Waney Squier

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Waney Squier is a neuropathologist specialising in the brain of the developing foetus and neonate. She has written a book on acquired damage to the developing brain [1] and is senior author on peer-reviewed publications ranging in topic from fetal [2] to childhood [3] infection, polymicrogyria, [4] hydrocephalus, [5] head trauma [6] [7] and mimics of trauma caused by vascular pathology. [8] She is an expert on dura mater [9] [10] and dural bleeding. [11] [12]

Many of her publications question [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] Shaken Baby Syndrome, preferentially termed Abusive Head Trauma since 2009. [23]

She worked at the John Radcliffe Hospital in Oxford, UK, but also served as an expert witness, particularly in cases where babies had died as a result of suspected abusive head trauma or shaken baby syndrome. In April 2010, a complaint about her was made to the General Medical Council by the National Policing Improvement Agency, since then disbanded. [24]

Following various disciplinary and legal processes, she appeared before the Medical Practitioners Tribunal Service between October 2015 and March 2016. The charges against her related to six babies about whom she had provided reports and given evidence. It was alleged that she expressed opinions outside her field of expertise, made assertions that were not supported by evidence, and misrepresented research papers to support her opinions. [24] At the conclusion of the hearing, the tribunal determined that Squier was guilty of repeated dishonesty, her fitness to practice was impaired, and that she should be struck off the medical register. [25] [26] [27]

Squier appealed the tribunal's decision to the High Court of England and Wales during October 2016. On 3 November 2016, the court published a judgment which concluded that "the determination of the MPT is in many significant respects flawed". [24] The judge found that she had committed serious professional misconduct but was not dishonest. She was reinstated to the medical register but is not allowed to give expert evidence in court for three years. [28] [29]

At one time, Squier believed in the theory of shaken baby syndrome and appeared as a witness for the prosecution in a number of cases. However on examining the available evidence for the theory more closely, she has come to believe that there is no evidence for shaken baby syndrome and that it does not exist. [30] She described her intellectual journey in a 2018 TEDx talk. [31]

Related Research Articles

<span class="mw-page-title-main">Cerebral palsy</span> Group of movement disorders that appear in early childhood

Cerebral palsy (CP) is a group of movement disorders that appear in early childhood. Signs and symptoms vary among people and over time, but include poor coordination, stiff muscles, weak muscles, and tremors. There may be problems with sensation, vision, hearing, and speech. Often, babies with cerebral palsy do not roll over, sit, crawl or walk as early as other children. Other symptoms include seizures and problems with thinking or reasoning. While symptoms may get more noticeable over the first years of life, underlying problems do not worsen over time.

<span class="mw-page-title-main">Microcephaly</span> Condition in which the head is small due to an underdeveloped brain

Microcephaly is a medical condition involving a smaller-than-normal head. Microcephaly may be present at birth or it may develop in the first few years of life. Brain development is often affected; people with this disorder often have an intellectual disability, poor motor function, poor speech, abnormal facial features, seizures and dwarfism.

<span class="mw-page-title-main">Plagiocephaly</span> Medical condition

Plagiocephaly, also known as flat head syndrome, is a condition characterized by an asymmetrical distortion of the skull. A mild and widespread form is characterized by a flat spot on the back or one side of the head caused by remaining in a supine position for prolonged periods.

<span class="mw-page-title-main">Cerebrovascular disease</span> Condition that affects the arteries that supply the brain

Cerebrovascular disease includes a variety of medical conditions that affect the blood vessels of the brain and the cerebral circulation. Arteries supplying oxygen and nutrients to the brain are often damaged or deformed in these disorders. The most common presentation of cerebrovascular disease is an ischemic stroke or mini-stroke and sometimes a hemorrhagic stroke. Hypertension is the most important contributing risk factor for stroke and cerebrovascular diseases as it can change the structure of blood vessels and result in atherosclerosis. Atherosclerosis narrows blood vessels in the brain, resulting in decreased cerebral perfusion. Other risk factors that contribute to stroke include smoking and diabetes. Narrowed cerebral arteries can lead to ischemic stroke, but continually elevated blood pressure can also cause tearing of vessels, leading to a hemorrhagic stroke.

<span class="mw-page-title-main">Shaken baby syndrome</span> Medical condition

Shaken baby syndrome (SBS), also known as abusive head trauma (AHT), is a medical condition in children younger than five years old, generally caused by blunt trauma, vigorous shaking, or a combination of both. SBS is the leading cause of fatal head injuries in children under two, with a risk of death of about 25%. The most common symptoms include retinal bleeds, multiple fractures of the long bones, and subdural hematomas.

<span class="mw-page-title-main">Subdural hematoma</span> Hematoma usually associated with traumatic brain injury

A subdural hematoma (SDH) is a type of bleeding in which a collection of blood—usually but not always associated with a traumatic brain injury—gathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain. It usually results from tears in bridging veins that cross the subdural space.

Hypotonia is a state of low muscle tone, often involving reduced muscle strength. Hypotonia is not a specific medical disorder, but a potential manifestation of many different diseases and disorders that affect motor nerve control by the brain or muscle strength. Hypotonia is a lack of resistance to passive movement, whereas muscle weakness results in impaired active movement. Central hypotonia originates from the central nervous system, while peripheral hypotonia is related to problems within the spinal cord, peripheral nerves and/or skeletal muscles. Severe hypotonia in infancy is commonly known as floppy baby syndrome. Recognizing hypotonia, even in early infancy, is usually relatively straightforward, but diagnosing the underlying cause can be difficult and often unsuccessful. The long-term effects of hypotonia on a child's development and later life depend primarily on the severity of the muscle weakness and the nature of the cause. Some disorders have a specific treatment but the principal treatment for most hypotonia of idiopathic or neurologic cause is physical therapy and/or occupational therapy for remediation.

<span class="mw-page-title-main">Moro reflex</span> Neurologic importance

The Moro reflex is an infantile reflex that develops between 28 and 32 weeks of gestation and disappears at 3–6 months of age. It is a response to a sudden loss of support and involves three distinct components:

  1. spreading out the arms (abduction)
  2. pulling the arms in (adduction)
  3. crying (usually)

Retinal hemorrhage is a disorder of the eye in which bleeding occurs in the retina, the light sensitive tissue, located on the back wall of the eye. There are photoreceptor cells in the retina called rods and cones, which transduce light energy into nerve signals that can be processed by the brain to form visual images. Retinal hemorrhage is strongly associated with child abuse in infants and young children and often leaves such abused infants permanently blind. In older children and adults, retinal hemorrhage can be caused by several medical conditions such as hypertension, retinal vein occlusion, anemia, leukemia or diabetes.

<span class="mw-page-title-main">Arachnoid cyst</span> Medical condition

Arachnoid cysts are cerebrospinal fluid covered by arachnoidal cells and collagen that may develop between the surface of the brain and the cranial base or on the arachnoid membrane, one of the three meningeal layers that cover the brain and the spinal cord. Primary arachnoid cysts are a congenital disorder whereas secondary arachnoid cysts are the result of head injury or trauma. Most cases of primary cysts begin during infancy; however, onset may be delayed until adolescence.

<span class="mw-page-title-main">Headbanging</span> Violent and choreographic shaking of ones head to music

Headbanging is the act of violently shaking one's head in rhythm with music. It is common in rock, punk, heavy metal music and dubstep, where headbanging is often used by musicians on stage. Headbanging is also common in traditional Islamic Sufi music traditions such as Qawwali in the Indian subcontinent and Iran.

<span class="mw-page-title-main">Intraventricular hemorrhage</span> Medical condition

Intraventricular hemorrhage (IVH), also known as intraventricular bleeding, is a bleeding into the brain's ventricular system, where the cerebrospinal fluid is produced and circulates through towards the subarachnoid space. It can result from physical trauma or from hemorrhagic stroke.

<span class="mw-page-title-main">Coup contrecoup injury</span> Type of head injury

In head injury, a coup injury occurs under the site of impact with an object, and a contrecoup injury occurs on the side opposite the area that was hit. Coup and contrecoup injuries are associated with cerebral contusions, a type of traumatic brain injury in which the brain is bruised. Coup and contrecoup injuries can occur individually or together. When a moving object impacts the stationary head, coup injuries are typical, while contrecoup injuries are produced when the moving head strikes a stationary object.

Kernohan's notch is a cerebral peduncle indentation associated with some forms of transtentorial herniation. It is a secondary condition caused by a primary injury on the opposite hemisphere of the brain. Kernohan's notch is an ipsilateral condition, in that a left-sided primary lesion evokes motor impairment in the left side of the body and a right-sided primary injury evokes motor impairment in the right side of the body. The seriousness of Kernohan's notch varies depending on the primary problem causing it, which may range from benign brain tumors to advanced subdural hematoma.

Dyskinetic cerebral palsy (DCP) is a subtype of cerebral palsy (CP) and is characterized by impaired muscle tone regulation, coordination and movement control. Dystonia and choreoathetosis are the two most dominant movement disorders in patients with DCP.

<span class="mw-page-title-main">Ataxic cerebral palsy</span> Medical condition

Ataxic cerebral palsy is clinically in approximately 5–10% of all cases of cerebral palsy, making it the least frequent form of cerebral palsy diagnosed. Ataxic cerebral palsy is caused by damage to cerebellar structures, differentiating it from the other two forms of cerebral palsy, which are spastic cerebral palsy and dyskinetic cerebral palsy.

<span class="mw-page-title-main">General movements assessment</span>

A general movements assessment is a type of medical assessment used in the diagnosis of cerebral palsy, and is particularly used to follow up high-risk neonatal cases. The general movements assessment involves measuring movements that occur spontaneously among those less than four months of age and appears to be most accurate test for the condition.

Arthur Norman Guthkelch was a British pediatric neurosurgeon. He is sometimes known as the first British pediatric neurosurgeon. He was the first physician to make a connection between shaking an infant and subsequent brain injury.

Infant and toddler safety are those actions and modifications put into place to keep babies and toddlers safe from accidental injury and death. Many accidents, injuries and deaths are preventable.

Perinatal stroke is a disease where an infant has a stroke between the 140th day of the gestation period and the 28th postpartum day, affecting up to 1 in 2300 live births. This disease is further divided into three subgroups, namely neonatal arterial ischemic stroke, neonatal cerebral sinovenous ischemic stroke, and presumed perinatal stroke. Several risk factors contribute to perinatal stroke including birth trauma, placental abruption, infections, and the mother's health.

References

  1. ↑ Squier, Waney (2002). Acquired Damage to the Developing Brain. Timing and Causation. London: Arnold Publishers. p. 1-227. ISBN   0 340 75930 5.
  2. ↑ Ferguson, DJP; Bowker, C; Jeffery, KJM; Chamberlain, P; Squier, W (2013). "Congenital toxoplasmosis: continued parasite proliferation in the fetal brain despite maternal immunological control in other tissues". Clinical Infectious Diseases. 56 (2): 204-208. doi:10.1093/cid/cis882. PMID   23074307.
  3. ↑ Bruch, LA; Jefferson, RJ; Pike, MG; Gould, SJ; Squier, W (2001). "Mycoplasma pneumoniae infection, meningoencephalitis, and hemophagocytosis". Pediatric Neurology. 25 (1): 67-70. doi:10.1016/s0887-8994(01)00274-0. PMID   11483400.
  4. ↑ Jansen, AC; Robitaille, Y; Honavar, M; Mullatti, N; Leventer, RJ; Andermann, E; Anderman, F; Squier, W (2016). "The histopathology of polymicrogyria: a series of 71 brain autopsy studies". Developmental Medicine and Child Neurology. 58 (1): 39-48. doi:10.1111/dmcn.12840. PMID   26179148.
  5. ↑ Squier, MV (1997). "Pathological approach to the diagnosis of hydrocephalus". Journal of Clinical Pathology. 50 (3): 181-186. doi:10.1136/jcp.50.3.181. PMC   499809 . PMID   9155665.
  6. ↑ Dobbs, TD; Barber, ZE; Squier, WL; Green, AL (2012). "Cerebral venous sinus thrombosis complicating traumatic head injury". Journal of Clinical Neuroscience. 19 (7): 1058-1059. doi:10.1016/j.jocn.2012.01.002. PMID   22551588.
  7. ↑ Squier, W; Mack, J (2014). "Mineralizing angiopathy and minor head trauma". Developmental Medicine and Child Neurology. 56 (7): 699. doi:10.1111/dmcn.12416. PMID   24575866.
  8. ↑ Larsen, KB; Barber, Z; Squier, W (2019). "The pathology and aetiology of subcortical clefts in infants". Forensic Science International. 296: 115-122. doi:10.1016/j.forsciint.2019.01.011. PMID   30711846.
  9. ↑ Mack, J; Squier, W; Eastman, JT (2009). "Anatomy and development of the meninges: implications for subdural collections and CSF circulation". Pediatric Radiology. 39 (3): 200-210. doi:10.1007/s00247-008-1084-6. PMID   19165479.
  10. ↑ Squier, W; Mack, J; Green, A; Aziz, T (2012). "The pathophysiology of brain swelling associated with subdural hemorrhage: the role of the trigeminovascular system". Child's Nervous System. 28 (12): 2005-2015. doi:10.1007/s00381-012-1870-1. PMID   22885686.
  11. ↑ Squier, W; Mack, J (2009). "The neuropathology of infant subdural haemorrhage". Forensic Science International. 187 (1–3): 6-13. doi:10.1016/j.forsciint.2009.02.005. PMID   19303229.
  12. ↑ Squier, W; Mack, J; Jansen, AC (2016). "Infants dying suddenly and unexpectedly share demographic features with infants who die with retinal and dural bleeding: a review of neural mechanisms". Developmental Medicine and Child Neurology. 58 (12): 1223-1234. doi:10.1111/dmcn.13202. PMID   27435495.
  13. ↑ Squier, W (2008). "Shaken Baby Syndrome: the Quest for Evidence". Developmental Medicine and Child Neurology. 50 (1): 10-14. doi:10.1111/j.1469-8749.2007.02004.x. PMID   18173622.
  14. ↑ Squier, W (2011). "The "Shaken Baby" syndrome: pathology and mechanisms". Acta Neuropathologica. 122 (5): 519-542. doi:10.1007/s00401-011-0875-2. PMID   21947257.
  15. ↑ Squier, W (2011). "The triad of retinal haemorrhage, subdural haemorrhage and encephalopathy in an infant unassociated with evidence of physical injury is not the result of shaking, but is most likely to have been caused by a natural disease: Yes". Journal of Primary Health Care. 3 (2): 159-161. PMID   21625666.
  16. ↑ Findley, KA; Barnes, PD; Moran, DA; Squier, W (2012). "Shaken baby syndrome, abusive head trauma, and actual innocence: getting it right". Houston Journal of Health, Law & Policy. 12: 209-312.
  17. ↑ Squier, W (2019). "Confusion over infant head trauma". Acta Paediatrica. 108 (2): 382. doi:10.1111/apa.14594. PMID   30256457.
  18. ↑ Högberg, U; Squier, W; Andersson, J; Högberg, G; Fellman, V; Thiblin, I; Wester, K (2020). "Do Inter-Country Differences in the Frequency of Abusive Head Trauma Reflect Different Proportions of Overdiagnosis of Abuse or True Differences in Abuse?". Journal of Epidemiology. 30 (6): 276-277. doi:10.2188/jea.JE20190066. PMC   7217690 . PMID   31178472.
  19. ↑ Zahl, SM; Mack, JA; Rossant, C; Squier, W; Wester, K (2021). "Thrombosis is not a marker of bridging vein rupture in infants with alleged abusive head trauma". Acta Paediatrica. 110 (10): 2686-2694. doi:10.1111/apa.15908. hdl: 11250/2768656 . PMID   33964045.
  20. ↑ Squier, W (2022). "Infant retinal haemorrhages correlate with chronic subdural haemorrhage, not shaking". Acta Paediatrica. 111 (4): 714-715. doi:10.1111/apa.16169. PMID   34766369.
  21. ↑ Squier, W; Olofsson, T (2023). The Neuropathology of Shaken Baby Syndrome or Retino-Dural Haemorrhage of Infancy. Cambridge: Cambridge University Press. p. 33-65. ISBN   1009384767.
  22. ↑ Squier, W (2024). "Retinodural haemorrhage of infancy, abusive head trauma, shaken baby syndrome: The continuing quest for evidence". Developmental Medicine and Child Neurology. 26 (3): 290-297. doi:10.1111/dmcn.15676. PMID   37353945.
  23. ↑ Christian, CW; Block, R; Committee on Child Abuse and Neglect, American Academy of Pediatrics (2009). "Abusive head trauma in infants and children". Pediatrics. 123 (5): 1409-1411. doi:10.1542/peds.2009-0408. PMID   19403508.
  24. 1 2 3 "Between : DR WANEY MARIAN VALERIE SQUIER - and - GENERAL MEDICAL COUNCIL" (PDF). Retrieved 27 November 2023.
  25. ↑ "Medical Practitioner's name: Dr Waney Marian Valerie SQUIER" (PDF). Archived from the original (PDF) on 16 April 2016. Retrieved 4 November 2016.
  26. ↑ "Dr Waney Squier struck off for shaken baby evidence". BBC News. 21 March 2016. Retrieved 1 August 2016.
  27. ↑ Campbell, Denis (21 March 2016). "Doctor who denies shaken baby syndrome struck off". The Guardian. ISSN   0261-3077 . Retrieved 1 August 2016.
  28. ↑ "Shaken baby evidence doctor reinstated". BBC News. 3 November 2016. Retrieved 7 August 2018.
  29. ↑ Press Association (4 November 2016). "Doctor wins appeal over shaken baby syndrome trials evidence". The Guardian. Retrieved 7 August 2018.
  30. ↑ Lawson, Dominic; Squier, Waney; Brunert, Jonathan (15 August 2018). "Waney Squier". Why I Changed My Mind. Series 4. BBC Radio 4 . Retrieved 7 August 2018.
  31. ↑ Squier, Waney (16 March 2018). "I believed in Shaken Baby Syndrome until science showed I was wrong". TED: Ideas Worth Spreading. Retrieved 3 April 2023.
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