Shaken baby syndrome

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at July 27, 2016
StartDiseasesShaken baby syndrome

Shaken baby syndrome is a form of brain injury that occurs when a baby or young child is shaken with extreme force and violence. It is a form of child abuse that can result in permanent brain damage or even death. Shaken baby syndrome is also referred to as whiplash shake syndrome, abusive head trauma, and shaken impact syndrome.  

Contents

Definition and Facts

According to the National Center on Shaken Baby Syndrome, there are approximately 1,300 cases of shaken baby syndrome in the U.S. each year. Approximately 25 percent of those children die, and 80 percent suffer life-long intellectual disabilities or physical disabilities as a result of their injuries.

Infants have weakened neck muscles and large heads in proportion to their body size. As a result, their heads can twist or whip back and forth when they are shaken or thrown. The force of the brain repeatedly hitting the sides of the skull can damage the delicate blood vessels inside the brain leading to swelling and bleeding.

Shaken babies may also suffer broken bones and injuries to their neck, spine, and eyes. As little as five seconds of forceful shaking can result in serious injury or death. The majority of abusive head trauma cases occur in babies between six and eight weeks old, but it can happen in children as old as five.

It is important to note that shaken baby syndrome does not occur during normal activities, such as gently bouncing a baby on the knee, sudden stops in a car, driving over bumps, or jogging or bicycling with the baby. 

Symptoms & Complaints

In cases where the damage to the brain is relatively mild, the child may initially appear okay but may develop cognitive, behavioral, or health problems over time. In more extreme cases, symptoms may develop rapidly and may include:

There may also be additional injuries, including broken bones, spinal damage, or internal bleeding. Many children who are victims of shaken baby syndrome also show evidence of past abusive injuries.

Any parent or caregiver or good samaritan who suspects that a child has been violently shaken should take the child to the nearest emergency room. Immediate medical attention may prevent long-term health problems and even save the child’s life. 

Causes

Shaken baby syndrome most often occurs when a young child starts crying inconsolably. The parent or caregiver becomes frustrated or angry and tries to stop the crying by shaking, hitting, or slamming the child into something. Young children with chronic illnesses, physical or mental developmental disabilities, or mental health issues are the most at risk of being the victims of abusive head trauma.

Men are more likely to inflict abusive head trauma than women. A variety of family, societal, and individual factors can increase the risk of an adult shaking or otherwise abusing a child, including:

  • An unstable home situation, including transient non-parental caregivers in the home.
  • Drug abuse or alcohol abuse in the home.
  • The caregiver’s own history of abuse as a child.
  • Domestic abuse in the home.
  • Young or single parents, especially those who are socially isolated and lack an adequate support system.
  • Stress, depression, or other mental health issues.
  • Ignorance or lack of understanding regarding parenting skills and a child’s needs and development.

Diagnosis & Tests

Shaken baby syndrome can be difficult to diagnose in the absence of other physical indications of abuse. The vomiting, irritability, and poor appetite can also be indicators of the flu or another type of infection. Depending on the child’s specific symptoms, medical history, and the doctor’s findings during a physical examination, lab tests may be used to rule out other conditions, including meningitis, blood disorders, or genetic disorders, such as osteogenesis imperfecta.

A CT scan provides cross-sectional images of the brain and can identify injuries requiring immediate intervention. MRIs may also be used to obtain images of the brain once the child is stable.

If abuse is suspected, a series of X-rays may be ordered to identify current or previous fractures and to determine if the fractures appear to be accidental or deliberately inflicted. The child may undergo an ophthalmological exam to reveal injuries or bleeding affecting the eyes. Health care providers are considered mandatory reporters and are legally required to report any suspected cases of child abuse to state authorities. 

Treatment & Therapy

In many cases of shaken baby syndrome, the caregiver does not realize the severity of the injuries and may even try putting the child to bed in the hopes that the symptoms will pass. The caregiver may even delay medical treatment out of fear or denial over what happened. By the time the child receives medical care, the situation is often dire, and the child requires hospitalization.

Medical interventions may include oxygen therapy or other forms of breathing support. Medications and cooling mattresses may be used to reduce brain swelling. Anticonvulsant medications may be needed to control seizures. Surgery may be necessary if CT scans show significant bleeding in the brain. Physical therapy, occupational therapy, and speech therapy may be useful in helping children affected by shaken baby syndrome regain functional skills; however, many children suffer permanent disabilities, including:

Prevention & Prophylaxis

Shaken baby syndrome is 100 percent preventable. It is natural for parents to feel frustrated when their child becomes inconsolable, but shaking is never the appropriate response.

It is normal for infants to cry more each week during the first couple of months of life. These crying spells may last for hours and often intensify in the late afternoon or evening. There may be no apparent reason for the crying, and it may continue regardless of what the parent tries.

Parents who feel like they are losing control should immediately ask a trusted friend or family member for support so that they can take a few minutes away from the situation. Many hospitals also offer programs to teach parents how to cope with the stress of caring for their child. A health care professional may also be able to provide a referral to a mental health provider.