1) Are Leah’s symptoms and the autopsy findings consistent with shaken baby syndrome? Explain your answer.
ANS: Leah, a 4 month old was found to suffer from brain hemorrhage. She was claimed to be fussy and vomited for three days straight. She also suffered from Subdural Hematoma as well as brain swelling. According to her autopsy report, there were multiple hemorrhages in Leah’s brain and right eye. All these symptoms as well as the autopsy report are consistent with Shaken Baby Syndrome (SBS).
Shaken Baby Syndrome occurs, when a baby is violently shaken. Not when bouncing a baby or shaking the baby lightly or even when a baby accidentally falls down. The neck muscles, nerves and blood vessels of a baby are unable to take the extreme force
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applied by an adult. When a baby is violently shaken, her head moves forwards and backwards rapidly causing the blood vessels, nerves and neck muscles to cramp, rupture and bleed. In Leah’s case, there were multiple brain hemorrhages and she suffered from Subdural Hematoma which indicates that the blood was collected outside the brain as well as her right eye. Vomiting is also a symptom of Shaken Baby Syndrome. 2) Describe the nature of a subdural hematoma, specifically: a. Where is a subdural hematoma found? b. How can shaking a baby lead to a subdural hematoma? c. How can a subdural hematoma lead to brain injury or death? ANS: a. Subdural Hematoma is found in the space between the Arachnoid and Dura layers. b. Shaken Baby Syndrome is caused by shaking a baby violently leading to severe brain damage. Shaking a baby hard causes her fragile neck muscles, nerves and blood vessels to rupture. This results in blood collection outside the brain as well as brain swelling. Thus leads to Subdural Hematoma. c. Subdural Hematoma is the collection of blood outside the brain caused by shaking a baby violently. This increases the pressure of blood on the brain rapidly, compressing the brain tissue. The unbearable pressure can lead to coma or death. 3) What could account for the scratches on Leah’s face? ANS: Leah is a 4 month old baby. During autopsy, scratches were found on her face. Babies normally scratch themselves most of the times. These scratches could be the result of her scratching herself accidentally or like other babies usually do. However, if her parents were abusive then she might have gotten herself scratched while trying to defend herself. 4) Describe the three mechanisms or phases of Hemostasis, with particular emphasis on coagulation. What are some of the biological components essential for coagulation? ANS: The Three Phases of Hemostasis are: a. Vascular Spasm or Vasoconstriction: It is the first response of blood vessels when there is an injury. The damaged blood vessels will constrict and reduce the amount of blood loss. This response is triggered by some factors such as a direct injury to vascular smooth muscle, chemicals released by endothelial cells and platelets, and reflexes initiated by local pain receptors. Increased damage causes spasm response to become more effective. It is also more effective in smaller blood vessels. b. Platelet Plug Formation: Platelets adhere to endothelium to form Platelet Plug (Primary Hemostasis) and then degranulate. Thromboregulation regulates this process. Platelets temporarily stick to form a Plug that seals the breakage of the vessel wall. It is activated by a glycoprotein called Von Willebrand Factor (vWF), which are found in blood plasma. Platelets also adhere to Collagen fibres of a wound. By releasing ADP, serotonin and thromboxane A2 they become even stickier. The released factors enhance vascular spasm and blood clotting occurs. Fibrin, a collagen fibre is formed. Fibrin mesh is produced all around the platelet plug which holds the Fibrin in place. Once this begins, red and white blood cells get caught up in the mesh which causes the blood clot to become even stronger. c. Coagulation: Clots form when Fibrinogen converts to Fibrin and its addition to the Platelet Plug (Secondary Hemostasis). This conversion is catalyzed by the enzyme Thrombin at the site of vessel injury. When the Fibrin Mesh is formed, it appears red due to the abundance of trapped RBCs. But the backbone of the clot is formed from Fibrin derived from plasma. The original Fibrin web is rather weak, because the Fibrin strands are loosely interlaced. However, chemical linkages rapidly form between adjacent strands to strengthen and stabilize the clot meshwork. This is catalyzed by a clotting factor called, Factor XII (Fibrin Stabilizing Factor). It is present in the plasma in the inactive form. Some of the biological components include clotting factors, Thrombin, Fibrinogen and Fibrin. Many of the clotting factors require vitamin K to function. 5) Why does Dr. Naswani think genetic liver disease could have contributed to Leah’s death? ANS: Genetic liver diseases can cause easy bruising. It was found that Leah had 15 bruises on her head and chest. It also shows similar symptoms to Shaken Baby Syndrome. Easy bruising is caused due to the low production of clotting factors. In babies, blood is first produced in the liver. If liver disease is passed down to the infant then the liver won’t function like it’s supposed to and makes the infant loose her normal blood functioning systems. In Amish families, the rate of genetic diseases is high. One of Leah’s brothers also had bruises similar to Leah when he was a toddler but outgrew it indicating that a liver disease might have been passed down to these children. This is why Dr. Naswani thought that genetic liver disease could have contributed to Leah’s death. 6) Explain Dr. Holmes’ theory that Leah’s injuries may have resulted from not receiving an injection of vitamin K. ANS: Amish families are usually peaceful. They like to stay isolated from the rest of the world since their beliefs and lifestyle are completely different from others. They don’t like modern technology and likes to lead there life the way similar to their forefathers. Dr. Micah Holmes is a physician and expert on Amish medical issues. Since he knows about the lifestyle and beliefs of the Amish families, it was clear to him that the child was born at home. Vitamin K is a major factor in blood clotting. Infants are not born with vitamin K in their bodies. So she needs vitamin K to activate the clotting factors. If vitamin K is not given, the infant’s blood clotting factors cannot function properly which leads to bleeding inside or outside the body. Weak blood clotting factors also lead to easy bruising. Since Dr. Holmes finds similarities between the symptoms of vitamin K deficiency and Leah’s symptoms, he suspects that the midwife who delivered Leah didn’t administer an injection of vitamin K. 7) It’s time to write up your report and make a recommendation. Do you conclude that the Millers should be charged with homicide, or did Leah die of natural causes? Explain your answer. ANS: After studying the case carefully and taking the suspects’ and experts’ claims and suspicions, I conclude that the Millers should not be charged with homicide. It is true that the symptoms and sufferings that Leah went through were similar to the symptoms related to Shaken Baby Syndrome (A form of abuse). But thorough study and analysis shows that it was natural death. First of all, Leah comes from an Amish family where technological reach is neglected and the people of that society tend to follow the ways of their forefathers. According to Dr. Draybill, crime in this community is very rare. They are peaceful, very religious and isolated from rest of the world to protect and preserve their beliefs, lifestyle and population. Since they are a very small population, every child and people of their society are important to them. So there is very little possibility that Leah’s parents abused her. The neighbours of the Millers claimed that Rachel Miller was a great mother and handled all 8 of her children well.
The Millers wanted a daughter badly after having 7 sons. And when they had one, they were extremely happy. There was no complaint of child abuse. This suggests that there were no previous cases of child abuse in the Miller Family. All the kids were fine and none of them had unnatural complications to deal with.
Lt. Olson, police officer, claimed to have seen bruises on one of Leah’s brothers. The boy kind of outgrew it. This matches the claim of Dr. Naswani. He claimed that Leah might have had some kind of genetic liver disease. In the Amish families, genetic diseases are quite common since they don’t have much knowledge about modern medical science and practice things that causes them to pass down the diseases without trying to prevent it. Genetic liver diseases inhibit the natural functioning of blood clotting factors. Thus weakening the body and causing easy bruising.
Leah’s brother was active and got bruised easily when he was young. Similarly, Leah, a 4 month old also had the same problem. This suggests that the Millers might have had some kind of genetic liver disease that was passed down to Leah and her brother. Her brother was able to outgrow it but poor Leah’s situation was too severe to outgrow
it. According to Stan Harrel, district attorney, the signs of having Subdural Hematoma, retinal bleeding and bruises are strongly consistent with Shaken Baby Syndrome (SBS). Dr. Stephens says that SBS occurs to children aging from 3-8 months and Leah was only 4 months old. Here though the facts are right, they missed out some important points. Dr. Fischer found out that there was blood collected on the outer part of the brain and Leah’s brain tissue was pressurized by it. But the source of blood was coming from inside the brain and this caused swelling of the brain. Subdural Hematoma occurs when blood is collected outside the brain that is in the space between the Dura and Arachnoid layers. The outer part of the brain is affected more than the inner part since shaking a baby would lead the brain to kind of put pressure on the outer layers rather than the inner layers. Since the source of blood was very deep inside the brain it is unlikely the cause of abuse. Retinal bleeding was a topic that mostly confused the experts. It is true that retinal bleeding is quite common in abuse than non abuse. But Dr. Micah Holmes provides very strong evidence suggesting that retinal hemorrhage of Leah was not because of abuse. Vitamin K is an essential substance in activation and functioning of blood clotting factors. When a child is born, she is not born with vitamin K in her system. It needs to be provided as soon as she is born. Deficiency in vitamin K disrupts the activation of clotting factors and they cannot function like they are supposed to. This weakens the body’s ability to withstand much pressure and thus causes bleeding. This bleeding and inability to clot creates bruises. Since the blood cannot clot as usual it tries to escape from the inside. This blood can travel to areas from which it can try to escape or accumulate and that includes brain and retina. The pressure and rising of blood in the brain causes the swelling from the inside and this leads to retinal hemorrhage. So clearly, this evidence and analysis of other experts’ claims proves that Leah Miller died a natural death.
In the essay "Overcoming Abuse - My Story", Shawna Platt talks about her childhood with her alcoholic parents and her struggles. She has experienced neglect, domestic, emotional and sexual abuse. She also talks about how she overcame all the abuse, the way the abuse effected her mental health, and how she broke the cycle with her children. While reading this essay, the one incident stood out the most was that her parents left Shawna alone with her newborn sister. At the time, Shawna was only ten years old.
I feel like the Jeannette’s father was sexually, physically or emotionally abused by his own family as a child growing up. From the way how Rex Walls became abusive to his family after he consumes alcohol drinks (Rex Walls wasn’t exactly abusive to the kids but he was abusive to his wife sometimes).
The afflicted was not just Abigail Williams, Betty Paris, Ruth Putnam, Mary Warren and the other neighborhood girls. According to historical depiction, older women and men came forth as being afflicted. Miller also got rid of Tituba’s husband John
The Millers appear to be permissive parents; therefore, the Millers seem to support Kevin in his behavior and his maladaptive ways of coping. Permissive parents are high on warm; subsequently, they are low in setting demands, rules, and guidelines. Kevin is obliviously gifted and talented, and
Sanders’ was a young boy when his father became an alcoholic. He recalls going into the shed and finding bottles of all kinds of different type of alcoholic beverage that his father was trying to hide from them. He talks about how he remembers his father pulling into the drive and stopping with whatever they were doing to watch him stumble by barley making it to the front door, he remembers his dad and mom getting into fights where he heard his mom crying horrifically from the words that her husband had said to her. “Eventually he wakes with a grunt, Mother slings accusations at him, he snarls back, she yells, he growls, their voices clashing” (182). Sanders’ dad would never hit his wife or Sanders. Sanders’ would try anything he could to help his dad not drink. Whenever they would go to the gas station he would try and go everywhere his father went to make sure he did not buy anything to get drunk off of. His dad knew what he was up to, he would cuss at them to stay in the car or he would hit him. His father never hit him however, he always threatened though. Sand...
Reviewing the 12 Core Concepts of the National Child Trauma Stress Network, James is suffering from three of the 12 concepts. Number 1 core concept, Traumatic experience are inherently complex. Traumatic experiences are inherently complex no experience are the same varying degrees of objective life threat, physical violation, witnessing of an injury or death. The victim perceives their surroundings and decides what is best for them now safety and self-protection. Number 4 core concept, A child or adolescent can exhibit an extensive range of reactions to suffering and loss. Number 9 core concept, the developmental neurobiology triggers a youth’s reactions to traumatic experience. In this paper, we will be covering another trauma that affects the social worker or case worker who works on these cases of
Ward, H. et al, 2012. Safeguarding babies and very young children from abuse and neglect. London: Jessica Kingsley Publishers. P 205.
When Deborah was only sixteen she became pregnant with her first child by Cheetah and boy she liked when she was younger. Cheetah and Deborah got married and then had their second child. Deborah became very unhappy in the marriage because Cheetah started drinking and doing drugs. He started abusing Deborah. Cheetah pushed Deborah so much she almost killed him if it wasn’t for Bobbette. Deborah’s brothers Sonny and Lawrence were doing well except for Joe. Joe was another case. Joe went to the military, and the family was hoping that would do him good; but he came out worse than when he went in. Joe was threatened and beaten up by a boy named Ivy. Joe was in so much rage he went and stabbed him and killed him. Joe eventually turned himself in to the law, was convicted of second degree murder and sentenced fifteen years in prison.
From a very young age, Bone was sexually abused by her step-father, Glen Waddell. Like Bone, Dorothy Allison also suffered abuse from her step-father, starting at the young age of five years-old. During the time of the novel, and until recent years, it was unthinkable to speak of any sort of abuse outside the household. Throughout history, children have been victims of abuse by their parents or other adults, and fo...
The babies were given up for adoption, because they came from an unwed mother; such babies became troubled youth, who were encouraged to drop out of high school and were sold to prostitution. “In the 1950s, psychiatrists dismissed incest reports as Oedipal fantasies on the part of children” (Dyk 96). Now children are safer as compared to in the past. In the past, 11-year-olds became gang members, 12-year-olds were prostitutes and middle class wives abused drugs; some of it might still be true, but a lot has changed because of policies and women rights and child protection laws.
Twenty five to thirty percent of babies shaken die (National Shaken Baby Syndrome). Immediate medical attention can help reduce the impact of shaking, but many children are left with permanent damage from the shaking. The treatment of survivors falls into 3 major categories. Those categories are medical, behavioral, and educational. In addition to medical care, children may need speech and language therapy, vision therapy, physical therapy, occupational therapy, and special education services. (Showers, 1997) Many incidents of Shaken Baby Syndrome are not reported out of fear. It is important to seek immediate and early medical attention. Serious complications and even death can be avoided.
The “Ashley Treatment” also referred to as “Pillow Angel” was based on the controversial set of medical procedures undergone by the Seattle child named Ashley X. Ashley was born in 1997 and was diagnosed with static encephalopathy of unknown etiology. She’s able to breath on her own, sleeps, awaken, and response to environmental stimuli; however, due to the cause of her severe developmental disabilities, Ashley is unable to raise her head, sit up, holds an object, walk, talk, and must be fed through a gastrostomy tube. Also, according to Robert W. Newsom, 2009, “ Ashley is able to experience the cognitive and emotional life of, at best, a typical 3-to-6 month old child.”
There are designated classes to take, so people can be aware of the effects of SBS and what to do when a baby has been shook. Even if you’re not a parent, it is still encouraged for any caregiver or babysitter, or anyone who deals with infants on a daily basis, to take this class to be aware. Most times, SBS occurs when a baby is 6 months or younger. What happens when you shake a baby? When you shake a baby there will be bleeding of the brain or bleeding in the retina’s.
Shaken Baby Syndrome is, “a condition of whiplash-type injuries, ranging from bruises on the arms and trunk to retinal hemorrhages or convulsions, as observed in infants and children who have been violently shake; a form of child abuse that often results in intracranial bleeding from tearing of cerebral blood vessels” (Jacobs & Jacobs, 2004, p. 214).
“Tutorial 7 · Recognizing and Addressing Trauma in Infants, Young Children, and Their Families.” Trauma Signs and Symptoms, 3 Dec. 2017, www.ecmhc.org/tutorials/trauma/mod3_1.html.