Shaken Baby Syndrome

A significant number of deaths from head trauma among children under age 2 are non-accidental. Shaken baby syndrome (SBS) is a leading cause of fatal physical abuse deaths, according to the Shaken Baby Syndrome Prevention Plus website (www.sbsplus.com). Research over the past two decades suggests that approximately one-fourth of SBS victims die and the majority of those who survive live with permanent impairment, including blindness, feeding difficulties, seizures, motor impairments and learning problems. Some of the injuries that are often associated with Shaken Baby Syndrome are:

A. Intracranial injury
1. Brain swelling (edema).
2. Sub-dural or sub-arachnoid hemorrhages are often found.
3. Inter-hemispheric bleeding is frequent.
4. “Shear injuries”
5. Evidence of external trauma is often lacking

B. Retinal hemorrhages
1. Found in most of cases of SBS on exam by ophthalmologist
2. Usually more than one/frequently many
3. Occasionally retinal detachment may occur
4. Visual impairment or blindness may result from the cortical damage

C. Other injuries
1. Rib fractures may be seen due to squeezing while shaking. Location of fractures is usually lateral or posterior.
2. May have bruises or other broken bones. It is rare to see bruises over the broken ribs. Grab marks are usually not seen.
3. Evidence of previous shaking episodes, old broken ribs or broken bones may be found on MRI or skeletal survey and are not unusual. Many have evidence of prior abuse.

Injuries from Shaken Baby Syndrome are NOT caused by bouncing on a knee, jogging with an infant in a backpack, or tossing infants in the air and catching them (these may not be good activities, however). A severe injury can be compared with falling from a 3rd floor window or a car accident when the child is unrestrained. In severe cases the symptoms are rather immediate and usually occur within 1-2 hours before arrival at the hospital or clinic.

In infants who have a severe injury and survive, some areas of the brain are destroyed. These die and are reabsorbed into the blood stream. The cavity which remains fills with fluid and the remaining brain tissue may continue to shrink over time. This type of brain damage means those areas of the brain are GONE forever- new pathways through it cannot be formed. When shaken baby syndrome is diagnosed, it is important to evaluate other children in the family as they may have been shaken or abused in other ways. A thorough psychosocial history is recommended.

According to the Arkansas Department of Human Services Child Maltreatment Assessment Protocol (used to determine whether the Hotline will accept a report), shaking a child age three or younger is defined as: the parent or caretaker uses one or both hands to violently and rapidly intentionally or knowingly move the body of a child age three or younger in a back and forth or up and down motion.

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