WHAT IS SHAKEN BABY SYNDROME?

Shaken Baby Syndrome is a term used to describe the constellation of signs and symptoms resulting from violent shaking or shaking and impacting of the head of an infant or small child. The degree of brain damage depends on the amount and duration of the shaking and the forces involved in impact of the head. Signs and symptoms range on a spectrum of neurological alterations from minor (irritability, lethargy, tremors, vomiting) to major (seizures, coma, stupor, death). These neurological changes are due to destruction of brain cells secondary to trauma, lack of oxygen to the brain cells, and swelling of the brain. Extensive retinal hemorrhages in one or both eyes are found in the vast majority of these cases. The classic triad of subdural hematoma, brain swelling and retinal hemorrhages are accompanied in some, but not all, cases by bruising of the part of the body used as a "handle" for shaking. Fractures of the long bones and/or of the ribs may also be seen in some cases. In many cases, however, there is no external evidence of trauma either to the head or the body. (Definition provided by Robert Reece, MD. Dr. Reece is a clinical professor of Pediatrics at the Tufts University School of Medicine and director of the Institute for Professional Education at the Massachusetts Society for the Prevention of Cruelty to Children)

Approximately 20% of cases are fatal in the first few days after injury and the survivors suffer from handicaps ranging from mild - learning disorders, behavioral changes - to moderate and severe, such as profound mental and developmental retardation, paralysis, blindness, inability to eat or a permanent vegetative state.

In a response provided by Dr. John Lancon, he defined Shaken Baby Syndrome as "the constellation of non-accidental intracranial and ocular hemorrhages occurring in infants and young children. Other injuries, including cutaneous bruises, lacerations, burns, parenchymal brain injuries, rib fractures, extremity fractures, and injuries to various internal organs may be seen in the setting of Shaken Baby Syndrome, but are not required for diagnosis. Some experts have suggested changing the name of the syndrome to Shaken Impact Syndrome to emphasize the importance of cranial impact in the genesis of the severe brain injury seen in some victims of Shaken Baby Syndrome."

• This form of serious child abuse usually happens because caregivers become enraged and lose control.
• Caregivers may be inadequately prepared for parenting, or may be under such stress that they cannot deal with the frustrations of parenting.
• Babies have proportionately larger heads and weaker neck muscles than older children and adults; they have intrinsically different propensities for brain injuries due to their young age (J. Kaplan, March 19, 1997).

The Child Abuse Prevention Center's National Information, Support and Referral service on SBS conducted a survey of the Child Fatality Review Teams in the United States in 1998. The survey questioned the number of deaths attributed to Shaken Baby Syndrome known by the teams, the average age of the victim and perpetrator, the gender of perpetrator and victim and the relationship of the victim to the perpetrator. Additionally, the team was asked about survivors. Teams from thirty states and three U.S. territories responded to the questionnaire.

From this study, 337 deaths were reported and 186 survivors were identified bringing the total number of cases for the reporting period inclusive of 1994 to March 1998 to 523.

In 247 of the cases, the relationship of the perpetrator to the victim was identified.

• 62% or 152 of the cases were parents
• 20% or 47 of the cases were live-in boyfriends
• 14% or 35 of the cases were non-relative care givers
• 3% or 9 of the cases were stepparents
• 1% or 4 of the cases were grandparents/other

In 292 of the cases the gender of the victim was known and reported.

• 57% or 167 were male
• 43% or 125 were female
• Average age was 8.9 months

In 266 of the cases reported, the gender of the perpetrator was known.

• 70% or 187 were male
• 30% or 79 were female
• Average age was 24

For more information on this study or to obtain a copy for ($7) contact the National Foundation for Abused and Neglected Children at P.O. Box 1841, Chicago, Illinois 60690-1841.

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