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Vigorous shaking might damage babies’ brains due to their soft brains and sensitive neck muscles.

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Even though we’d rather not think about it, shaken baby syndrome is a real danger and knowing about it isn’t just about being aware; it’s about understanding how serious it is, recognising the signs, and knowing what to do if you or someone else might be at risk of harming a baby out of frustration.

Being informed can help prevent this tragic outcome and keep babies safe.

What is Shaken Baby Syndrome

Shaken Baby Syndrome (SBS) is a severe form of abusive head trauma inflicted on infants and young children. It occurs when a baby is forcefully shaken, causing the brain to move back and forth within the skull. This violent shaking can result in serious brain injury, including bleeding, swelling, and even death.

Babies are highly vulnerable to violent shaking because their brains are softer and have more water content than adults. Shaking a baby can cause brain damage by making the brain hit the skull, leading to cell death and decreased oxygen supply. Even brief shaking can result in brain bleeding, bruising, and swelling, causing serious and irreversible harm.

Shaken baby syndrome occurs when a baby is forcefully shaken, causing their head to jerk back and forth rapidly. This violent motion can lead to severe brain injury or even death. 

According to the American Academy of Paediatrics, it’s important to note that everyday activities like rocking, bouncing, or swinging your baby gently do not cause this syndrome. Shaken baby syndrome is a form of child abuse and is more formally referred to as pediatric abusive head trauma (AHT).

According to the National Center on Shaken Baby Syndrome, each year in the U.S., there are an estimated 600 to 1,400 cases of shaken baby syndrome, making it the leading cause of child abuse fatalities in children under 5 years old in the country. 

Moreover, because babies have underdeveloped neck muscles and relatively large heavy heads, shaking can cause their delicate brains to bounce back and forth within the skull. This can result in bruising, swelling, and bleeding, potentially leading to permanent and severe brain damage or even death.

Causes of Shaken Baby Syndrome

Shaken baby syndrome is typically caused by violent shaking, hitting, or purposeful dropping of a baby or young child. This action can cause the child’s brain to shake within the skull, tearing blood vessels, nerves, and tissues, resulting in swelling, bruising, and bleeding in the brain.

While shaken baby syndrome can affect children of all ages, it typically occurs before they turn 1 year old. On average, infants with shaken baby syndrome are between 3 and 8 months old.

Children’s soft brains, weak ligaments, underdeveloped neck muscles, and large, heavy heads make them particularly susceptible to these injuries. 

Shaken baby syndrome often occurs when overwhelmed caregivers, unable to manage a baby’s persistent crying, lose control and act out of frustration or anger. Though often unintentional, such actions still constitute a form of child abuse.  

Another frequent cause of shaken baby syndrome is when the baby experiences a hard blow on the head.

Shaken baby syndrome doesn’t happen from gentle bouncing, playful swinging, tossing the child in the air, or jogging with them. It’s also highly unlikely to occur from accidents like falling off chairs or stairs or being accidentally dropped by a caregiver. Minor head injuries from shortfalls may occur but are different from shaken baby syndrome.

Risk Factors of Shaken Baby Syndrome

According to the CDC, several factors can heighten the risk of a person carrying out an action that causes harm to a baby.  These include: 

  • Holding unrealistic hopes regarding parenting.

  • Having unrealistic anticipations about child growth.

  • Enduring abuse or neglect during childhood.

  • Being subjected to domestic violence or witnessing it.

  • Single-parent families or young parents without support

    Other potential risk factors include:

  • Depression 

  • Alcohol or substance abuse 

  • Unstable family situations

  • A baby who cries excessively due to a health issue such as colic or gastroesophageal reflux disease (GERD).

Signs of Shaken Baby Syndrome

It’s hard to spot the signs of shaken baby syndrome because they might appear immediately or much later. Plus, many cases of shaken baby syndrome aren’t often reported.

Signs of shaken baby syndrome can differ based on how serious the injury is and may include: 

  • Drowsiness

  • Irritability 

  • Trouble sucking or swallowing

  • Body tremors

  • Difficulty breathing 

  • Vomiting

  • Pale or blue-coloured skin

  • Lack of appetite 

  • Seizures

  • Paralysis

  • Dilated pupils

  • Subdural haemorrhages

  • Retinal haemorrhages, bleeding in the retina

  • Permanent brain damage 

  • Lack of body control

Long-Term Effects of Shaken Baby Syndrome

In approximately 80% of cases, shaken baby syndrome results in long-term disabilities. It induces a traumatic brain injury, known as a closed-brain injury. While mild symptoms may resolve with time and medical attention, others can persist, impacting various aspects of life.

Around 25% of cases lead to the infant’s death, either shortly after the incident or sometime later.

The long-term effects of shaken baby syndrome include:

Thinking Problems

  • Confusion

  • Difficulty maintaining focus

  • Memory issues

  • Impaired judgement

  • Challenges grasping abstract concepts

  • Difficulty following multi-step directions

Movement Problems

  • Cerebral palsy 

  • Muscle weakness

  • Stiffness (spasticity)

  • Poor balance and coordination

  • Tremors

Sensory Problems

  • Difficulty speaking or understanding speech

  • Reading and writing difficulties

  • Slow speech

  • Difficulty identifying objects and their functions

Physical Symptoms

  • Fatigue

  • Dizziness

  • Headaches

  • Loss of bowel or bladder control

According to research, in some cases, traumatic brain injuries can result in epilepsy, which may not appear until years later.

How to Prevent Shaken Baby Syndrome

To prevent shaken baby syndrome (SBS), parents and caregivers must recognise the risks associated with shaking a baby. Understanding the triggers and risk factors for abuse is also essential.

SBS often arises when caregivers react to persistent and inconsolable crying. If a parent or caregiver struggles to soothe a crying baby, they may consider implementing the following strategies:

  • Gently rock your baby in your arms.

  • Swaddle your little one snugly in a cosy blanket.

  • Offer your baby a soothing pacifier.

  • Hold your baby close to your warm skin.

  • Sing or speak softly to comfort your little one.

  • Take your baby for a stroll in the neighbourhood.

  • Enjoy a calming car ride with your baby.

If you feel overwhelmed by a crying baby, you might need to concentrate on calming yourself by taking the following steps:

  • Place your baby in their crib with the sides up, close the door, and step away for a moment.

  • Enjoy relaxing activities like taking a bath or showering, watching TV, or listening to music.

  • Sit down, close your eyes, and take deep breaths to calm yourself.

  • Reach out to a friend or family member for a chat.

Ask someone to come over and provide you with some time to rest.

If you’ve attempted different methods to soothe your baby and they won’t stop crying, consider the following steps:

  • Look for signs of illness or discomfort, such as diaper rash, teething, or tight clothing.

  • Contact your doctor if you suspect your child is injured or unwell.

  • Determine if your baby is hungry or needs to be burped.

Remember, it’s okay if you can’t always calm your baby’s cries—it’s neither your fault nor your baby’s fault. It’s perfectly normal for healthy babies to cry a lot, especially in their first 4 months of life. This period of increased crying is often called the period of PURPLE crying , as defined by the National Center for Shaken Baby Syndrome (NCSBS).

Let’s break down PURPLE:

  • Peak pattern: Crying peaks around 2 months of age and then gradually decreases.

  • Unpredictable: Your baby’s crying may come and go without any apparent reason.

  • Resistant to soothing: Sometimes, your baby may continue crying for extended periods, no matter what you try.

  • Pain-like look on face: Your baby’s crying may sometimes look like they’re in pain, even if they’re not.

  • Long bouts of crying: Your baby may cry for hours.

  • Evening crying: It’s common for babies to cry more in the late afternoon and evening.

While purple crying can be very challenging and stressful for parents, it is a normal developmental phase for many infants and typically resolves on its own. It is not usually a cause for concern. However, If you have any concerns about your baby’s crying or your ability to cope with it, talk to your pediatrician for guidance and support.

Treatment for Shaken Baby Syndrome

When diagnosing shaken baby syndrome (SBS), a doctor starts by gathering the baby’s medical history and examining their symptoms. A physical examination may follow this to identify any signs of injury.

The doctor may use brain imaging scans, such as MRI or CT scans, to further assess the extent of the damage.

If SBS is confirmed, immediate treatment is crucial. This often involves providing emergency care, including respiratory support, to maintain the baby’s vital functions.

In severe cases, surgery may be necessary to address any bleeding in the brain or internal bleeding. Treatment aims to stabilise the baby’s condition and prevent further harm while also addressing any complications resulting from the syndrome.

Key Facts

  • The softness and higher water content of babies’ brains make them more vulnerable to harm from violent shaking.

  • Overwhelmed caregivers, unable to manage a baby’s persistent crying, may lose control and act out of frustration or anger, leading to shaken baby syndrome.

  • Signs of shaken baby syndrome vary in severity and may include drowsiness, trouble sucking or swallowing, body tremors, difficulty breathing, vomiting, pale or blue-colored skin, and lack of appetite.

  • Around 25% of cases of shaken baby syndrome result in the death of the infant, either immediately after the incident or later.

  • Understanding the characteristics of the Period of PURPLE Crying can help you feel more confident and less stressed when dealing with your baby’s crying.

  • In severe cases of SBS, surgery may be required to address bleeding in the brain or internal bleeding, aiming to stabilise the baby’s condition and prevent further harm.

Frequently Asked Questions

Sometimes, there are no visible signs of injury, making it hard for caregivers and healthcare providers to realise a baby has been shaken. Internal injuries might not appear immediately, so symptoms could be mistaken for a viral infection.

Determining the exact incidence of shaken baby syndrome (SBS) is challenging because reliable data collection methods are lacking. The National Center on Shaken Baby Syndrome estimates that there are between 600 to 1,400 cases of SBS each year in the United States.

Despite the uncertainty in the precise numbers, this form of abusive head trauma remains the leading cause of both death and long-term disability among infants and young children who are victims of child abuse.

The force needed to cause shaken baby syndrome is significant, making it highly improbable to occur accidentally. Everyday activities like gently bouncing your baby on your knee or taking them for a jog in a stroller do not generate the force necessary to cause this syndrome.

Symptoms of shaken baby syndrome may appear immediately after shaking the baby and usually peak within 4-6 hours afterwards.

Shaken baby syndrome primarily impacts infants under 1 year old, especially those aged between 2 and 8 months. While it’s rare in children over 2, cases have been reported in children as old as 6.

Frequently Asked Questions

Sometimes, there are no visible signs of injury, making it hard for caregivers and healthcare providers to realise a baby has been shaken. Internal injuries might not appear immediately, so symptoms could be mistaken for a viral infection.

Determining the exact incidence of shaken baby syndrome (SBS) is challenging because reliable data collection methods are lacking. The National Center on Shaken Baby Syndrome estimates that there are between 600 to 1,400 cases of SBS each year in the United States.

Despite the uncertainty in the precise numbers, this form of abusive head trauma remains the leading cause of both death and long-term disability among infants and young children who are victims of child abuse.

The force needed to cause shaken baby syndrome is significant, making it highly improbable to occur accidentally. Everyday activities like gently bouncing your baby on your knee or taking them for a jog in a stroller do not generate the force necessary to cause this syndrome.

Symptoms of shaken baby syndrome may appear immediately after shaking the baby and usually peak within 4-6 hours afterwards.

Shaken baby syndrome primarily impacts infants under 1 year old, especially those aged between 2 and 8 months. While it’s rare in children over 2, cases have been reported in children as old as 6.

1. American Association of Neurological Surgeons: Shaken Baby Syndrome

2. Center for Disease Control And Prevention: Abusive Head Trauma

3. Center for Disease Control And Prevention: A Journalist Guide to Shaken Baby Syndrome: A preventable Tragedy

4. Cleveland Clinic: Shaken Baby Syndrome

5. KidsHealth: Abusive Head Trauma (Shaken Baby Syndrome)

6. Medline: Shaken Baby Syndrome

7. National Center on Shaken Baby Syndrome

8. National Center on Shaken Baby Syndrome.

9. National Institute of Health: Paediatric Abusive Head Trauma

10. National Institute of Health: Shaken Baby Syndrome

11. New York State Department of Health: Shaken Baby Syndrome

12. The Pan African Medical Journal: Parental awareness, knowledge, and attitude about shaken baby syndrome in Riyadh, Saudi Arabia: a cross-sectional study

13. Long-term outcome of the shaken baby syndrome and medicolegal consequences: a case report. Annals of Physical and Rehabilitation Medicine, 52(5), pp.436-447.

14. WebMD: Shaken Baby Syndrome

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