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Shaken baby syndrome - Symptoms and causes

Overview

Shaken baby syndrome is a serious brain injury resulting from forcefully shaking an infant or toddler. It's also known as abusive head trauma, shaken impact syndrome, inflicted head injury or whiplash shaken infant syndrome.

Shaken baby syndrome destroys a child's brain cells and prevents his or her brain from getting enough oxygen. This form of child abuse can cause 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.

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Symptoms

Shaken baby syndrome symptoms and signs include:

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

While sometimes there's bruising on the face, you may not see signs of physical injury to the child's outer body. Injuries that might not be immediately seen include bleeding in the brain and eyes, spinal cord damage, and fractures of the ribs, skull, legs and other bones. Many children with shaken baby syndrome show signs and symptoms of prior child abuse.

In mild cases of shaken baby syndrome, a child may appear normal after being shaken, but over time they may develop health or behavioral problems.

When to see a doctor

Seek immediate help if you suspect your child has been injured by violent shaking. Call 911 or emergency medical help, 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.

Health care professionals are legally required to report all suspected cases of child abuse to state authorities.

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Causes

Babies have weak neck muscles and can't support the weight of their heads. If a baby is forcefully shaken, their 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.

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

Risk factors

The following things may increase the risk that parents or caregivers are more likely to forcefully shake a baby and cause shaken baby syndrome:

  • Unrealistic expectations of babies
  • Young or single parenthood
  • Stress
  • Domestic violence
  • Alcohol or substance abuse
  • Unstable family situations
  • Depression
  • A history of mistreatment as a child

Also, men are more likely to cause shaken baby syndrome than are women.

Complications

Even brief shaking of an infant can cause irreversible brain damage. Many 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
  • Developmental delays, learning problems or behavior issues
  • Intellectual disability
  • Seizure disorders
  • Cerebral palsy, a disorder that affects movement and muscle coordination

Prevention

New parent education classes can help parents better understand the dangers of violent shaking and may provide tips to soothe a crying baby and manage stress.

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. Nothing justifies shaking a child.

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 provider.

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.

By Mayo Clinic Staff

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Shaken Baby Syndrome – Symptoms, Prognosis and Prevention

Shaken Baby Syndrome (also known as Shaken Impact Syndrome) is a serious form of abuse inflicted upon a child. It usually occurs when a parent or other caregiver shakes a baby out of anger or frustration, often because the baby will not stop crying.

Babies have very weak neck muscles that cannot fully support their proportionately large heads. Severe shaking causes the baby’s head to move violently back and forth, resulting in serious and sometimes fatal brain injury. These forces are exaggerated if the shaking is interrupted by the baby’s head hitting a surface.

Shaking, with or without the sudden deceleration of the head when it impacts a surface, can cause the following:

  • Subdural hematoma, which is a collection of blood between the surface of the brain and the dura (the tough, fibrous outer membrane surrounding the brain. ) This occurs when the veins that bridge from the brain to the dura are stretched beyond their elasticity, causing tears and bleeding.
  • Subarachnoid hemorrhage, which is bleeding between the arachnoid (web-like membrane surrounding the brain filled with spinal fluid) and the brain.
  • Direct trauma to the brain substance itself, caused when the brain strikes the inner surfaces of the skull.
  • Shearing off or breakage of nerve cell branches (axons) in the cortex and deeper structures of the brain caused by violent motion to the brain.
  • Further irreversible damage to the brain substance from the lack of oxygen if the child stops breathing during shaking.
  • Further damage to the brain cells when injured nerve cells release chemicals that add to oxygen deprivation to the brain.

Other injuries related to this abuse include:

  • Retinal hemorrhages ranging from a few scattered hemorrhages to extensive hemorrhages involving multiple layers of the retina.
  • Skull fractures resulting from impact when the baby is thrown against a hard or soft surface.
  • Fractures to other bones, including the ribs, collarbone and limbs; bruising to the face, head and entire body.

This syndrome is primarily seen in children younger than age two, with the majority of cases occurring before the baby’s first birthday. The average victim is between three and eight months old. However, children up to age four have been victims of this abuse. The perpetrator of the abuse is most often the father, boyfriend of the mother, female babysitter or the mother. Parents experiencing stress because 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.

The National Center on Shaken Baby Syndrome estimates that there are between 600 and 1400 cases in the U. S. a year. Because there is currently no reliable method of collecting these statistics, the true incidence is unknown. This syndrome is the most common cause of death and long-term disability in infants and young children who are victims of child abuse.

There is often no obvious external evidence of injury or physical sign of violence, resulting in under diagnosis of this syndrome. Caregivers and even physicians who are not aware of what has happened to a baby may not detect injuries that are primarily internal, attributing the baby’s fussiness to an underlying cause such as a virus.

Symptoms vary and are caused by generalized brain swelling secondary to trauma. They may appear immediately after the shaking and usually reach a peak within 4-6 hours. The following signs and symptoms may indicate shaken baby syndrome:

  • Altered level of consciousness
  • Drowsiness accompanied by irritability
  • Coma
  • Convulsions or seizures
  • Dilated pupils that do not respond to light
  • Decreased appetite
  • Vomiting
  • Posture in which the head is bent back and the back arched
  • Breathing problems and irregularities
  • Abnormally slow and shallow respiration
  • Cardiac arrest
  • Death
  • Retinal hemorrhages
  • Closed head injury bleeding (subdural, epidural, subarachnoid, subgaleal)
  • Lacerations
  • Contusions
  • Concussions
  • Bruises to the face, scalp, arms, abdomen or back
  • Soft tissue swelling that may indicate a fracture to the skull or other bones
  • Abdominal injuries
  • Chest injuries
  • Abnormally low blood pressure
  • Tense fontanel (soft spot)
  • History
  • Optic fundus exam for retinal hemorrhages
  • Computed tomography scan (CT or CAT scan) of the head and abdomen
  • Magnetic resonance imaging (MRI) in select cases
  • Lumbar puncture with precautions
  • Skeletal survey
  • Nuclear scan
  • Drug screening
  • Routine blood samples

The prognosis for victims of shaken baby syndrome varies with the severity of injury but generally is poor. Many cases are fatal or lead to severe neurological deficits. Death is usually caused by uncontrollable increased intracranial pressure from cerebral edema, bleeding within the brain or tears in the brain tissue. However, even babies with injuries that appear to be mild may show developmental difficulties. Typically, surviving babies with this syndrome may develop any of the following disabilities:

  • Cerebral palsy
  • Paralysis
  • Vision loss or blindness
  • Mental retardation
  • Epilepsy
  • Seizures

Shaken baby syndrome is completely preventable. Taking care of a baby can present challenges, especially for first-time parents. However, it is important to remember that it is never acceptable to shake, throw or hit a baby. The following tips may help prevent abuse:

  • Take a deep breath and count to 10
  • Take time out and let the baby cry alone
  • Call someone for emotional support
  • Call apediatrician – there may be a medical reason why the baby is crying
  • Never leave a baby with a caregiver, friend or family member in whom there is not complete trust
  • Always check references carefully before entrusting a baby to a caregiver or daycare center

The AANS does not endorse any treatments, procedures, products or physicians referenced in these patient fact sheets. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific neurosurgical advice or assistance should consult his or her neurosurgeon, or locate one in your area through the AANS’ Find a Board-certified Neurosurgeon online tool.

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Shaken baby syndrome

Everyone knows that mothers simply need rest (however, like other people who regularly care for a small child). Today we will raise the topic of what can happen if a mother does not rest for a long time and, as a result, burns out.

Babies cry a lot in their first year of life. Sometimes mothers cannot stand it and, in response to prolonged crying, they begin to do things that they could not even think of before: they shake the child strongly or throw him about something.

After that, 2 scenarios can follow:

1. The kid is lucky - he will get off with only a slight fright, a couple of bruises and abrasions.

2. The baby will not be lucky - the crumbs will have a baby shaking syndrome, which poses a threat to his health and life.

What is shaken baby syndrome?

A small child has weak neck muscles, and if the baby is shaken, his head begins to dangle freely, and its contents begin to beat against the skull. This causes multiple damage to the brain tissue and supply vessels.

Note that the consequences of shaking are much more serious than from a blow when a child falls from a small height.

Of course, shaken baby syndrome can also develop with increased rocking, tossing up and other situations from everyday life. However, it is incomparably less common than what is defined as child abuse.

What's next?

The child has difficulty breathing, convulsions, lethargy and drowsiness. When parents contact a medical institution, the correct diagnosis is made, at best, in a day.

Late diagnosis is usually associated with the following reasons:

1. Parents did not even realize that the child's symptoms could be the result of shaking, so they kept silent about this fact.

2. Parents realized that the child was experiencing symptoms from shaking and, fearing the consequences, kept silent about this fact.

Without truthful evidence, it is rather difficult to diagnose pathology, because with a concussion, there are usually no external injuries. But it is at this stage that lost time can lead to death.

The baby is usually brought to the hospital with non-specific symptoms: respiratory failure, drowsiness, vomiting, convulsions, loss of consciousness. At the same time, the fact of the presence of an injury is denied, and there are no external injuries.

Much later, however, it turns out that the symptoms appeared immediately after shaking (in more than 90% of cases) and the child was shaking not for the first time (in 70% of cases).

Which diagnosis is needed?

To diagnose shaken baby syndrome, a pediatrician may prescribe the following tests:

1. Neuroimaging methods (MRI or CT) - are necessary to detect hemorrhages and ischemic areas.

2. CSF analysis - used to confirm the presence of hemorrhage and exclude meningitis (due to the similarity of symptoms).

3. General and biochemical blood test.

4. Ultrasound and radiography - are necessary if additional damage is suspected.

The most important and at the same time difficult task of a doctor is to prove that brain damage is associated with an act of abuse, and not just with an injury resulting from a fall (for example, when a baby is just learning to walk and often hits).

And it is impossible to determine what is more terrible - not to recognize an adult who harms a child or to blame an innocent person, thereby destroying a family.

How to help a child?

Shaken baby syndrome is often accompanied by retinal hemorrhage, as well as other manifestations of domestic violence - fractures, hematomas, damage to internal organs, etc.

A child with a concussion should be treated in intensive care. Doctors need to try to save as much brain tissue as possible in the first minutes (by removing the accumulation of blood, sometimes surgically, to eliminate respiratory and circulatory disorders). Note that about 39% of children need emergency resuscitation upon arrival at a medical facility.

Unfortunately, medical assistance can not always help to avoid the tragedy:

  • about 23% of children with shaken baby syndrome die;
  • up to 55% of children remain with neurological pathologies;
    • 90,061 up to 65% subsequently suffer visual impairment.

Thus, the best option is not to bring to such a state and try to find enough time for a good rest.

Why you shouldn’t shake a baby, or what is Shaking Baby Syndrome – City Polyclinic No. 7, Grodno

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03/16/2020

We will tell you why you shouldn’t shake a child, why you shouldn’t throw a child or throw him on the bed. The fact is that all these actions can lead to serious consequences, even lethal!

Shaken baby syndrome (SBS) is also known as postconcussion syndrome, shaken baby syndrome, shaken baby syndrome. All these names mean the same thing: brain damage as a result of a head injury in a child.

DFS can also be found in children under 5 years of age, although the median age for illness is 3 to 5 months. The peak falls at the age of 6-8 weeks, the time when babies cry the most. In babies up to a year old, the head is the largest and heaviest part of the body (up to 15% of the total body weight). Against the background of a large head, the neck muscles are extremely weak.

In 70% of cases of child injuries, males are to blame - fathers or stepfathers, often of a young age. But any person who is not able to cope with emotions and overcome anger, and who is also prone to the use of force, can resort to shaking the child vigorously in order to calm him down. Alcohol abuse is also a common cause of SDS.

When a person shakes a baby vigorously, the loose head dangles because the weak neck muscles are not yet able to properly support the head. As a result of this, the child's brain is also not in a static state, the membranes of brain cells are torn, blood vessels are torn and tissues are damaged. All this can provoke a hemorrhage under the lining of the brain.

The situation can be aggravated by such an action of an adult as throwing the child with force onto the bed. Swelling in the brain due to strong shaking can cause a lot of internal pressure, compress blood vessels, and further injure the baby's fragile brain.

Habitual play with children, light tossing or kneeling, does NOT cause this injury. But under no circumstances should you shake a child.

Even if the child looks absolutely normal after a strong shaking, after a while one of the symptoms may still appear. Most often, the problem occurs without any outward signs of damage, and problems with behavior, memory, or learning become apparent only during the period when the child goes to school.

How to prevent concussion syndromes?

To know that a baby's crying is normal. Learn to calm the child. To be aware of what to do with the feeling of one's own powerlessness and anxiety at the moments of the baby's incessant crying. Remember that shaking can be deadly for a baby.

How to calm the baby?

  • W-P Method S-P-K

SH-noise: white noise or other noise similar to that heard by the baby in the womb. A vacuum cleaner, hair dryer, dryer, tap water or a special apparatus for creating white noise will help you.

R-lying or side-lying position: (laying on the left side to help the baby digest food, on the stomach while the parent holds the baby)

C-nipple: breastfeeding, bottle, teat or finger.

P- swaddling : wrapping a baby in a blanket like a burrito will help him feel safe. You can use loose swaddling.

K-Swing: Slight rocking in a chair, in a cradle, or driving a car can help a baby feel similar vibrations as they did when in their stomach.

If the child continues to cry: