Shaken baby syndrome (SBS) is a type of abusive head trauma that results from a baby or small child being vigorously shaken with or without impact. The rapid acceleration and deceleration of shaking produces the characteristic injuries that include bleeding around the brain, retinal damage, and cervical spine injuries. Less frequently, the child may sustain concomitant skull, rib, or other fractures as well as soft tissue damage from the abuse. SBS is widely considered to be the most serious form of child abuse, and the consequences are often catastrophic. Research shows that nearly 25% of victims die as a direct result of their injuries, and a majority of survivors suffer long-term cognitive, motor, and/or visual disabilities.
Behavioral problems and learning disabilities are also highly prevalent among survivors of SBS.
The large majority of victims of SBS are less than 6 months old at the time of diagnosis, an age which is also the period of an infant’s life associated with the most frequent crying episodes. Infant distress may exacerbate parental frustration and indeed crying is frequently cited as the precipitating cause for this kind of abuse. As a result of their small size, infants are also more vulnerable to shaking than older children.
Victims of SBS are often brought to the emergency room exhibiting symptoms associated with head trauma such as fussiness, lethargy, or seizures, but often there are no visible signs of abuse such as bruises, burns, or lacerations. Consistent with other forms of child abuse, the nature and severity of the child’s injuries are frequently discrepant with the alleged origin of the trauma. In many cases, clinical examination of the injured children and inquiries into their medical histories yield evidence of chronic abuse including prior hospitalizations for related injuries and previous complaints registered with child welfare agencies against their parents or caretakers. Due to the high improbability that the classic SBS injuries could result by accident, clinicians should consider SBS as a possible diagnosis for all young children presenting with these symptoms. As mandated by the American Academy of Pediatrics, all suspicious cases should be referred to the appropriate professionals for evaluation to prevent further victimization.
Several risk factors have been identified among perpetrators of SBS. Histories of substance abuse, mental illness, domestic violence, and childhood physical abuse are more prevalent among perpetrators of SBS than in the general population. Perpetrators are more likely to be male, have limited education, and be of a lower socioeconomic status. Female perpetrators are more likely to suffer from postpartum depression and be younger than their nonabusing counterparts. Of note, research has shown that the reporting of suspected cases of child abuse is inconsistent; thus, the elevated rate of certain demographic characteristics among substantiated perpetrators may be due in part to differential reporting by medical professionals.
Clearly, every effort should be made to ensure that victims of SBS are not returned to volatile environments. Of particular importance is that cases of potential child abuse be identified and reported immediately. Health professionals should make every effort to recognize and attend to early signs of abuse to decrease the chance of the child being subjected to further debilitating and potentially fatal violence. Identification and early intervention for people at risk for perpetration, such as those with histories of violence and substance abuse, may help to avert future episodes of shaking. In addition, prevention of SBS may be accomplished to some degree by educating all new parents about the crying patterns of infants and the frustration that inconsolable crying can evoke in caretakers. Moreover, parents should be informed that it is never, under any circumstance, acceptable to shake a baby or child. One study found that providing this type of information to parents before they take their newborn home from the hospital may dramatically reduce the incidence of SBS. Furthermore, home visits by nurses have also been found to decrease the rates of SBS among at-risk families with infants.
- Makaroff, K. L., & Putnam, F. W. (2003). Outcomes of infants and children with inflicted traumatic brain injury. Developmental Medicine & Child Neurology, 45, 497–502.
- Wheeler, P. L. (2003). Shaken baby syndrome—An introduction to the literature. Child Abuse Review, 12, 401–415.
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