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Shaken Baby Syndrome

Definition

Shaken baby syndrome is a group of symptoms in babies or small children. They may be temporary problems, severe disabilities, or death. The symptoms are caused by injuries from a violent shaking or hit to the head. The severity of the symptoms will depend on the type of injuries to the baby's brain.

Causes

Shaken baby syndrome is caused by shaking or jerking a baby or young child. Even a few seconds of shaking can injure a baby. Babies and young children are more vulnerable to injuries from this type of movement because:

  • The neck muscles of young children, especially babies, are not strong. It can be tough for them to fully support their heavy heads or protect themselves from harsh movements.
  • Baby's brains are more fragile than adults. Shaking movements can cause the brain to move back and forth inside their skulls. The movement can injure the brain and tear small blood vessels. The bleeding can affect the brain and the eyes.

Shaken baby syndrome usually happens when a parent or other caregiver becomes angry or frustrated. It often happens because the baby will not stop crying.

Brain Bruised from Whiplash—Similar Effect in Shaken Baby Syndrome
Whiplash brain
Copyright © Nucleus Medical Media, Inc.

Risk Factors

Boys are more likely to be abused in this way than girls. Other factors that may increase the chance of a shaking injury include a family history of:

  • Domestic or child abuse
  • Drug and/or alcohol abuse
  • History of stress or social difficulties

Symptoms

Symptoms can vary based on the severity of the injury. The injury depends on the length of time the baby is shaken or how hard the baby's head has hit a surface. Injuries caused by shaking are often extremely serious and can include:

  • Failure-to-thrive—not growing as expected
  • Poor feeding or vomiting
  • Seizures or spasms
  • Weakness
  • Semi-consciousness or loss of consciousness—not fully awake or aware of surroundings
  • Difficulty breathing
  • Dilated or unresponsive pupils
  • Swollen head
  • Lethargy or irritability

These are serious symptoms. If your baby has any of the above symptoms, then go to the emergency room right away.

There are not always bruises or other signs of injury to the child’s head or body. If there are visible injuries they may be:

  • Bruising of the part of the body used as a handle for shaking
  • Fractures of the arm bones, leg bones, and/or ribs

Diagnosis

Your doctor will ask about your child’s symptoms and medical history. A physical exam will be done. An eye exam may also be done. Your child may be referred to doctors who specialize in brain injuries. This may include a neurologist or neurosurgeon.

Imaging tests evaluate your child's brain and surrounding structures. These can be done with:

Your child's bodily fluids may be tested. This can be done with blood tests.

Treatment

It is important to get medical care right away if your baby is severely or violently shaken. Immediately take your child to an emergency room. Early medical care may decrease the amount of brain damage. Don't let embarrassment, guilt, or fear get in the way of protecting your child's health or life.

The goal of immediate care is to stop any further brain damage and support the baby. Early intervention is treatment or therapy to help your baby's long term recovery.

Immediate Care

Your child's treatment plan will be based on the specific injuries your child has. Some steps for immediate care include:

  • Supportive care—Your child may need assistance with basic functions like breathing.
    • This care may be temporary. It will help support your baby during healing.
    • If the injuries are severe, your baby may require permanent supportive care.
  • Treatment to relieve elevated pressure in the head—Pressure may be caused by bleeding or swelling of the brain. The increased pressure can cause further brain damage. Elevated pressure may be treated with:
    • Medications
    • Draining fluid from the head
    • Surgery to remove blood on the brain or rarely to remove part of the skull
  • Anti-seizure medications may be prescribed. Some head injuries can cause seizures.

Early Intervention

If the baby survives the injuries, the full recovery can take months to years. This type of injury can impair or delay motor skills like eating, walking, or speech. Early intervention is a form of rehabilitation. It can help your child develop motor skills as expected. The treatments include work with a team of doctors, nurses, and rehabilitation therapists. The sooner this treatment starts, the better your baby will do over time.

A family therapist is also important. This therapy will help your family with emotional issues related to your child’s injury.

Prevention

It is important to talk to anyone caring for your baby about the dangers of shaking. Taking care of a crying baby can be very frustrating for anyone. If you have tried to calm the crying baby, but feel like nothing is working, then stay in control of your temper. Keep from hurting the baby out of frustration. If you feel you might lose control, take the following steps:

  • Take a deep breath and count to 10.
  • Take time out. Place your child in a safe place, like the crib. Let your baby cry alone.
  • Call someone close to you for emotional support. Ask friends or family for help to care for your baby.
  • Call your baby’s doctor. There may be a medical reason why your child is crying.

Share this information with anyone who is caring for the baby.

Revision Information

  • Reviewer: Kari Kassir, MD
  • Review Date: 09/2013 -
  • Update Date: 09/30/2013 -
  • Brain Injury Association of America

    http://www.biausa.org

  • Healthy Children—American Academy of Pediatrics

    http://www.healthychildren.org

  • Brain Injury Association of Nipissing

    Shaken Baby Syndrome

    http://dawn.thot.net/brain/baby.htm

  • Caring for Kids—Canadian Paediatric Society

    http://www.caringforkids.cps.ca

  • Abusive head trauma. KidsHealth. Nemours website. Available at: http://kidshealth.org/parent/medical/brain/shaken.html. Updated March 2014. Accessed September 28, 2014.

  • Concussion and mild traumatic brain injury. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 15, 2014. Accessed September 28, 2014.

  • Moderate to severe traumatic brain injury. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 28, 2014. Accessed September 28, 2014.

  • Shaken baby syndrome. American Association of Neurological Surgeons website. Available at: http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Shaken%20Baby%20Syndrome.aspx. Accessed September 28, 2014.

  • Shaken baby syndrome. American Humane Association website. Available at: http://www.americanhumane.org/children/stop-child-abuse/fact-sheets/shaken-baby-syndrome.html. September 28, 2014.