Baby / Shaken Impact Syndrome
a young au pair from Great Britain was charged in 1997 in
the death of Matthew Eappen, an 8-month-old Massachusetts
boy in her care, the case received phenomenal media coverage
both in the United States and abroad. Lawyers for the prosecution
and the defense waged a charged battle throughout the trial,
trying to assign the blame for the baby's death. But when
it was all over, the only thing that was clear was that Matthew's
case had become one of the most publicized cases of shaken
baby/shaken impact syndrome (SBS).
a form of inflicted head trauma. Head injury, as a form of
child abuse, can be caused by direct blows to the head, dropping
or throwing the child, or shaking the child. Head trauma is
the leading cause of death in child abuse cases in the United
other forms of inflicted head trauma, SBS results from injuries
caused by someone vigorously shaking an infant. Because of
the anatomy of infants, they're at particular risk for injury
from this kind of action. Therefore, the vast majority of
incidents occur in infants who are younger than 1 year old.
The average age of victims is between 3 and 8 months, although
SBS is occasionally seen in children up to 4 years old.
in SBS cases are almost always parents or caregivers, who
shake the baby out of frustration or stress when the little
one is crying inconsolably. Sadly, the shaking has the desired
effect: although at first the baby cries more out of fear,
it eventually stops crying as the brain is damaged.
60% of shaken babies are male, and children of families who
live at or below the poverty level are at an increased risk
for SBS as well as any type of child abuse. And it's estimated
that the perpetrators in 65% to 90% of cases are males - usually
either the baby's father or the mother's boyfriend, often
someone in his early 20s.
Does It Happen?
someone forcefully shakes a baby, the child's head rotates
about uncontrollably because infants' neck muscles aren't
well developed and provide little support for their heads.
The violent movement pitches the infant's brain back and forth
within the skull, rupturing blood vessels and nerves throughout
the brain and tearing the brain tissue. The brain strikes
the inside of the skull, causing bruising and bleeding to
is even greater when the shaking 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 its delicate structure.
interaction with a child, like bouncing the baby on a knee,
will not cause SBS, although it's important to never shake
a baby under any circumstances because gentle shaking can
Are the Effects?
causes irreversible damage. In the worst cases, the death
rate is almost half of all babies involved.
who survive may have:
or total blindness
and learning difficulties
with memory and attention
(some particularly traumatic episodes leave children in
in milder cases, in which babies looks 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.
Are the Signs and Symptoms?
SBS case, the duration and force of the shaking, the number
of episodes, and whether impact is involved all affect the
severity of the infant'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 cases, a baby who has been shaken may experience:
sucking or swallowing
of smiling or vocalizing
inability to lift the head
inability to focus the eyes or track movement
Is It Diagnosed?
cases of SBS 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 "silent epidemic"
can 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.
unless a doctor has reason to suspect SBS, 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 diagnosis of shaken baby syndrome and any
resulting intervention with the parents or caregivers, these
children may be shaken again, worsening any brain injury or
baby syndrome is suspected, doctors may look for:
in the retinas of the eyes (which are extremely rare in
any accidental injuries, such as falls)
of the brain
hematomas (blood collections pressing on the surface of
and long bone (bones in the arms and legs) fractures
around the head, neck, or chest
The Child's Development and Education
makes SBS so devastating is that it usually involves a total
brain injury. Because the infant's immature brain has little
stored information and few developed capacities to make up
for the deficit, the brain's adaptive abilities are substantially
impaired. 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.
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 SBS.
impairment can require rigorous physical and occupational
therapy to help the child acquire skills that would have developed
on their own had the brain injury not occurred. Therapists
do this by providing a sensory-rich environment, which forces
the child to be attentive.
often work one on one with a child, concentrating on building
the child's ability to pay attention. They use sound and other
stimuli to increase the child's interest in objects, such
as repeatedly squeaking a toy near the child's ear. As they
get older, kids who were shaken as babies may require special
education and continued therapy to help with language development
and daily living skills, such as dressing themselves.
age 3, a child can receive speech or physical therapy through
the Department of Public Health. Federal law requires that
each state provide these services for children who have developmental
disabilities as a result of being shaken as babies.
schools are also increasingly providing information and developmental
assessments for children under the age of 3. Parents can turn
to a variety of rehabilitation and other therapists for early
intervention services for children after abusive head trauma.
Developmental assessments can assist in improving education
outcomes as well as the overall well being of the child.
a child who's been diagnosed with SBS turns 3, it's your school
district's responsibility to provide additional special educational
SBS Be Prevented?
It is 100% preventable.
aspect of prevention of the syndrome is increasing awareness
of the potential dangers of shaking. Some hospital-based programs
have helped new parents identify and prevent shaking injuries
and understand how to respond when infants cry.
ways to alleviate the parent or caregiver's stress at the
critical moments when a baby is crying can significantly reduce
the risk to the child. One method that may help is author
Dr. Harvey Karp's "five S's":
(using "white noise," or rhythmic sounds that
mimic the constant whir of noise in the womb, with things
like vacuum cleaners, hair dryers, clothes dryers, a running
tub, or a white noise CD)
positioning (placing the baby on the left side - to help
digestion - or on the belly while holding him or her, then
putting the sleeping baby in the crib or bassinet on his
or her back)
(letting the baby breast feed or bottle-feed, or giving
the baby a pacifier or finger to suck on)
(wrapping the baby up snugly in a blanket to help him or
her feel more secure)
gently (rocking in a chair, using an infant swing, or taking
a car ride to help duplicate the constant motion the baby
felt in the womb)
baby in your care won't stop crying, you an also try the following:
sure the baby's basic needs are met (for example, he or
she isn't hungry and doesn't need to be changed).
for signs of illness, like fever or swollen gums.
or walk with the baby.
or talk to the baby.
the baby a pacifier or a noisy toy.
the baby for a ride in a stroller or strapped into a child
safety seat in the car.
the baby close against your body and breathe calmly and
a friend or relative for support or to take care of the
baby while you take a break.
nothing else works, put the baby on his or her back in the
crib, close the door, and check on the baby in 10 minutes.
your child's doctor if nothing seems to be helping your
infant, in case there is a medical reason for the fussiness.
potential SBS, parents and caregivers of infants need help
with responding to their own stress. It's important to talk
to anyone caring for your baby about the dangers of shaking
and how it can be prevented.
Courtesy of: KidsHealth.org
Updated and reviewed by:
Vincent J. Palusci, MD, MS
Date reviewed: August 2004
Originally reviewed by:
Steven Dowshen, MD, and Jane Crowley, PsyD
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