shaken baby syndrome

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Shaken Baby Syndrome

 

Definition

Shaken baby syndrome (SBS) is a collective term for the internal head injuries a baby or young child sustains from being violently shaken.

Description

Shaken baby syndrome was first described in medical literature in 1972. Physicians earlier labeled these injuries as accidental, but as more about child abuse became known, more cases of this syndrome were properly diagnosed.
Every year, nearly 50,000 children in the United States are forcefully shaken by their caretakers. More than 60% of these children are boys. The victims are on average six to eight months old, but may be as old as five years or as young as a few days.
Men are more likely than women to shake a child; typically, these men are in their early 20s and are the baby's father or the mother's boyfriend. Women who inflict SBS are more likely to be babysitters or child care providers than the baby's mother. The shaking may occur as a response of frustration to the baby's inconsolable crying or as an action of routine abuse.

Causes and symptoms

Infants and small children are especially vulnerable to SBS because their neck muscles are still too weak to adequately support their disproportionately large heads, and their young brain tissue and blood vessels are extremely fragile. When an infant is vigorously shaken by the arms, legs, shoulders, or chest, the whiplash motion repeatedly jars the baby's brain with tremendous force, causing internal damage and bleeding. While there may be no obvious external signs of injury following shaking, the child may suffer internally from brain bleeding and bruising (called subdural hemorrhage and hematoma); brain swelling and damage (called cerebral edema); mental retardation; blindness, hearing loss, paralysis, speech impairment, and learning disabilities; and death. Nearly 2,000 children die every year as a result of being shaken.
Physicians may have difficulty initially diagnosing SBS because there are usually few witnesses to give a reliable account of the events leading to the trauma, few if any external injuries, and, upon close examination, the physical findings may not agree with the account given. A shaken baby may present one or
Shaken baby syndrome is a collective term for the internal head injuries a baby or young child sustains from being violently shaken. Because of the fragile state of an infant's brain tissue and blood vessels, when a baby is vigorously shaken by the chest, as shown in the illustration above, the whiplash motion repeatedly jars the baby's brain with extreme force, causing serious internal damage and bleeding. Nearly 2,000 American children die annually from this condition.
Shaken baby syndrome is a collective term for the internal head injuries a baby or young child sustains from being violently shaken. Because of the fragile state of an infant's brain tissue and blood vessels, when a baby is vigorously shaken by the chest, as shown in the illustration above, the whiplash motion repeatedly jars the baby's brain with extreme force, causing serious internal damage and bleeding. Nearly 2,000 American children die annually from this condition.
(Illustration by Electronic Illustrators Group.)
more signs, including vomiting; difficulty breathing, sucking, swallowing, or making sounds; seizures; and altered consciousness.

Diagnosis

To diagnose SBS, physicians look for at least one of three classic conditions: bleeding at the back of one or both eyes (retinal hemorrhage), subdural hematoma, and cerebral edema. The diagnosis is confirmed by the results of either a computed tomography scan (CT scan) or magnetic resonance imaging (MRI).

Treatment

Appropriate treatment is determined by the type and severity of the trauma. Physicians may medically manage both internal and external injuries. Behavioral and educational impairments as a result of the injuries require the attention of additional specialists. Children with SBS may need physical therapy, speech therapy, vision therapy, and special education services.

Alternative treatment

There is no alternative to prompt medical treatment. An unresponsive child should never be put to bed, but must be taken to a hospital for immediate care.

Key terms

Cerebral edema — Fluid collecting in the brain, causing tissue to swell.
Hematoma — A localized accumulation of blood in tissues as a result of hemorrhaging.
Hemorrhage — A condition of bleeding, usually severe.
Retinal hemorrhage — Bleeding of the retina, a key structure in vision located at the back of the eye.
Subdural hematoma — A localized accumulation of blood, sometimes mixed with spinal fluid, in the space of the brain beneath the membrane covering called the dura mater.

Prognosis

Sadly, children who receive violent shaking have a poor prognosis for complete recovery. Those who do not die may experience permanent blindness, mental retardation, seizure disorders, or loss of motor control.

Prevention

Shaken baby syndrome is preventable with public education. Adults must be actively taught that shaking a child is never acceptable and can cause severe injury or death.
When the frustration from an incessantly crying baby becomes too much, caregivers should have a strategy for coping that does not harm the baby. The first step is to place the baby in a crib or playpen and leave the room in order to calm down. Counting to 10 and taking deep breaths may help. A friend or relative may be called to come over and assist. A calm adult may then resume trying to comfort the baby. A warm bottle, a dry diaper, soft music, a bath, or a ride in a swing, stroller, or car may be offered to soothe a crying child. Crying may also indicate pain or illness, such as from abdominal cramps or an earache. If the crying persists, the child should be seen by a physician.

Resources

Organizations

American Humane Association, Children's Division. 63 Inverness Drive East, Englewood, CO 80112-5117. (800) 227-4645. www.americanhumane.org.
Child Abuse Prevention Center of Utah. 2955 Harrison Boulevard, #102, Ogden, UT 84403. (888) 273-0071.
National Center on Shaken Baby Syndrome. 2955 Harrison Blvd., #102, Ogden, UT 84403. (801) 627-3399. http://www.dontshake.com.

shaken baby syndrome (SBS),

a syndrome of neurologic and other injuries, of variable presentation, induced by the violent shaking of an infant.

SBS is the leading cause of death and of long-term disability and permanent damage in physically abused infants and children. Vigorous shaking of an infant, with or without direct violence to the head, can result in spinal cord injury or intracranial bleeding, with irreversible brain damage, blindness, hearing loss, seizures, learning disabilities, paralysis, or death. SBS occurs most often before the age of 1 and seldom after age 2. Infants under 6 months are particularly vulnerable because of their disproportionately heavy heads, weak neck muscles, and thin skulls. The higher water content of the infant brain and its incomplete myelination render it more compressible during a shaking episode and more vulnerable to contusion and vascular injury with subdural or diffuse subarachnoid hemorrhages. Shearing of retinal blood vessels (uncommon in other types of head injury) can lead to intraocular hemorrhage, often bilateral. Death usually results from steadily increasing intracranial pressure due to subdural hemorrhage and cerebral edema. About 1,000 babies are hospitalized annually in the U.S. with this diagnosis. About 25% of them die and more than 50% of the survivors suffer irreversible residual neurologic or visual impairment. Long-term studies show that 25% of survivors initially considered symptom-free eventually display severe disorders of development. Men are more likely than women to inflict injury by shaking, as are people with a history of depression, anxiety, or substance abuse. Other risk factors are poor prenatal care, low family income, close child spacing, disappointment in the gender of the infant, and a family history of abuse or neglect. Boys are more likely than girls to be victims, and twins are at higher risk than singletons. Very-low-birth-weight and premature infants and those with disabilities or chronic illnesses are also at greater risk. Most shaking occurs as an impulsive response of the caregiver to a child's persistent crying. In the typical incident, no one is present but the caregiver and the victim. There may be a prior history of abuse or evidence of previous injury. The perpetrator may invent a story of accidental injury to explain the findings. Presenting signs of SBS vary widely, from a flulike condition, poor feeding, irritability, or lethargy to vomiting, respiratory arrest, seizures, or coma. The classical triad of subdural hematoma, cerebral edema, and retinal or subhyaloid hemorrhage is often absent. Finger marks may be found on the chest wall or around the shoulders, but typically there are no external signs of injury. One half of patients with subdural hematoma have no skull fracture. CT without intravenous contrast may show subarachnoid hemorrhages, mass effect, and subtle skull fractures missed by plain radiography. MRI and lumbar puncture may also help to refine or confirm the clinical diagnosis. Prevention of SBS requires education of parents and others entrusted with the care of small children as to the grave danger of shaking a baby. New parents should be informed that a normal infant cries a total of 1.5-3 hours each day and that shaking is never an appropriate response. Alternative ways of coping with the stress of a crying baby need to be planned. Parents must also exercise caution in selecting babysitters, day-care centers, or child-care agencies. All caregivers should be enjoined never to touch a child in anger. Health care professionals must be alert for subtle signs of SBS and other forms of child abuse.


shaken baby syndrome (SBS),

a syndrome of neurologic and other injuries, of variable presentation, induced by the violent shaking of an infant.

SBS is the leading cause of death and of long-term disability and permanent damage in physically abused infants and children. Vigorous shaking of an infant, with or without direct violence to the head, can result in spinal cord injury or intracranial bleeding, with irreversible brain damage, blindness, hearing loss, seizures, learning disabilities, paralysis, or death. SBS occurs most often before the age of 1 and seldom after age 2. Infants under 6 months are particularly vulnerable because of their disproportionately heavy heads, weak neck muscles, and thin skulls. The higher water content of the infant brain and its incomplete myelination render it more compressible during a shaking episode and more vulnerable to contusion and vascular injury with subdural or diffuse subarachnoid hemorrhages. Shearing of retinal blood vessels (uncommon in other types of head injury) can lead to intraocular hemorrhage, often bilateral. Death usually results from steadily increasing intracranial pressure due to subdural hemorrhage and cerebral edema. About 1,000 babies are hospitalized annually in the U.S. with this diagnosis. About 25% of them die and more than 50% of the survivors suffer irreversible residual neurologic or visual impairment. Long-term studies show that 25% of survivors initially considered symptom-free eventually display severe disorders of development. Men are more likely than women to inflict injury by shaking, as are people with a history of depression, anxiety, or substance abuse. Other risk factors are poor prenatal care, low family income, close child spacing, disappointment in the gender of the infant, and a family history of abuse or neglect. Boys are more likely than girls to be victims, and twins are at higher risk than singletons. Very-low-birth-weight and premature infants and those with disabilities or chronic illnesses are also at greater risk. Most shaking occurs as an impulsive response of the caregiver to a child's persistent crying. In the typical incident, no one is present but the caregiver and the victim. There may be a prior history of abuse or evidence of previous injury. The perpetrator may invent a story of accidental injury to explain the findings. Presenting signs of SBS vary widely, from a flulike condition, poor feeding, irritability, or lethargy to vomiting, respiratory arrest, seizures, or coma. The classical triad of subdural hematoma, cerebral edema, and retinal or subhyaloid hemorrhage is often absent. Finger marks may be found on the chest wall or around the shoulders, but typically there are no external signs of injury. One half of patients with subdural hematoma have no skull fracture. CT without intravenous contrast may show subarachnoid hemorrhages, mass effect, and subtle skull fractures missed by plain radiography. MRI and lumbar puncture may also help to refine or confirm the clinical diagnosis. Prevention of SBS requires education of parents and others entrusted with the care of small children as to the grave danger of shaking a baby. New parents should be informed that a normal infant cries a total of 1.5-3 hours each day and that shaking is never an appropriate response. Alternative ways of coping with the stress of a crying baby need to be planned. Parents must also exercise caution in selecting babysitters, day-care centers, or child-care agencies. All caregivers should be enjoined never to touch a child in anger. Health care professionals must be alert for subtle signs of SBS and other forms of child abuse.

shaken baby syndrome

also

shaken infant syndrome

n.
Brain injury in an infant caused by being violently shaken or tossed, resulting in intracranial swelling and bleeding and subsequent symptoms such as lethargy, seizures, loss of consciousness and often permanent brain damage or death.

shaken baby syndrome

a condition of whiplash-type injuries, ranging from bruises on the arms and trunk to retinal hemorrhages, rib fractures, coma, or convulsions, as observed in infants and children who have been violently shaken. This form of child abuse often results in intracranial bleeding from tearing of cerebral blood vessels.
enlarge picture
Shaken baby syndrome: retinal hemorrhages

shaken baby syndrome

A condition defined as “…acute brain injuries—cerebral contusions or subdural or subarachnoid haemorrhages—in infants who have no discernible evidence of blunt head trauma. Associated findings, especially metaphyseal long-bone fractures and evidence of injury to the cervical spinal cord, suggest that the condition is the result of the child’s having been held by the torso and shaken violently, with subsequent whiplash injury to the head, neck, and limbs.”

It is a severe form of child abuse that may be fatal, or leave permanent neurologic sequelae. Severe shaking of an infant—who has virtually no neck muscle tone—may cause bilateral subdural haematomas due to laceration of veins bridging the dura mater and cerebral cortex; skull fractures are uncommon given the relative softness of neonatal bone. Over half of deaths from non-accidental paediatric trauma are due to shaken baby syndrome.

Short-term consequences
Skull fractures, subarachnoid haemorrhage, retinal haemorrhage, cerebral oedema, cerebral haemorrhage, subdural haematoma, death.
 
Long-term sequelae
Microcephaly, mental retardation, learning disabilities, epilepsy, visual impairment, psychiatric problems, death, calvarial thickening, dural changes.

shaken baby syndrome

Whiplash shaken baby syndrome Forensic medicine A severe form of child abuse that may be either fatal, or leave its victim with permanent neurologic sequelae; severe shaking of an infant–who has virtually no neck muscle tone, may cause bilateral subdural hematomas–due to laceration of the veins bridging the dura mater and cerebral cortex. See Battered child syndrome, Bucket handle fracture. Cf Infanticide.

shak·en ba·by syn·drome

(SBS) (shā'kĕn bā'bē sin'drōm)
A syndrome of neurologic and other injuries, of variable presentation, induced by the violent shaking of an infant.

shaken baby syndrome

The association in a small baby of unexplained fractures of long bones and blood clot under the main membrane surrounding the brain (subdural haematoma). These injuries, which are caused by whiplash and rotational movement of the head caused by violent shaking in the course of child abuse, may lead to irritability, convulsions, coma and death. Legal developments have led to the questioning of the evidential basis for the syndrome and it is now accepted that no single sign, such as subdural or retinal haemorrhage, or even a combination of such sgns are, in themselves, sufficient to establish criminal activity.

shak·en ba·by syn·drome

(SBS) (shā'kĕn bā'bē sin'drōm)
A syndrome of neurologic and other injuries, of variable presentation, induced by the violent shaking of an infant.

shaken baby syndrome,

n a condition of whiplash-type injuries ranging from bruises on the arms and trunk to retinal hemorrhages, coma, and convulsions, as observed in infants and children who have been violently shaken. Physicians are required by law to report cases of suspected child abuse and are granted immunity from liability for filing such reports. See also child abuse.
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The judge's decision comes just a week after the Crown announced it planned to appeal against the decision to place two other men on probation in separate baby-shaking cases.