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By JoNel Aleccia Health writer
msnbc.com
updated 5/1/2010 12:21:50 AM ET 2010-05-01T04:21:50

Cases of shaken baby syndrome have jumped sharply during the recession, researchers say, further fueling worries about the link between economic stress and the deadliest form of child abuse.

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The number of babies and young children suffering abusive head trauma climbed by 55 percent in the months after the recession began in December 2007, according to a review of 511 cases at four children’s hospitals across the U.S.

The spike came during a period of rising unemployment, falling home prices and cuts to state and county budgets, including those that fund safety net programs to prevent child abuse.

“We do know that poverty and stress are clearly risk factors for child abuse,” said Dr. Rachel P. Berger, a University of Pittsburgh Medical Center brain injury specialist who led the study. “Here, you had the perfect storm: increased stress, increased poverty and yet the social services were being cut.”

Equally startling, about a third of the cases involved children older than 1, including kids up to age 6, hinting at a level of caregiver frustration sparked by more than the stress of wailing newborns.

“I find this to be one of the most disturbing things,” said Berger, an assistant professor of pediatrics at the Children’s Hospital of Pittsburgh. “These are not crying infants. These are walking, talking defiant toddlers.”

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Leonard ‘L.J.’ McIntire, a 19-month-old Pennsylvania toddler, died after being beaten, bitten and shaken by his mother's boyfriend.

Bitten, beaten, shaken
One of those children was 19-month-old Leonard “L.J.” McIntire of Black Lick Township, Penn., who was bitten, beaten and shaken by his mother’s boyfriend in October 2008.

The boyfriend, Joshua Turner, 20, of Burrell Township, Penn., told police the toddler bit him and he decided to bite the baby back “to show him what pain felt like,” according to local news reports. He confessed to punching the boy as hard as he could and then shaking him violently. The child also had a broken left arm and ligature marks on his neck.

The baby's mother, Kimberly Shirley, 22, testifed that she left L.J. with Turner to go to the welfare office and then to the Salvation Army to add his name to a charity Christmas tree so he would receive a gift, according to reports.

L.J. McIntire spent five days on a ventilator at Children’s Hospital of Pittsburgh before he died as a result of blunt force head trauma. This week, Turner was sentenced to life in prison for the baby’s murder.

That fatal case and others sparked Berger’s concern after she noticed that more children died at her hospital in 2008 because of head injuries caused by abuse than from any non-inflicted cause.

“We thought maybe it was just something in our hospital,” she said.

But numbers of shaken baby cases also rose at children’s hospitals in Seattle and in Columbus, Ohio. Cincinnati Children's Hospital, the fourth included in the review, didn't see an increase.

Dr. Ken Feldman, medical director of the Children’s Protection Program at Seattle Children’s confirmed the grim trend. In 2006, the hospital logged 14 cases of shaken baby syndrome, and 16 in 2007. In 2008, the number jumped to 31, followed by 24 cases in 2009, he said.

“What happened in 2008 is the largest number in my memory,” said Feldman.

Shaken baby syndrome is the top cause of child abuse deaths in the U.S., where an estimated 1,200 to 1,400 cases are logged each year, according to Amy Wicks, a spokeswoman for the National Center on Shaken Baby Syndrome in Ogden, Utah.

Father or boyfriends were responsible for the head injury in the majority of cases where the perpetrators were identified, and about 60 percent of the victims were 6 months old or younger, with the peak age being 2 months.

Shaken baby syndrome occurs when someone forcefully shakes an infant or child, even for as little as 5 seconds, causing the child's head to rotate around the neck uncontrollably. The violent movement pitches the child's brain back and forth within the skull, sometimes rupturing blood vessels and nerves throughout the brain and tearing brain tissue. Blindness, brain damage, seizures and severe learning difficulties are common in children who survive.

Wicks said the new study, to be presented Saturday at the international Pediatric Academic Societies meeting in Vancouver, British Columbia, echoed anecdotal reports from child welfare workers across the United States.

“We have been hearing from the people in the trenches dealing with the cases that it is up,” Wicks said.

16 percent of victims died
Berger and the other researchers looked at 511 unequivocal cases of abusive head trauma during a six year period, from Jan. 1, 2004 through Dec. 31, 2009. The number of cases per month jumped 55 percent, from a mean of six per month before the recession began to more than nine per month after Dec. 1, 2007.

Sixty-three percent, or 322 children, were injured severely enough to be admitted to a pediatric intensive care unit, researchers said. Sixteen percent, or 82 children, died as a result of their injuries.

Researchers could not confirm a link between the rise in shaken baby cases and unemployment, which Berger attributed partly to gaps in data collection, which did not track the employment status of individual caregivers. However, nearly 90 percent of the injured children were enrolled in Medicaid, the federal program that provides health care to poor and disabled people.

Berger's research follows a new government report last month that said while the number of victims of child abuse in the U.S. dropped sharply in 2008, the number of deaths from abuse went up. Cases fell from 903,000 in 2006 to 772,000 in 2008, while deaths from child abuse or neglect rose to 1,740 in 2008, up from 1,330 in 2000, according to information from the National Child Abuse and Neglect Data System.

Berger suspects that recession-linked cuts in social services meant that there were fewer child protection workers to collect and report overall abuse cases, but that deaths are still captured by other systems.

Most cases of shaken baby syndrome result in devastating injuries to the children and a life of constant monitoring for their families and caregivers, Berger said.

“There’s almost nobody who comes out of this unscathed,” she said. “These kids, they are never OK.”

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