Many criminal defense attorneys are starting to realize the benefits of utilizing a certified forensic nurse to evaluate their criminal cases. The certified forensic nurse is a registered nurse who has undergone specialized training in the area of forensics. This specialized training may include sexual assault nurse examinations (SANE), nurse death investigations, domestic violence training, child abuse and neglect, elder abuse and neglect, mass disaster training and correctional nursing. Obtaining a certified forensic nurse trained in evaluating criminal cases, such as “shaken baby syndrome,” can provide the defense attorney with a thorough, cost effective medical evaluation.    

In “shaken baby syndrome” cases, the controversies and conflicting reports among experts in abusive head trauma make these cases very challenging.  As a result of early literature and lack of acceptance of other possible etiology, the presence of a subdural hematoma, retinal hemorrhage and brain injury has been the staple for the diagnosis of abusive head trauma.  There are many other possible etiologies to this triad of diagnoses which include hypoxic/ischemic events, vascular abnormalities, issues with clotting processes, seizures, infections, fluid and electrolyte imbalances, and even certain vitamin deficiencies.

In my years of evaluating criminal cases, several of these “shaken baby syndrome” abuse cases are coming across my desk for medical evaluation.  It seems that the majority of the medical and scientific community are still very rigid in their opinions regarding the possible etiology of the injuries seen many times in the reported “shaken baby syndrome.” A conclusion is typically postulated without knowledge of current or past medical histories or situational histories, as the parents or caregivers are typically removed from the presence of the child.

In several cases that I have evaluated for possible “shaken baby syndrome,” the possibilities of other etiologies are apparent due to evidence of a hypoxic/ischemic event from a seizure and/or aspiration. In other cases, I have discovered apparent histories of coagulopathies leading to issues with bleeding events, as well as the possibility of “re-bleeds” as being the initial insult diagnosed.

In these cases, it is imperative that a medical professional evaluate the medical records for possible causes of the injuries present. The complexities of the brain and the sometimes highly complex critical illnesses seen in some children can truly only be accurately examined by a medical professional. Furthermore, it is very important to obtain all medical records involving the event and hospitalization, as well as birth records and pediatrician records for evaluation.