Shaken Baby Syndrome
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Shaken Baby Syndrome

(Shaken Impact Syndrome)

Definition

Shaken baby syndrome is a group of injuries caused by violent shaking or shaking and hitting the head of an infant or small child. These injuries can severely hurt a baby and may cause death.

Causes

Young children, especially babies, have very weak neck muscles that do not fully support their heavy heads. When babies or young children are shaken, their fragile brains move back and forth within their skulls. This causes serious injury and bleeding to the brain and eyes. Shaken baby syndrome usually happens when a parent or other caregiver shakes a baby out of anger or frustration, often because the baby will not stop crying.

Brain Bruised from Whiplash—Similar Effect in Shaken Baby Syndrome

Whiplash brain

© 2008 Nucleus Medical Art, Inc.

Risk Factors

A risk factor is something that increases the chance of getting a disease or condition. The following factors increase the chance of shaken baby syndrome:

  • History of domestic or child abuse within the family
  • History of drug and/or alcohol abuse within the family
  • Shaking a baby, even for a few seconds
  • History of stress or social difficulties in the family
  • Boys are more likely to be abused in this way than girls
  • Crying of the infant or child may play a role

Symptoms

In general, 1/3 die, 1/3 have major neurologic damage, and 1/3 survive in good condition. The severity of injury depends on the length of time the baby is shaken and how hard he or she is hit. Injuries caused by shaking are often extremely serious and can include:

  • Failure to thrive
  • Poor feeding or vomiting
  • Seizures or spasms
  • Weakness
  • Semi-consciousness or loss of consciousness
  • Difficulty breathing
  • Dilated or unresponsive pupils
  • Swollen head
  • Lethargy or irritability

In many cases, there are no bruises or other signs of injury to the child’s head or body. Visible injuries may include:

  • Bruising of the part of the body used as a "handle" for shaking
  • Fractures of the arm bones, leg bones, and/or ribs

Diagnosis

If you or your caregiver severely or violently shake your baby because of anger or frustration, the most important step is to get medical care right away. Immediately take your child to your pediatrician or an emergency room because early medical care may lessen some kinds of brain injuries caused by this problem. Don't let embarrassment, guilt, or fear get in the way of protecting your child's health or life.

Your doctor will ask about your child’s symptoms and medical history, and will perform a physical examination. Your child will probably be referred to other doctors (a neurologist or neurosurgeon) who specialize in brain injuries. The following tests will be used by the doctors to learn the extent of the child’s injuries and the parts of the body that are involved:

  • CT scan—a procedure that makes detailed computer pictures of the brain. This procedure is also called computed tomography or computerized axial tomography. This test can be used to detect bleeding or swelling.
  • MRI (magnetic resonance imaging)—a procedure that uses a magnet, radio waves, and a computer to make detailed pictures of the brain. This procedure is also called nuclear magnetic resonance imaging (NMRI). This test can be used to determine the extent of the injury.
  • Lab tests include blood work to look for evidence of bleeding and to see if the blood clots normally.
  • An eye evaluation by a qualified ophthalmologist.
  • X-rays of the long bones to check for new or healing fractures (other signs of abuse).

Treatment

Treatment options include:

  • Supportive care with treatment of elevated pressure in the head as needed.
  • Anti-seizure medications may be prescribed.
  • Surgery may be needed to remove blood on the brain.
  • If the baby survives his or her injuries, physical recovery can take months to years, and in many cases the child does not develop normally. In general, the sooner your child’s rehabilitation starts, the better he or she will do over time.
  • During rehabilitation, the child and family work with a team of doctors, nurses, and other professionals. This team includes rehabilitation therapists to help your child develop motor skills like eating and walking. Involvement of a family therapist is very important to help the family with emotional issues related to the child’s injury.

Complications:

Prevention

It is important to talk to anyone caring for your baby about the dangers of shaking and how it can be prevented. Taking care of a crying baby can be very frustrating. If you have tried to calm your crying child but feel like nothing is working, it's important to stay in control of your temper to keep from hurting your baby or child out of frustration. If you feel you might lose control, take the following steps:

  • Take a deep breath and count to 10.
  • Take time out and let your baby cry alone.
  • Call someone close to you for emotional support.
  • Call your baby’s doctor. There may be a medical reason why your child is crying.

RESOURCES:

American Academy of Pediatrics
http://www.aap.org

Brain Injury Association of America–Parent Education
http://www.biausa.org

National Center on Shaken Baby Syndrome
http://www.dontshake.com

CANADIAN RESOURCES:

Caring for Kids, The Canadian Paediatric Society
http://www.caringforkids.cps.ca

Never Shake a Baby
The Kiwanis Club of Ottawa
http://www.nevershakeababy.org/shakenbaby/index.htm

References:

Blumenthal I. Shaken baby syndrome. Postgrad Med J . 2002;78(926):732-735.

Carbaugh SF. Understanding shaken baby syndrome. Adv Neonatal Care . 2004;4(2):105-114. Erratum in: Adv Neonatal Care . 2004;4(3):177.

Intentional head trauma in infants: Shaken baby syndrome. Virtual Children’s Hospital. Available at: www.vh.org/pediatric/provider/pediatrics/shakenimpactsyndrome/ 2003. Accessed September 2005.

Lowenstein LF. Recent research and views on shaking baby syndrome. Int J Psychiatry Med . 2004;34(2):131-141.

Patel N, Moorani B. Neonatal injuries in child abuse . Available at: www.emedicine.com/neuro/topic238.htm 2005. Accessed September 2005.

RM Kleigman, RE Behrman, HB Jenson, BF Stanton. Nelson Textbook of Pediatrics . 18th Edition. Eds. Saunders Publishers, Philadelphia PA, 2007.

Shaken baby syndrome–a potentially deadly concern. American Association of Neurological Surgeons. Available at: www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZ9G8DUE8C&sub_cat=355 2000. Accessed September 2005.

Smith J. Shaken baby syndrome. Orthop Nurs . 2003;22(3):196-203.



Last reviewed January 2008 by Kari L. Kassir, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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