Shaken Baby Syndrome

This paper will cover a type of abuse known as Shaken Baby Syndrome. Shaken baby syndrome is a major cause of infant morbidity and mortality which is widely recognized in the medical literature. Signs may include retinal hemorrhage, subdural or subarachnoid hemorrhage, and associated fractures. Victims are often younger than 6 months old and have been affected by violent shaking with rapid angular deceleration and possible terminal impact. In this paper I will discuss the symptoms, prevalence, treatment and research of Shaken Baby Syndrome.

Imagine that you are a sweet, innocent, precious little baby. Babies are totally dependent upon adults to give them what they need and most importantly love. Your only means of communication
is crying so you cry when you are hungry and need to be fed, when your diaper needs to be changed, as well as when you aren’t feeling so well, or you just want attention. You begin cry and someone comes over to you and picks you up. However instead picking you up and holding you and comforting you or talking affectionately to you, they shake you violently and vigorously. Beings that you are only a baby, imagine the fear and pain that the shaking causes you. This is known as Shaken Baby Syndrome and it is a form of abuse that is happening more often than we know. It is hard to imagine that someone would even want to harm a baby or young child.

Shaken baby syndrome is a serious brain injury that often times results in death.
This type of injury results when a person forcefully shakes and infant or a toddler. Shaken baby syndrome also has different names. Some of these names include: abusive head trauma, inflicted head injury, and whiplash shake syndrome. This type of injury is a big cause of infant mortality. It is so severe that it can even destroy a child’s brain cells and prevents his or her brain from getting oxygen. Shaken Baby Syndrome is a form of child abuse which may lead to permanent damage or even
death.

Babies, newborn to one year are at the greatest risk of injury from shaking.
Shaking them violently can trigger “whiplash” that can lead to internal injuries. Injuries that included: bleeding in the brain or in the eyes. Often times there are no obvious external physical signs of trauma such as bruising or bleeding. The perpetrator of the abuse is most often the father, boyfriend of the mother, female babysitter, or the mother. Parents experiencing stress as a result of environmental, social, biological, or financial situations may be more prone to impulsive and violent behavior. Those involved with domestic violence and/or substance abuse may be at higher risk of inflicting this abuse. Children with special needs, multiple siblings, colic, or GERD tend to have a higher risk of shaken baby syndrome. Boys are more likely than girls to be victims. Families that live in poverty are also at high risk of suffering from this type of abuse. The perpetrator becomes so frustrated that they just lose control and just start shaking them. Most often they are just average people who lose their temper in the heat of the moment and lose control. Many of those who are charged with shaking a child have no previous history of any type of violence. According to the National Center on Shaken Baby Syndrome estimates that there are between 600 and 1400 cases in the US each year (AAONS, 2005). Currently there is not a reliable method of collecting these statistics. This syndrome is the most
common cause of death and long term disability in infants and your children who are victims of child abuse.

Children with this syndrome usually always are between the ages of 6 months and 2 years old. Medical attention is usually sought when the child shows irritability, poor or lack of eating habits, lethargy, or unresponsiveness. When a child is shaken or thrown very hard or forcefully, the head twists or whips back and forth. This kind of force can cause tears in the tissue of the brain, blood vessels, and nerves. Swelling and bleeding can occur in the brain. Signs and symptoms of shaken baby syndrome include:
• Breathing problems
• Tremors
• Vomiting
• Pale skin
• Seizures
• Paralysis
• Coma

In most cases an angry parent or caregiver will shake the baby to make them be quiet or to punish them. A caregiver will usually start shaken a baby when it has cried for a long time inconsolably. The parent doesn’t mean to hurt the child in most cases. In any case it is still a form of child abuse. Injuries most likely will occur when the baby’s is shaken and then their head hits something. Children’s brains are softer than adults, their neck muscles are weak, and their heads are disproportioned to their body. This syndrome does not happen from gently bouncing a baby or tossing the child in the air. It occurs from trauma from falling or being dropped by the caregiver.

In order to diagnose shaken baby syndrome a doctor will look for three conditions that are often a sign of the syndrome. These conditions are: brain swelling, bleeding in the brain, and bleeding in the retina of the eye. In order to check for signs of brain damage a doctor will perform several tests that include: CT scan, MRI, X-ray, and eye exam. There are other conditions that have similar symptoms as shaken baby. These disorders are osteogenesis imperfecta and certain bleeding disorders.
If you suspect that a child has shaken baby syndrome call 911 immediately. If the child has stopped breathing perform CPR until help arrives. To perform CPR:
• Carefully place child on his/her back
• Position two fingers on the middle of the breast bone
• Perform 30 compressions
• Give 2 rescue breaths
• Repeat cycle of 30 compressions and 2 breaths until help arrives

One of the biggest devastating outcomes of this syndrome is that it causes total brain injury. It decreases the child’s ability to learn. A child with brain damage will need intensive physical and occupational therapy to help acquire skills that they won’t be able to do on their own. As they get older they may require special education and continued therapy.
There is no medicine to treat this syndrome. In emergency situations and the child survives they will often undergo emergency treatment. This includes respiratory support and possibly surgery. Broken bones are treated by placing in a cast. Eye surgery may be necessary as well to treat any eye problems. A child who suffers from seizures is evaluated by a neurologist who may prescribe anticonvulsant medicine. Other types of specialists will assess and treat children who have long term care issues. Other children who are in the care of the suspected abuser must be protected and examined for injury.

Parents may regain custody of their children if they have lost guardianship because of child abuse or neglect. Whether they do or not depends on the severity of abuse or neglect. In severe cases parent and child contact must be supervised. Sometimes parents lose all of their parental rights. Intention injury is a crime. Police will perform investigations and interview other caregivers. If intention injury is suspected charges will be filed and they will be tried in criminal court.
Shaken Baby Syndrome is 100% preventable. Taking care of a baby can be challenging, especially for a first time parent. If you are angry or arguing with someone do not hold your child as you may accidently shake them out of anger. Take a break if you feel yourself getting overwhelmed. Place the child in his/her crib if they are crying. Call a family member or friend to come over for support.
Another method that can help is the “five S's" approach, which stands for:
1. Shushing (by using "white noise" or rhythmic sounds that mimic the constant whir of noise in the womb. Vacuum cleaners, hair dryers, clothes dryers, a running tub, or a white noise machine can all create this effect.)
2. Side/stomach positioning (placing the baby on the left side — to help with digestion — or on the belly while holding him or her. Babies should always be placed on their backs to sleep.)
3. Sucking (letting the baby breastfeed or bottle-feed, or giving the baby a pacifier or finger to suck on).
4. Swaddling (wrapping the baby in a blanket like a "burrito" to help him or her feel more secure. Hips and knees should be slightly bent and turned out).
5. Swinging gently (rocking in a chair, using an infant swing, or taking a car ride to help duplicate the constant motion the baby felt in the womb).

To prevent yourself from acting out of anger you need to learn how to respond to your stress. Screen your potential child care providers to learn about their child care skills and abilities. Get a police background check on a prospective child care provider. Choose a child care center that has a good reputation and that is licensed in your province. Visit your child's caregiver without warning to get an idea of what kind of care is given when an observation is not expected.
Everyone, from caregivers to bystanders, can do something to prevent SBS. Giving parents and caregivers tools to know how they can cope if they find themselves becoming frustrated are important components of any SBS prevention initiative. You can play a key role in reinforcing prevention through helping people understand the dangers of violently shaking a baby, the risk factors and the triggers for it, and ways to lessen the load on stressed out parents and caregivers. All of which may help to reduce the number of children impacted by SBS.
If you suspect that a child is the victim of child abuse, do not ignore the problem. Call the local police or the Childhelp National Child Abuse Hotline: 1-800-4-A-CHILD.