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Ethan Alan Shawen struggled with health problems throughout his short life.

Parents Amber and Preston Shawen said they took Ethan, born June 18, to their doctor 10 times in nine weeks for illnesses that included respiratory infections, vomiting and a rash.

They later learned Ethan suffered from meningitis, a treatable bacterial or viral infection that causes swelling of the brain and spinal cord. It is rarely fatal.

But Ethan's doctor didn't find meningitis, and neither did the doctors at Children's Medical Center of Dayton, where Ethan was admitted to the emergency department Aug. 19. He died Aug. 20 in the intensive care unit.

Doctors, social workers, police and others suspected the Shawens shook Ethan to death. Six weeks later, the Montgomery County Coroner's autopsy report attributed the death to meningitis, closing the police investigation of the case.

Now the Shawens, in mourning and still rattled from the accusations, are left wondering how the infection went undetected until it was too late and how many other babies and parents have suffered similar experiences.

"My husband would probably be sitting in jail, and so would I, if it weren't for the Montgomery County Coroner's Office," Amber Shawen said this week.

Case under review

Children's sees more than 1,000 suspected child abuse cases a year, eight to nine believed to involve shaken baby syndrome, hospital officials reported.

It's not clear how many of the shaken baby cases are confirmed without question. But the Shawens' experience and other cases locally and nationwide cast doubt on the shaken baby diagnosis as a sure thing.

It also illustrates doctors' often difficult task of determining whether a child's injuries are accidental or intentional. Some medical conditions — meningitis is just one — can mimic the symptoms of violent shaking.

Children's staff is distressed over Ethan's case, said Dr. Thomas Murphy, the hospital's vice president for medical affairs. The hospital continues to review the case, as it does with all deaths there for a time, looking for what staff might have missed and ways to improve their practices, he said.

"There are 35 deaths a year in the ICU," Murphy said. "Each one is taken personally."

A decade later, a father seethes

Steve Howell of Kettering knows how the Shawens feel.

In 1996, Howell and wife Roxanne Howell took their 11-month-old son, Cameron, to Children's after the baby's second fall in eight days.

To their horror, the Howells were branded as child abusers. Doctors attributed Cameron's injuries to shaken baby syndrome. They had found evidence of retinal hemorrhages (bleeding behind the eyes) and subdural hematoma (blood clotting beneath a membrane that covers the brain), classic signs of shaken baby.

What the doctors seemed to ignore, the Howells said, is that Cameron was born with macrocephaly. He was healthy but had an unusually large head that left him top-heavy and unbalanced.

The Howells found an ally in Dr. Marvin E. Miller, director of the Department of Medical Genetics and Birth Defects at Children's. Miller determined Cameron's pronounced macrocephaly put him "at increased risk for incurring subdural hematomas with minimal trauma."

Still, the Howells lived under a shadow of suspicion for eight months, until a juvenile court magistrate found child protection officials failed to prove the parents abused their son.

"We were guilty until proven innocent," Steve Howell said at the time.

Cameron, an 11-year-old fifth-grader at Oakview Elementary School in Kettering, is fine today and knows about his history. But 10 years and at least $10,000 in legal fees later, Steve Howell still seethes, wishing someone would be held accountable.

"I've still got a big chip on my shoulder about this," he said.

In Darke County,

a family torn apart

Daniel Crowe Jr. spent more than five years in a vegetative state and died Dec. 29, 2003.

The death was initially ruled a homicide. Doctors at Wayne Hospital in Greenville and later Children's in Dayton had suspected shaken baby syndrome.

In June 2005, however, the manner of Daniel's death was changed to "undetermined" after tests confirmed he had the same rare genetic disease that killed his 6-month-old brother last year.

Logan Crowe died of Menkes Disease, which stems from a defective gene that regulates the metabolism of copper.

Symptoms may include seizures, low body temperature and osteoporosis that can cause fractures. Most children with the disease die before age 10.

In the years before the case was closed, however, the boys' mother lost two other children that child protection officials put up for adoption because of suspected abuse of Daniel.

Tammy Fourman, 30, of Union City, Ind., continues to seek custody of her children, according to her attorney, Jeff Slyman of Vandalia.

Fourman could not be reached for comment.

Elsewhere in the United States, a Colorado couple in the 1990s won an undisclosed settlement after doctors accused them of shaking their daughter, who had fallen and hit her head.

Experts later determined the girl suffered from glutaric aciduria type 1, or GA-1, a rare condition that causes symptoms doctors may confuse with abuse by shaking.

And in Florida, Alan Yurko spent six years in prison for allegedly shaking his baby son to death in 1998. His supporters, meanwhile, contended the baby died from an overdose of vaccinations and other health problems.

A mixed-up autopsy report led to Yurko's conviction. When the case was reopened, a judge saw the new evidence and vacated Yurko's sentence in 2005.

A tricky diagnosis

Children's performed a spinal tap on baby Ethan when he was admitted Aug. 19, Amber Shawen said, but the test, which involves drawing fluid from the spinal cord, apparently failed to show meningitis.

Children's can't talk about the Shawen case because of privacy laws, and the Shawens did not give permission for the hospital to discuss their case. But Dr. Murphy, also an infectious disease specialist, explained the difficulty of spinal taps in babies.

"Doing a spinal tap in itself can be a challenge," he said.

Doctors might miss their mark with the puncture, he said, or blood might contaminate the fluid, rendering the test useless. And when babies are medically unstable, repeated tests can't be performed.

Absent a successful spinal tap, the diagnosis is more difficult, especially with babies who can't talk and explain their symptoms.

"The younger they are, the symptoms can be very, very nonspecific," Murphy said.

Dr. Lori Vavul-Roediger, Children's medical director for child advocacy, said doctors typically rule out a variety of confounding diagnoses — blood, metabolic and genetic disorders, for instance — before approaching a family about the possibility of Shaken Baby Syndrome or inflicted head trauma.

And when it reaches that point, "it's a multidisciplinary approach," involving social workers and child protection officials, police and hospital staff, she said.

Murphy stressed the hospital's role is not to accuse parents of child abuse but to raise the possibility of abuse when injuries can't be explained otherwise. It's also bound by law to report suspicious cases.

"I have absolute faith in the ability of our staff — of our intensivists, of our nurses, of our social workers — to handle this with the family in the most supportive way that we possibly can," he said.

Contact this reporter at (937) 225-7408 or agottschlich@DaytonDailyNews.com.

Parents speak out

'We were guilty until proven

innocent ... I've still got a big chip on my shoulder about this.'

Steve Howell

He and his wife Roxanne were branded as child abusers when their son was a baby — his symptoms were later found to be from a genetic condition

'My husband would probably be sitting in jail, and so would I, if it weren't for the Montgomery County Coroner's Office.'

Amber Shawen

She and her husband Preston were suspected by the police for shaking their baby to death — his symptoms were from undiagnosed meningitis