Shaken baby syndrome (SBS) is a form of child abuse that occurs when an abuser violently shakes an infant or small child, creating a whiplash-type motion that causes acceleration-deceleration injuries.
“Injury is estimated to affect between 1,200 and 1,600 children every year in the USA,”according to the August 2001 Canadian Centre for Justice Statistics publication "Family Violence in Canada: A Statistical Profile.” Injuries from impacts with hard objects may accompany SBS; this combination of shaking with striking against a hard object is sometimes termed the shaken impact syndrome or shaken/slam syndrome.The usual trigger for shaking a baby is inconsolable crying in the infant.
One Shaken Baby in Four Dies
In 1971, Guthkelch proposed that whiplash injury caused subdural hemorrhage in infants by tearing the veins in the subdural space (Canadian Centre for Justice Statistics).
In 1972, the term "whiplash shaken baby syndrome" was popularized by Dr. John Caffey, a pediatric radiologist (Canadian Centre for Justice Statistics). Development of computed tomography and magnetic resonance imaging techniques in the 1970s and 1980s advanced the ability to diagnose the syndrome.
Children under the age of three years are especially susceptible to brain damage from shaking (Canadian Centre for Justice Statistics). This is due to several anatomical factors. Children's heads are bigger and weigh more with respect to their bodies than adults' heads, and their neck muscles are weak and cannot prevent violent motions. Infants' brains are not fully myelinated.
The water content of the brain is reduced as neurons gain myelin during development, so babies have a greater percentage of brain water than adults do. Because of this higher water content, children's brains are softer and are much more susceptible to acceleration-deceleration injuries and diffuse axonal injury.
SBS may be misdiagnosed and underdiagnosed, and caregivers may lie or be unaware of the mechanism of injury. Commonly, there are no externally visible signs of the injury. Examination by an experienced ophthalmologist is often critical in diagnosing shaken baby syndrome, as particular forms of ocular bleeding are quite characteristic of this condition.
No alternative condition mimics all of the symptoms of SBS exactly, but those that must be ruled out include hydrocephalus, sudden infant death syndrome (SIDS), seizure disorders, and infectious or congenital diseases like meningitis and metabolic disorders. CT scanning and magnetic resonance imaging are used to diagnose the condition.
Children of families who live at or below the poverty level are at an increased risk for these injuries (Canadian Centre for Justice Statistics). Unfortunately, the statistics have also shown that disabled and chronically ill children are most vulnerable to abuse. 50% of offenders are natural parents.
The characteristic injuries associated with SBS include retinal hemorrhages, multiple fractures of the long bones, and subdural hematomas (bleeding in the brain). These signs have evolved through the years as the accepted and recognized signs of child abuse and the shaken baby syndrome.
Medical professionals strongly suspect shaking as the cause of injuries when a baby or small child presents with retinal hemorrhage, fractures, soft tissue injuries or subdural hematoma, that cannot be explained by accidental trauma or other medical conditions. Additional effects of SBS are diffuse axonal injury, oxygen deprivation and swelling of the brain, which can raise intracranial pressure and damage delicate brain tissue.
Victims of SBS may display decreased responsiveness, irritability, failure to thrive, alterations in eating patterns, lethargy, vomiting, seizures, bulging or tense fontanels, increased size of the head, altered respirations, and dilated pupils. Fractures of the vertebrae and ribs may also be associated with SBS.
Symptoms can start quickly, especially in a badly injured child. Other times, it may take a few days for brain swelling to show symptoms. These symptoms may at first seem related to an infection, such as the flu or meningitis.
A child with shaken baby syndrome needs to be hospitalized. Oxygen therapy may be used to help the child breathe. Doctors may give the child medicine to help ease brain swelling. Sometimes a cooling mattress will help lower the child's body temperature and reduce brain swelling as well. A child who has severe bleeding in the brain may need surgery. Depending on the symptoms, doctors may try seizure medicine, physical therapy, or other treatments.
Of the Thousands That Survive Death, Serious Injury Usually Occurs
Approximately 1 out of 4 children who are forcefully shaken or thrown against an object die from their injuries. More than 60% of the victims of Shaken Baby Syndrome are male and almost 80% of the perpetrators of SBS are male (Canadian Centre for Justice Statistics).
Long-term complications from Shaken Baby Syndrome can include speech and learning disorders, sucking or swallowing disorders, mild to severe retardation, behavior problems, paralysis, hearing loss, blindness, cerebral palsy, seizures or autism.
Very tragically, abusive head trauma accounts for 95% of fatal or life-threatening injuries attributed to child abuse (Canadian Centre for Justice Statistics.)Shaken baby syndrome is a serious and clearly definable form of child abuse. A key aspect of prevention is increasing awareness of the potential dangers of shaking. Finding ways to alleviate the parent or caregiver's stress at the critical moments when a baby is crying can significantly reduce the risk to the child.
