Shaken baby syndrome

Shaken baby syndrome

Shaken baby syndrome is a severe form of child abuse caused by violently shaking an infant or child.

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Considerations

Shaken baby syndrome can occur from as little as 5 seconds of shaking.

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Shaken baby injuries usually occur in children younger than 2 years old but may be seen in children up to the age of 5.

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When an infant or toddler is shaken, the brain bounces back and forth against the skull. This can cause bruising of the brain (cerebral contusion), swelling, pressure, and bleeding in the brain. The large veins along the outside of the brain may tear, leading to further bleeding, swelling, and increased pressure. This can easily cause permanent brain damage or death.

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Shaking an infant or small child may cause other injuries, such as damage to the neck, spine, and eyes.

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Causes

In most cases, an angry parent or caregiver shakes the baby to punish or quiet the child. Such shaking usually takes place when the infant is crying inconsolably and the frustrated caregiver loses control. Many times the caregiver did not intend to harm the baby. Still, it is a form of child abuse.

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Injuries are most likely to happen when the baby is shaken and then the baby’s head hits something. Even hitting a soft object, such as a mattress or pillow, may be enough to injure newborns and small infants. Children’s brains are softer, their neck muscles and ligaments are weak, and their heads are large and heavy in proportion to their bodies. The result is a type of whiplash, similar to what occurs in some auto accidents.

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Shaken baby syndrome does not result from gentle bouncing, playful swinging or tossing the child in the air, or jogging with the child. It also is very unlikely to occur from accidents such as falling off chairs or down stairs, or accidentally being dropped from a caregiver’s arms. Short falls may cause other types of head injuries, although these are often minor.

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Symptoms

The symptoms can vary from mild to severe. They may include:

• Convulsions (seizures)

• Decreased alertness

• Extreme irritability or other changes in behavior

• Lethargy, sleepiness, not smiling

• Loss of consciousness

• Loss of vision

• No breathing

• Pale or bluish skin

• Poor feeding, lack of appetite

• Vomiting

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There may not be any physical signs of injury, such as bruising, bleeding, or swelling. In some cases, the condition can be difficult to diagnose and may not be identified during an office visit. However, rib fractures are common and can be seen on x-ray.

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An eye doctor may find bleeding behind the baby’s eye or retinal detachment. There are, however, other causes of bleeding behind the eye and they should be ruled out before diagnosing shaken baby syndrome. Other factors must be considered.