In about the time it takes to read this paragraph out loud, 16-month-old Elijah C. Fisher of Layton had the life shaken out of him by his biological father Dec. 21, 1998.
In less than 10 seconds, he was "gone." Blood vessels in his eyes and brain rippled and burst from centrifugal force. Electrical connections frayed and twinkled out altogether three days later, on Christmas Eve.
His death was among at least a dozen cases reviewed this week at an international conference in Salt Lake City on shaken baby syndrome. Some are more infamous but all follow the pattern of what experts gathered here agree is the most severe, and perhaps most primal, form of child abuse.
Mark Dias, formerly of Salt Lake City and now with Children's Hospital of Buffalo, N.Y., said about a third of reported shaken baby cases are ultimately fatal.
The most recent death in Utah, which has 16 to 20 cases reported annually, was this past June 24 when Salem Corey Hogan died from lingering complications of being shaken Oct. 12, 2000, 2 1/2 months after he was born.
Shaking accounts for most of the severe head injuries in children younger than a year old, and half of its survivors have permanent neurological damage leading to blindness, seizures, developmental delays and poor muscle control, Dias said. Dias and others estimate that 1,400 children die of abusive injuries in the United States every year, and most of those deaths are attributed to severe head injuries related to shaking.
The anger that becomes an uncontrollable urge to shake a baby is normally the result of persistent crying, reported two Colorado researchers who have interviewed 81 perpetrators who had admitted the abuse.
That frustration-induced anger taps into some primal urge to brutally shake or tightly grip whatever people think is the source of the anger, said Carole Jenny, one of the country's leading experts on shaken baby syndrome, a conference keynote speaker and professor of pediatrics at Brown University School of Medicine.
"Perpetrators have said that some kind of animal rage briefly takes over because they have reached their rope's end and don't know what else to do," Jenny said.
"Animals will often attack whatever is infuriating them in the same way," she said, noting how a tomcat that recently came into her back yard managed to shake to death three kittens before he could be stopped.
"Somehow, shaking becomes OK for people who would never think of punching or hitting a child," Jenny said. "They think shaking won't hurt them as much, when actually just the opposite is true."
Educational video
Dias said a "literally pummeled" child recently at his hospital arrived with no brain injuries, yet babies who are shaken have massive brain injuries.
Shaking will stop a child from crying, and injuries may or may not occur if the shaking isn't severe, several conference experts said.
"The thing is, we just don't know," said Debra Williams, program and research director for the Ogden-based National Center on Shaken Baby Syndrome. "The one thing we do know is the only way to not hurt a child is never to do it."
In an effort to get the word to all new parents that shaking is never an option, the center and all 40 hospitals in the state now show new parents a center-produced videotape of Elijah Fisher's case. After hearing testimony from his mother, Emily, from the boy's father, his grandparents, the detective and the judge in the case, parents are asked to sign a form stating they have seen the film, read accompanying information, understand it and will tell others about it.
Whether the 18-minute video, which is patterned after one originally developed by Dias, is actually resulting in a reduction of cases isn't known, although the first year it was used in Salt Lake area hospitals the number of shaken baby cases declined from 27 in 2000 to 16 in 2001, according to the center. None of the nine cases reported since January involved families who had seen the video, Williams said.
Some parents report they didn't like seeing such troubling images on what is supposed to be the happy occasion of the birth of their child, Williams said. "But every parent we talked to says that's the one thing of everything they were told when they left the hospital that they remember."
International case
Such warnings weren't available in London, England, in April 1998, when 6-month-old Caroline Jongen was shaken to death by her nanny. It is the most well-known case of shaken baby syndrome, which literally involved witnesses from three continents and received the most detailed review at the conference.
Three principal police and medical investigators in the case tracked the incidents that led up to the image broadcast in January 1999 worldwide of Louise Sullivan reading a handwritten note confessing she had killed the child.
Matthew Kehoe, a detective from Sullivan's home in Sydney, Australia, said Friday that the nanny had gone to England to try to revive her career that had so far proved disappointing. She had been twice dismissed for abusive treatment of children in her care, Kehoe said.
Philip Wheeler, the lead police inspector in London, said Friday that Sullivan shook Caroline for more than five seconds but not more than 10, causing her to lapse almost immediately into unconsciousness. He said Sullivan first called a neighbor, not emergency medical personnel, at 11:15 a.m. April 17, 1998, and said the baby had suddenly gone limp.
Michael Green, an independent consulting forensic pathologist from Leeds, England, said that by 6:45 p.m. that day, a brain scan showed that 75 percent of Caroline's brain was already dead.
Most of it was caused within just three shakes, Green said, noting that his and other research has shown that after the third shake, a baby's head will actually be moving violently in a figure-8 pattern, the centrifugal force "causing injuries that increase geometrically and out of all proportion to the actual movement."
Green advised police officers and other investigators at the conference that any number of "red herring" excuses will be used by perpetrators and defense attorneys to cast doubt on a case.
"Know enough to know when you don't know and then find someone to ask," Green said.
Because Green was able to counter every defense assertion in the Jongen case, such as hitting her head in the bath, not receiving a vitamin K injection at birth and having a rare bleeding disorder, Sullivan pleaded guilty to involuntary manslaughter and was sentenced to 15 months in prison.
As a result of Jongen's death, new standards have been set in the training in shaken baby cases throughout the United Kingdom. Efforts are under way to make those standards the norm worldwide.
E-MAIL: jthalman@desnews.com