Shaken Baby Syndrome

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Shaken Baby syndrome is a severe form of head injury caused by violently shaking an infant or child. It usually occurs in children younger than 2 years old but may be seen in children up to the age of 5. The violent shaking may result in severe injuries to the infant including permanent brain damage and may cause death.

All of these factors make infants highly vulnerable to whiplash forces:

  • A baby’s head is large and heavy in proportion to his or her body. For this reason, when a baby is dropped or thrown, he or she will tend to land on his head.
  • There is space between the brain and skull to allow for growth and development.
  • Babies’ neck muscles and ligaments are weak and not fully developed.
  • An infant’s skull is soft and pliable

When an infant or toddler is shaken, the skull is not yet strong enough to absorb much force. The force, therefore, is transmitted to the brain, which rebounds against the skull. This can cause bruising of the brain, swelling, pressure, and bleeding.

The large veins along the outside of the brain are also vulnerable and may tear with these injuries. Damage to these veins can lead to further bleeding, swelling, and increased pressure. This can easily cause permanent, severe brain damage or death.

Shaking an infant or small child may cause other injuries, such as damage to the neck, spine, and eyes. Eye damage is very common and may result in loss of vision.

Shaken baby syndrome is seldom an accident. The injuries are almost always caused by non-accidental trauma in other words, child abuse. An angry parent or caregiver may shake a baby to punish or quiet him or her. Many times they do not intend to harm the baby.

In rare instances, these types of injuries may be caused accidentally by actions such as tossing the baby in the air or jogging with the baby in a backpack. Shaken baby syndrome does not result from gentle bouncing or play.

Symptoms:

  • Change in behavior, irritability
  • Lethargy, sleepiness
  • Decreased alertness
  • Loss of consciousness
  • Pale or bluish skin
  • Vomiting
  • Convulsions (seizures)
  • Poor feeding
  • Not breathing (apnea)

There are usually no outward physical signs of trauma, such as bruising, bleeding, or swelling. An ophthalmologist examining the infant’s eyes may detect retinal hemorrhage (bleeding behind the eye) or detachment.

First Aid:

  • Call the local emergency number (such as 911). For a severe head injury such as this, immediate emergency treatment is necessary.
  • If the child stops breathing before emergency help arrives, begin CPR.
  • If the child is vomiting:
    • If you don’t suspect a spinal injury, turn his or her head to the side to prevent choking and aspiration.
    • If you suspect a spinal injury, CAREFULLY roll the whole body to the side as one unit (logrolling) while protecting the neck to prevent choking and aspiration.
  • If the child has a convulsion, follow instructions for seizure first aid.

Do Not:

  • DO NOT pick up or shake the child to attempt to wake him or her up.
  • DO NOT attempt to give anything by mouth.

Call immediately for emergency medical assistance if:

  • A child exhibits any of the above signs or symptoms.
  • You suspect a child has sustained this type of injury

Prevention:

  • NEVER shake a baby or child, whether in play or in anger.
  • Do not hold your baby during an argument.
  • If you find yourself becoming annoyed or angry with your baby, put him in the crib and leave the room. Try to calm down. Call someone for support.
  • Call a friend or relative to come and stay with the child if you feel out of control.
  • There are resources available such as a local crisis hotline or child abuse hotline.
  • Seek the help of a counselor and attend parenting classes.
  • Do not ignore the signs if you suspect child abuse in your home or the home of someone you know.

REMEMBER:  Crying is normal for babies.  Crying is one way babies communicate. Excessive crying is a normal phase in infant development;  babies cry most between 2 and 4 months.  Prolonged, inconsolable crying generally lessens when babies are around 5 months old.  Most babies who cry a great deal are healthy and stop crying spontaneously.  You are not a bad parent if your baby continues to cry after you have done all you can to calm him or her.  Remember, this will get better.

When a baby cries, there are steps you can take to try to comfort him or her.  First, check for signs of illness or discomfort like a dirty diaper, diaper rash, teething, fever, or tight clothing.  Maybe your baby hungry or needs to be burped. Rub his/her back, gently rocking him/her; offer a pacifier; sing or talk; take a walk using a stroller or a drive in a properly secured car seat. Call the doctor if you think the child is ill.

REMEMBER when you feel frustrated, angry, or stressed while caring for your baby, take a break. Call a friend, relative, neighbor, or a parent helpline for support. Put your baby in a crib on his or her back, make sure the baby is safe, and then walk away for a bit, checking on him or her every 5 to 10 minutes. Be aware of signs of frustration and anger in yourself and others caring for your baby and call or go to see your health care professional if you have anger management or other behavioral concerns. Also, make sure others caring for your baby see a health care professional if they easily become angry or frustrated around your baby.

It may help to think of this as the Period of PURPLE Crying® as defined by the National Center for Shaken Baby Syndrome (NCSBS). PURPLE, stands for: Peak Pattern: Crying peaks around 2 months, then decreases. Unpredictable: Crying for long periods can come and go for no reason. Resistant to Soothing: The baby may keep crying for long periods. Pain-like Look on Face. Long Bouts of Crying: Crying can go on for hours. Evening Crying: Baby cries more in the afternoon and evening.  Most importantly, remember things will get better, be patient with yourself and your baby and stay calm!

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