Non-accidental injury (NAI) is a complicated area of law and medicine, both of which are filled with technical terms and jargon. I’ll do my best to make some of this clearer for you, starting with something you might hear a lot of in non-accidental injury proceedings; shaken baby syndrome. This is also sometimes known as ‘the triad’, ‘non-accidental head injury’ or ‘inflicted head injury’.
These phrases refer to three areas of intracranial (inside the head) injury which are believed by many to be caused by shaking.
- Bleeding within the eye (retinal haemorrhage);
- Bleeding beneath the dura in the brain (subdural haemorrhage); and
- Damage affecting brain function (encephalopathy).
The current consensus among medical professionals, taken from confessions and other evidence, is that these injuries are caused by the movement and forces that take place during shaking (rotational acceleration and deceleration forces), with or without impact against a hard or soft surface. The brain moves within the skull which causes the bridging veins to tear and bleed into the dura.
These brain injuries are often accompanied by cessation of breathing (apnoea), floppiness, lethargy, vomiting, unconsciousness and/or seizures. All of these symptoms are a result of the disturbance to the brain (known as encephalopathy). This disturbance can be caused by a lack of oxygen (hypoxia) or a lack of blood (ischaemia) to the brain, or both (hypoxic-ischaemic injury).
Many doctors and local authorities often take the view that the presence of any one of these three injuries, whilst not absolute proof of shaking, is indicative of NAI and is therefore highly likely to kick start care proceedings.
Other signs of NAI might be bruising, long bone fractures (e.g. thigh bone), rib fractures, metaphyseal fractures, torn frenulum, scalp swelling, etc.
This is a controversial area of medicine and law in that there are many other theories about how these ‘injuries’ can be caused as well as a belief among some that shaking alone cannot cause such injuries. Other causes of these injuries can include accidents, birth, infection, metabolic disease, altered pressure within the brain, coagulation disorders, etc.
Medical knowledge is advancing and opinions have changed significantly over the last 10 years. With these advances, a parent who had their child removed following an allegation of shaking 10 years ago, may well receive a different outcome if the matter was heard today.