April 15, 2008
Shaken Baby Syndrome (SBS)
Jonathan Wood, MD
Shaken babies are a small but significant portion of the estimated 900,000 victims of child abuse and neglect every year. Of the estimated 1,500 children killed annually by abuse, one in four is a victim of shaken baby syndrome (SBS). For every casualty of SBS, three other babies are shaken severely enough to require medical treatment and will have lifelong complications including seizures, blindness and paralysis. No one knows how many thousands of other less severe cases of shaking are never brought to a physician’s attention and go undiagnosed.
Most SBS cases occur when a parent or other caregiver becomes frustrated with an infant who won’t stop crying. Severe shaking of a baby results in brain injury and swelling that usually stops the crying. The cause (crying baby) and effect (quiet baby) of shaking provide behavioral reinforcement for the abusive caregiver, who may not realize the long-term damage being done.
What are the signs of shaken baby syndrome?
SBS is a serious type of head injury that happens when an infant or toddler is severely or violently shaken. Babies are not able to fully support their heavy heads. As a result, violent and forceful shaking causes a baby's brain to be injured. Too often, this leads to the death of a baby.
When a baby is violently shaken, brain cells are destroyed and the brain cannot get enough oxygen. As a result, a victim of SBS may show one or all of the following signs and symptoms immediately following or in the hours or days to follow:
- Lethargy (difficulty staying awake)
- Difficulty breathing
- Tremors (shakiness)
SBS usually occurs when a parent or other caregiver shakes a baby out of anger or frustration, often because the baby will not stop crying. Shaken baby syndrome is a serious form of child abuse.
The long term consequences of SBS include:
- Learning disabilities
- Physical disabilities
- Visual or hearing problems (including blindness or deafness)
- Speech disabilities
- Cerbral Palsy
- Behavior disorders
- Cognitive impairment
Why does it cause such severe injuries?
Babies' heads are relatively large and heavy, making up about 25% of their total body weight. Their neck muscles are too weak to support such a disproportionately large head. In addition, babies' brains are immature and more easily injured by shaking. The blood vessels around their brain are more susceptible to tearing than in older children or adults.
What do I do if I think a baby has been shaken?
If you think your baby might have been injured from violent shaking, the most important step is to get medical care right away. Call your pediatrician or take your baby to the nearest emergency department. If your baby's brain is damaged or bleeding inside from severe shaking, it will only get worse without treatment. Getting medical care right away may save your baby's life and prevent serious health problems from developing.
Be sure to tell your pediatrician or the doctor in the emergency room if your baby was shaken. Do not let embarrassment, guilt, or fear get in the way of your baby's health or life. Without the correct information, your pediatrician or the doctor may assume your baby has an illness. Mild symptoms of shaken baby syndrome are very similar to colic, feeding problems, and fussiness. Your baby may not get the right treatment if the doctor does not have all the facts.
How can I avoid injuring my child?
First and foremost, be aware of the dangers inherent in shaking a baby or young child. Most parents are not aware of how seriously they can injure their child through a seemingly minor action. Secondly, during periods of calm, think through options you will have when you become frustrated as a parent. Again, it is best to consder this when you are calm and not in the midst of a stressful situation. Who can you call? How can you get a break?
Talk to people you trust about their experiences and difficulties. Ask your pediatrician for tips and advice.
Spread the word
If other people help take care of your baby, make sure they know about the dangers of SBS. This includes child care providers, older siblings, grandparents, and neighbors - - anyone who cares for your baby.
Make sure they know: it is never okay to shake a baby.
Useful websites to explore further:
The text of this article was drawn from a number of sources, including the AAP’s statement on Shaken Baby Syndrome, the National Center on Shaken Baby Syndrome’s website, and the Child Welfare Information Gateway.