Shaken Baby Syndrome

Definition

Shaken baby syndrome is a group of symptoms in babies or small children. They may be temporary problems, severe disabilities or death. The symptoms are caused by injuries from a violent shaking or hit to the head. The severity of the symptoms will depend on the type of injuries to the baby's brain.

Causes

Shaken baby syndrome is caused by shaking or jerking a baby or young child. Even a few seconds of shaking can injure a baby. Babies and young children are more vulnerable to injuries from this type of movement because:

• The neck muscles of young children, especially babies, are not very strong. It can be tough for them to fully support their heavy heads or protect themselves from harsh movements.
• Baby's brains are more fragile than adults. Shaking movements can cause the brain to move back and forth inside their skulls. The movement can injure the brain and tear small blood vessels. The bleeding can affect the brain and the eyes.

Shaken baby syndrome usually happens when a parent or other caregiver becomes angry or frustrated. It often happens because the baby will not stop crying.

Brain Bruised from Whiplash—Similar Effect in Shaken Baby Syndrome

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Risk Factors

The following factors increase the chance of a shaking injury:

• Family with history of domestic or child abuse
• Family with history of drug and/or alcohol abuse
• Family with history of stress or social difficulties
• Boys are more likely to be abused in this way than girls

Symptoms

Symptoms can vary based on the severity of the injury. The injury depends on the length of time the baby is shaken or how hard the baby's head has hit a surface. Injuries caused by shaking are often extremely serious and can include:

• Failure-to-thrive —not growing as expected
• Poor feeding or vomiting
• Seizures or spasms
• Weakness
• Semi-consciousness or loss of consciousness—not fully awake or aware of surroundings
• Difficulty breathing
• Dilated or unresponsive pupils
• Swollen head
• Lethargy or irritability

There are not always bruises or other signs of injury to the child’s head or body. If there are visible injuries they may be:

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

Diagnosis

Your doctor will ask about your child’s symptoms and medical history. A physical exam will be done. Your child may be referred to doctors who specialize in brain injuries. This may include a neurologist or neurosurgeon.

Tests will be done to determine the extent of the injuries. They may include:

• CT scan —a procedure that makes detailed computer pictures of the brain. This procedure is also called computed tomography or computerized axial tomography. It 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. May also be called nuclear magnetic resonance imaging (NMRI). This test can be used to determine the extent of the brain injury.
• Lab tests—including blood work to look for evidence of bleeding or the blood's ability to clot.
• An eye evaluation by a qualified ophthalmologist.
• X-rays of the bones in arms an legs to check for signs of abuse. This includes new or healing fractures.

Treatment

It is important to get medical care right away if your baby is severely or violently shaken. Immediately take your child to your pediatrician or an emergency room. Early medical care may decrease the amount of brain damage. Don't let embarrassment, guilt, or fear get in the way of protecting your child's health or life.

The goal of immediate care is to halt any further brain damage and support the baby. Early intervention is treatment or therapy to help your baby's long term recovery.

If your baby is diagnosed with shaken baby syndrome, follow your doctor's instructions.

Prevention

It is important to talk to anyone caring for your baby about the dangers of shaking. Taking care of a crying baby can be very frustrating for anyone. If you have tried to calm the crying baby, but feel like nothing is working—stay in control of your temper. Keep from hurting the baby 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. Place your child in a safe place, like the crib. Let your baby cry alone.
• Call someone close to you for emotional support. Ask friends or family for help to care for your baby.
• Call your baby’s doctor. There may be a medical reason why your child is crying.

Share this information with anyone who is caring for the baby.