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Shaken baby syndrome

see Cervical Spine in abusive head trauma.

Abusive head trauma, also called shaken baby syndrome (or SBS), goes by many other names, including inflicted traumatic brain injury and shaken impact syndrome. All of these names mean the same thing: an injury to a child's brain as a result of child abuse.

Abusive head trauma (AHT) can be caused by direct blows to the head, dropping or throwing a child, or shaking a child. Head trauma is the leading cause of death in child abuse cases in the United States. Because the anatomy of infants puts them at particular risk for injury from this kind of action, the majority of victims are infants younger than 1 year old.

Abusive head trauma (AHT) peaks during early infancy and decreases in toddler years. Infants and toddlers experience different injuries, possibly impacting the risk of mortality.

The average age of victims is between 3 and 8 months. However, the highest rate of cases occur among infants just 6 to 8 weeks old, which is when babies tend to cry the most.

How These Injuries Happen

Abusive head trauma results from injuries caused by someone (most often a parent or other caregiver) vigorously shaking a child or striking the child's head against a surface. In many cases, the caregiver cannot get the baby to stop crying and, out of frustration or anger, will shake the baby. Unfortunately, the shaking may have the desired effect: Although at first the baby cries more, he or she may stop crying as the brain is damaged.

Children with special needs, multiple siblings, or conditions like colic or GERD have an increased risk of AHT. Boys are more likely to be victims of AHT than girls, and children of families who live at or below the poverty level are at an increased risk for these injuries and other types of child abuse.

The perpetrators in about 70% of cases are males — usually either the baby's father or the mother's boyfriend, often someone in his early twenties. But anyone has the potential to shake a baby if he or she isn't able to handle stressful situations well, has poor impulse control, or has a tendency toward aggressive behavior. Substance abuse often plays a role in AHT.

When someone forcefully shakes a baby, the child's head rotates uncontrollably. This is because infants' neck muscles aren't well developed and provide little support for their heads. This violent movement pitches the infant's brain back and forth within the skull, sometimes rupturing blood vessels and nerves throughout the brain and tearing the brain tissue. The brain may strike the inside of the skull, causing bruising and bleeding to the brain.

The damage can be even greater when a shaking episode ends with an impact (hitting a wall or a crib mattress, for example), because the forces of acceleration and deceleration associated with an impact are so strong. After the shaking, swelling in the brain can cause enormous pressure within the skull, compressing blood vessels and increasing overall injury to the brain's delicate structure.

Normal interaction with a child, like bouncing the baby on a knee or tossing the baby up in the air, will not cause these injuries. But it's important to never shake a baby under any circumstances.

What Are the Effects? AHT often causes irreversible damage, and about 1 out of every 4 cases results in the child's death.

Children who survive may have:

partial or total blindness hearing loss seizures developmental delays impaired intellect speech and learning difficulties problems with memory and attention severe mental retardation cerebral palsy Even in milder cases, in which babies look normal immediately after the shaking, they may eventually develop one or more of these problems. Sometimes the first sign of a problem isn't noticed until the child enters the school system and exhibits behavioral problems or learning difficulties. But by that time, it's more difficult to link these problems to a shaking incident from several years before.

Signs and Symptoms In any abusive head trauma case, the duration and force of the shaking, the number of episodes, and whether impact is involved all affect the severity of the child's injuries. In the most violent cases, children may arrive at the emergency room unconscious, suffering seizures, or in shock. But in many cases, infants may never be brought to medical attention if they don't exhibit such severe symptoms.

In less severe cases, a child who has been shaken may experience:

lethargy irritability vomiting poor sucking or swallowing decreased appetite lack of smiling or vocalizing rigidity seizures difficulty breathing blue color due to lack of oxygen altered consciousness unequal pupil size an inability to lift the head an inability to focus the eyes or track movement

Diagnosis Many cases of AHT are brought in for medical care as “silent injuries.” In other words, parents or caregivers don't often provide a history that the child has had abusive head trauma or a shaking injury, so doctors don't know to look for subtle or physical signs. This can sometimes result in children having injuries that aren't identified in the medical system.

In many cases, babies who don't have severe symptoms may never be brought to a doctor. Many of the less severe symptoms such as vomiting or irritability may resolve and can have many non-abuse-related causes.

Unfortunately, unless a doctor has reason to suspect child abuse, mild cases (in which the infant seems lethargic, fussy, or perhaps isn't feeding well) are often misdiagnosed as a viral illness or colic. Without a suspicion of child abuse and any resulting intervention with the parents or caregivers, these children may be shaken again, worsening any brain injury or damage.

If shaken baby syndrome is suspected, doctors may look for:

hemorrhages in the retinas of the eyes skull fractures swelling of the brain subdural hematomas (blood collections pressing on the surface of the brain) rib and long bone (bones in the arms and legs) fractures bruises around the head, neck, or chest The Child's Development and Education What makes AHT so devastating is that it often involves a total brain injury. For example, a child whose vision is severely impaired won't be able to learn through observation, which decreases the child's overall ability to learn.

The development of language, vision, balance, and motor coordination, all of which occur to varying degrees after birth, are particularly likely to be affected in any child who has AHT. Such impairment can require intensive physical and occupational therapy to help the child acquire skills that would have developed normally had the brain injury not occurred.

Before age 3, a child can receive free speech or physical therapy through state-run early intervention programs. Federal law requires that each state provide these services for children who have developmental disabilities as a result of being abused. After a child turns 3, it's the school district's responsibility to provide any needed additional special educational services.

As kids get older, they may require special education and continued therapy to help with language development and daily living skills,



There is a considerable risk of mortality associated with age at diagnosis in children with AHT.Children <2 and those 2-4 year olds present with different types of injuries. The high risk of mortality in the 2-4 years old is unique to AHT. Efforts should be made to increase awareness about the risk of mortality and identify factors that can aide in a timely accurate diagnosis 1).

Nuño M, Ugiliweneza B, Bardini RL, Ozturk A, Stephenson JT, Magaña JN. Age-Related Mortality in Abusive Head Trauma. J Trauma Acute Care Surg. 2019 Mar 8. doi: 10.1097/TA.0000000000002255. [Epub ahead of print] PubMed PMID: 30865156.
shaken_baby_syndrome.txt · Last modified: 2019/03/14 13:22 by administrador