are growing wary of the science behind shaken baby syndrome and that innocent people have wrongly been convicted based on this bad science.)

Here is her slightly edited response:

I appreciate the interest and attention being
focused on this important issue. While I am not able to comment on blog
comments, I think it is worthwhile to emphasize – as I’ve done in my
work – the importance of viewing these scientific developments from the
perspective of criminal justice. From this vantage, outstanding areas of
disagreement within the scientific community are dwarfed in importance
by the ground that is shared.

If your blog readers are interested in a more thorough discussion of how
our criminal justice system has responded to SBS, my article can be
accessed here

I am hopeful that the Times Op-Ed can catalyze a productive


Deborah Tuerkheimer
Professor of Law
DePaul University College of Law

The Real Consensus On Shaken Baby Syndrome?

Nanny Louise Woodward after her 1998 conviction

Note: Please check out our latest post on this topic here: Queens prosecutors appalled by op-ed.

Last week, CommonHealth linked to a provocative Op-Ed piece in The New York Times on the abusive shaking of babies. Written by law professor Deborah Tuerkheimer, it said that “experts are questioning the scientific basis for shaken baby syndrome. Increasingly, it appears that a good number of the people charged with and convicted of homicide may be innocent.”

In fact, according to one child-abuse expert, Dr. Daniel Lindberg of Brigham and Women’s Hospital, Tuerkheimer “systematically distorts the scientific consensus.” She “relies exclusively on the opinions and work of ‘experts’ who derive substantial income from lucrative court testimony on behalf of the accused perpetrators of child abuse,” he wrote in a response to our link. And “her sources rarely, if ever, provide medical care for children. “

Continue reading