SHAKEN BABY SYNDROME

DEFINITION

Shaken baby syndrome (SBS) refers to a combination of injuries that occurs when a baby or young child is violently shaken.

DESCRIPTION

Medical writers first described shaken baby syndrome in 1972. At first, doctors thought that shaken baby syndrome was caused by accidents. Later, they became more aware of patterns of child abuse and more cases of SBS were properly diagnosed.

Every year, about fifty thousand cases of SBS are reported. Boys make up more than 60 percent of those injured. The average SBS victim is six to eight months old, but children as old as five years or as young as a few days can be affected.

Some cases of SBS occur when a very angry or frustrated adult shakes an infant. In other cases, the injury is a result of ongoing abuse. Statistically, men inflict injury more often than women. These men tend to be in their early twenties. Men responsible for causing SBS are often either the baby's father or the mother's boyfriend. Data shows that women who injure babies are more likely to be babysitters or child care providers than the victim's mother.

CAUSES

Shaking is more likely to injure a baby than an older child or adult for three reasons. First, a baby's neck muscles are still weak. Second, its head is still relatively large and heavy, compared to its body size. Third, the baby's brain tissue and blood vessels are still quite fragile.

When a child is shaken violently, its head snaps back and forth. The brain is pushed first against one side of the skull, then against the other side. The bumping action can cause brain tissue to tear and blood vessels to break.

SYMPTOMS

Shaking may produce no visible symptoms in the baby even when extensive damage has occurred within the brain. Internal (inside) bleeding within the skull may cause the brain to swell. If the swollen brain pushes against the skull, damage to nerves and other parts of the brain may occur. Such damage can cause serious problems including blindness, hearing loss, paralysis, speech impairment, mental retardation, learning disabilities, and death. Nearly two thousand children die every year as a result of being shaken.

DIAGNOSIS

Shaken baby syndrome is often difficult to diagnose. There are usually no witnesses to the shaking. The baby may seem to be normal for a period of time after shaking. Babies who act abnormally may be diagnosed with some other medical disorder. Some changes in behavior that may suggest SBS include vomiting, seizures, or loss of consciousness. A baby may also have difficulty breathing, sucking, swallowing, or making sounds.

Additional clues about SBS sometimes come from interviews with the baby's parents. The parents may offer other reasons for the baby's unusual behavior. The explanations offered may not seem reasonable to a doctor.

A doctor who suspects SBS may look for several characteristic conditions that accompany the disorder. The first condition is bleeding at the back of both eyes. Shaking easily breaks blood vessels at the back of the eye. The bleeding is easy to see when the eyes are examined carefully.

Two other conditions often found with SBS are cerebral edema (pronounced suh-REE-bruhl ih-DEE-muh) and subdural hematoma (pronounced sub-DYOOR-uhl hee-muh-TOE-muh). These two terms refer to masses of blood in the brain caused when tissues swell and blood vessels break. The two conditions can be detected by using some form of imaging technique, such as a computed tomography (CT) scan (often also called a computerized axial tomography (CAT) scan), and magnetic resonance imaging (MRI). These techniques use X-ray photographs or electromagnetic fields to provide pictures of the interior of the brain without actually doing surgery.

Shaken Baby Syndrome: Words to Know

Cerebral edema:

Swelling of the brain caused by an accumulation of fluid.

Child abuse:

Intentional harm done to infants and children, usually by parents or care givers.

Computed tomography (CT) scan:

A technique in which X-ray photographs of a particular part of the body are taken from different angles. The pictures are then fed into a computer that creates a single composite image of the internal (inside) part of the body. CT scans provide an important tool in the diagnosis of brain and spinal disorders, cancer and other conditions.

Computerized axial tomography (CAT) scan:

Another name for a CT scan.

Magnetic resonance imaging (MRI):

A procedure that uses electromagnets and radio waves to produce images of a patient's internal tissue and organs. These images are not blocked by bones, and can be useful in diagnosing brain and spinal disorders and other diseases.

Subdural hematoma:

An accumulation of blood in the outer part of the brain.

TREATMENT

The type of treatment provided to an injured baby depends on the kind and extent of injuries. In mild cases, the injury may simply heal over time. In more serious cases, treatment may be needed to deal with a specific symptom or injury, such as hearing loss or speech impairment.

Steps are often taken to protect the baby from further injury. The child may have to be placed in a foster home and/or the adult responsible for causing the injuries may be provided with counseling. Adults who cause SBS may also face criminal charges in the courts.

Alternative Treatment

There are no alternative treatments for SBS. A child who is not behaving normally should be taken to a hospital immediately.

PROGNOSIS

The prognosis for shaken baby syndrome is usually not good. A significant number of babies who are mistreated die.

Many others suffer serious, long-term damage that will stay with them throughout their lives. Injuries that cause blindness, mental retardation, or loss of motor (muscular) control, for example, are permanent. They can not be repaired. Rehabilitation, however, can help a child learn to live and cope with their new disability.

PREVENTION

Because this medical problem is caused by adults who intentionally and physically abuse a child, the only way to prevent shaken baby syndrome is by educating adults.

A common reason given by adults for this type of abuse is frustration with a crying baby. Parents and caregivers can be taught how to deal with this frustration. One general rule is to leave a crying baby alone until the adult has calmed down. Possible reasons for the baby's discomfort should then be considered. A warm bottle, dry diaper, soft music, a bath, or a ride in a swing may calm the child, which in turn may calm the adult.

Adults should also be aware that a baby who cries excessively may have a medical disorder and should be examined by a doctor.

FOR MORE INFORMATION

Books

Morey, Ann-Janine. What Happened to Christopher: An American Family's Story of Shaken Baby Syndrome. Carbondale, IL: Southern Illinois University Press, 1998.

Organizations

American Humane Association. Children's Division. 63 Inverness Drive East, Englewood, CO 80112. (303) 792–9900.

Shaken Baby Syndrome Prevention Plus. 649 Main Street, Suite B, Groveport, OH 43125. (800) 858–5222; (614) 836–8360. http://members.aol.com/sbspp/sbspp.html.

Web sites

"Ask NOAH About: Neurological Problems." NOAH: New York Online Access to Health. [Online] http://www.noah.cuny.edu/neuro/neuropg.html#Shaken (accessed on October 31, 1999).