Shaken Baby Syndrome

Approximately 1,200 to 1,400 children suffer severe or fatal head trauma from violent shaking in the U.S. every year, and most experts believe that this form of child abuse is still under-reported. Shaken Baby Syndrome, or SBS, is the most common cause of child mortality and accounts for most long-term disability in infants and young children due to physical abuse. One third of all victims of SBS die, and another third are left with permanent injuries.

Shaken baby syndrome is the term used to describe the group of injuries that results when a baby or small child is violently shaken, dropped or thrown, or from the impact of the child's head against a hard surface. When a baby is shaken the brain rotates within the skull cavity injuring or destroying brain tissue and tearing blood vessels that feed the brain, causing bleeding around the brain and additional damage. Violent shaking can also result in retinal (back of the eye) bleeding, which can cause blindness.

The injuries exhibited by shaken babies and children cannot be caused by short falls, seizures, or as a result of vaccinations. The force of a child shaken in anger is 10 times greater than the force of a simple fall. The amount of brain damage suffered by a shaken child depends on the intensity and duration of the shaking and the degree of force with which the head strikes a hard surface. The symptoms of shaken baby syndrome vary from minor, such as irritability, lethargy, tremors, and vomiting; to major neurological changes, such as seizures, coma, stupor, and even death. In severe cases of SBS, the child immediately loses consciousness and suffers rapid, life-threatening failure of the central nervous system. A shaken child may also have bruises on the body (usually the arms or shoulders) where he or she was grabbed, and have fractured ribs or long bones. In many cases, however, there is no evidence of trauma to either the head or the body.

Because there are often no visible signs of abuse, head injuries in babies and toddlers are often difficult to diagnose and may be mistaken for a variety of other conditions or illnesses. Vomiting, fever, irritability, and lethargy are all symptoms of other diseases that commonly strike children, so if the attending physician fails to take an accurate history of injury and the child is too young to speak, the abusive head trauma may be misdiagnosed and critical treatment delayed. Many children who survive SBS suffer permanent handicaps ranging from mild learning and behavioral disorders to profound mental and developmental retardation, paralysis, blindness, or they remain in a permanent vegetative state. If you suspect a child has been shaken, seek medical attention immediately and let the doctor know your suspicions. Without this knowledge, the doctor may waste precious time looking for other symptoms of illness.

Approximately 60 percent of shaking victims are boys. Males are also overwhelmingly the perpetrators of SBS - approximately 65 to 90 percent are men, often in their early 20s, and many times the baby's father or mother's boyfriend. Infants born to families who live at or below the poverty level are also more likely to fall victim to SBS (as well as any form of child abuse).

* 50% of shakers are natural parents
* 17% are non-relatives
* 17% are the mother's boyfriend
* 6% are a step-parent
* 10% other

It is estimated that 25 to 50 percent of parents and caretakers are not aware of the harmful effects of shaking a baby. Many babies are shaken out of frustration when the caregiver cannot get the infant to stop crying. Crying peaks in babies between 6 weeks and 4 months old, which coincides with the age when most babies are shaken. Ironically, the abusive shaking behavior may be self-reinforcing since an infant who is shaken may cease to cry because of the resulting brain injury. The adult may then conclude that shaking is an effective and appropriate way to quiet a cranky baby, and repeat the abuse when the baby begins fussing or crying again. The adult may think the quiet, drowsy baby is displaying the desired behavior, but he or she may actually be displaying symptoms of irreversible brain damage.

Shaken baby syndrome is completely preventable. Parents and caregivers need to be aware of the dangers of shaking and learn ways to reduce stress. If you cannot get your baby to stop crying and feel as if you might hurt your baby, remove yourself from the situation. Call a friend or relative to watch your baby for a few minutes while you calm down. If you cannot call anyone, put your baby in a safe place, such as his or her crib, and go into another room or outside until you are composed. Remember that it is okay to ask for help when you need it, but it is never okay to shake a baby.