• The triad of subdural hematoma, cerebral edema and retinal hemorrhage represents a diagnosis of SBS but all 3 may not be present.
• An SBS case may have no external signs of injury like bruising or broken bones.
• Finger marks may be found on the chest wall or around the shoulders; posterior rib fractures may be present as well (Kairys & Kaplin, 1997).
• Often children that are shaken have been known to Child Protective Services Agencies, other injuries may precede shaking incidents (Kairys & Kaplan, 1997).
• Guilty caregivers may weave a trivial story of a fall or other minor mishap into their account of what happened to try to cover their tracks (Kairys & Kaplan, 1997).
• There is a need to have caregivers and others involved commit to their story early; controversy may exist about whether or not health care workers should be interrogating in suspected SBS cases; health care and law enforcement workers need to plan together how best to explore potential SBS cases.

It is important to note that SBS is preventable. Shaking occurs frequently when a frustrated care giver loses control with an inconsolable crying baby. It is important to realize just saying, "don't shake a baby" is not enough. A plan of action or suggestions to deal with the situation need to be offered. The Child Abuse Prevention Center has a list of Ways to Cope with a Crying Baby, Dealing with Colic and many other informative and supportive materials. Parents and other care providers need assurance that allowing a baby to cry is okay if all their needs have been met. The care provider should address their stress level and try stress management.

Parents should share the message of the dangers of shaking with all who care for their infant or child, including spouses, their own parents, siblings, day care providers and others. Parents need to let those caring for the infant or child know that it is okay to call for help when needed.

A baby's crying is not a reflection on how good a parent or care provider is. Babies cry as a way of communicating their needs.

The Shaken Baby Syndrome Programs and Resources for the United States directory is available from the Child Abuse Prevention Center's National Information, Support and Referral Service on SBS. It can be obtained by calling 1-888-273-0071 or by E-mail at capcente@ix.netcom.com.

• Shaking a child or infant is dangerous. Infants have heads that are large compared to their bodies. Shaking an infant or child can cause serious injury, even death.
• Crying is often the trigger for the shaking. The care giver is often frustrated and loses control.
• When an infant won't quit crying there are steps to take cope with crying handout.
• Most important, it is okay to let an infant cry if you have tried numerous things to quiet the baby. Check on them every 15 minutes or so. If concerned, contact your health care provider.
• Remember a crying baby is not a reflection on your parenting skills and doesn't make you a bad parent.

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