Shaken baby syndrome

Definition

Shaken baby syndrome — also known as abusive head trauma, shaken impact syndrome, inflicted head injury or infant whiplash syndrome — is a serious brain injury that occurs when an infant or toddler is forcefully shaken. Shaken baby syndrome destroys a child's brain cells and prevents his or her brain from getting enough oxygen. Shaken baby syndrome is a form of child abuse that can result in permanent brain damage or death.

Shaken baby syndrome is preventable. Help is available for parents who are at risk of harming a child. Parents also can educate other caregivers about the dangers of shaken baby syndrome.

Symptoms

Shaken baby syndrome symptoms and signs include:

• Extreme irritability
• Difficulty staying awake
• Breathing problems
• Poor eating
• Tremors
• Vomiting
• Pale or bluish skin
• Seizures
• Paralysis
• Coma

Other injuries that may not be noticeable include bleeding in the brain and eye, damage to the spinal cord and neck, and fractures of the ribs, skull and bones. Evidence of prior child abuse also is common.

In mild cases of shaken baby syndrome, a child may appear normal after being shaken — but over time he or she may develop health, learning or behavior problems.

When to see a doctor
If you're concerned that your child has been injured by violent shaking, seek help immediately. Contact your child's doctor or take your child to the nearest emergency room. Getting medical care right away may save your child's life or prevent serious health problems. Keep in mind that health care professionals are legally required to report all suspected cases of child abuse to state authorities.

Causes

Babies have weak neck muscles and often struggle to support their heavy heads. If a baby is forcefully shaken, his or her fragile brain moves back and forth inside the skull. This causes bruising, swelling and bleeding.

Shaken baby syndrome usually occurs when a parent or caregiver severely shakes a baby or toddler due to frustration or anger — often because the child won't stop crying. No behavior, however, justifies shaking a child.

Shaken baby syndrome isn't usually caused by bouncing a child on your knee, minor falls or even rough play.

Risk factors

For parents and other caregivers, factors that may increase the risk of inflicting shaken baby syndrome include:

• Unrealistic expectations of babies
• Stress
• Domestic violence
• Alcoholism or other forms of substance abuse
• Unstable family situations
• Depression
• A history of mistreatment as a child

Men are more likely to inflict shaken baby syndrome than are women.

Tests and diagnosis

A child who's been forcefully shaken may need to be examined by a number of medical specialists as well as an expert in child abuse. Various tests may be needed to detect injuries, such as:

• Computerized tomography (CT) scan. A CT scan uses X-ray images to provide cross-sectional images of a child's brain. This test can help detect injuries that need urgent intervention.
• Magnetic resonance imaging (MRI). MRI uses a powerful magnetic field and radio waves to create detailed images of a child's brain. Because MRI is difficult to perform on a child who's unstable, it's usually done two to three days after the injury.
• Skeletal survey. A series of skeletal X-rays — possibly including the arms, hands, legs, feet, spine, ribs and skull — may be used to gauge whether fractures are accidental or purposeful and find previous fractures.
• Ophthalmologic exam. An eye exam can reveal bleeding and other eye injuries.

Depending on the extent of the injuries, monitoring may be needed in a pediatric intensive care unit.

Complications

About half of children affected by shaken baby syndrome die. Survivors of shaken baby syndrome may require lifelong medical care for conditions such as:

• Partial or total blindness
• Hearing loss
• Developmental delays or learning problems
• Mental retardation
• Seizure disorders
• Cerebral palsy

Treatments and drugs

Emergency treatment for a child who has been shaken may include life-sustaining measures, such as breathing support and surgery to stop bleeding in the brain.

Prevention

When your crying baby can't be calmed, you may be tempted to try anything to get the tears to stop — but it's important to always treat your child gently. It only takes a few seconds of shaking to cause irreversible brain damage in an infant. If you're having trouble managing your emotions or the stress of parenthood, seek help. Your child's doctor may offer a referral to a counselor or other mental health professional.

If other people help take care of your child — whether a hired caregiver, sibling or grandparent — make sure they know the dangers of shaken baby syndrome.