By Sheree Baga and Kashiefa Ajam
Child welfare experts are witnessing a worrying increase in the number of "shaken babies" ending up in hospital casualty wards, suffering from brain damage or dying from the violence of their abuse.
In the most recent case, the Sandton parents of a two-month-old premature baby are facing murder charges after they allegedly shook their baby so forcefully that it died. The extent of its injuries shocked childcare workers on the case.
Shaken baby syndrome (SBS) is a medical condition characterised by vigorous shaking of an infant, often with such force that blood vessels and neural tissue are ruptured.
It can lead to brain damage and permanent blindness.
But the scourge is being overlooked as a significant cause of child deaths in South Africa, says Professor Lorna Jacklin, the principal consultant paediatrician at Charlotte Maxeke Johannesburg Academic Hospital.
Speaking at a high-level conference in the country earlier this year, she said: "For most professionals, the idea of a parent or other caregiver deliberately harming a baby is inconceivable. In spite of the lack of reporting on the condition in South Africa, it's evident from overseas literature that SBS is an important cause of brain damage in children."
This week, Jacklin said the US recorded as many as 1 400 cases every year of SBS, but South Africa suffered from a lack of similar research.
In recent years she had seen an increasing number of cases.
"I am seeing a lot of children. Most children are being referred to us by our colleagues in the private sector."
SBS is difficult to identify and legally complicated, particularly when parents try to conceal their violent behaviour.
"You're often dealing with parents who look like they love their babies and look very innocent," Jacklin said.
"Obviously the baby can't tell us what happened. And one has to be sure that what you're saying is correct and that you're not misdiagnosing."
"The parents bring the baby in and say it started fitting or they are worried because it has a bruise or a lack of appetite. These babies are usually from three to seven months old, and they can be very demanding at that age."
Luke Lamprecht, of the Big Shoes Foundation, which provides medical interventions that help orphaned and vulnerable children, is involved in the Sandton case.
"This baby's brain was mashed. It has a massive bruise on its brain and there was bleeding everywhere. I've never seen anything like it," said the seasoned abuse investigator.
The foundation, he said, deals with many tiny babies shaken and battered by their caregivers. But toddlers also fall victim.
"I've been working on a case of a three-year-old baby bashed so badly, shaken and potentially strangled, that he now has cerebral palsy."
There were numerous causes of SBS, Lamprecht said.
"The parents have not bonded with the child. The child is a burden and a frustration. They can't get the child to stop crying. In 99 percent of the cases, both parents are involved."
He said the law needed to be better equipped to prosecute abusive parents and caregivers.
"The current legal response is not sufficient. We need very serious professionals and good people leading police prosecutions who understand the issue, and good social workers who stand their ground and don't accept that the child 'fell'."
Meanwhile, Joan van Niekerk, the manager of advocacy and training at Childline, urged stressed-out parents to seek help before taking their anger out on their babies.