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Putting an End to
Shaken Baby Syndrome

Shaken Baby Syndrome

The National Foundation for Abused and Neglected Children (NFANC®) seeks to prevent Shaken Baby Syndrome (SBS), otherwise known as abusive head trauma, from occurring in infants in the United States. Based in Chicago, Illinois, we aim to spread awareness about SBS and help put a stop to this often deadly condition.

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 on the head. Signs and symptoms range on a spectrum of neurological alterations from minor (irritability, lethargy, tremors, and vomiting) to major (seizures, coma, stupor, and death). These neurological changes are due to the 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.)

Baby Being Fed

Approximately 20% of cases are fatal in the first few days after injury and the survivors suffer from handicaps ranging from mild — learning disorders and 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 SBS 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. 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."

Why does it happen?

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).

How serious is the problem in the US?

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 SBS known by the teams, the average age of the victim and perpetrator, the gender of the perpetrator and victim, and the relationship of the victim to the perpetrator. Additionally, the team was asked about survivors. Teams from 30 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. For more information on this study or to obtain a copy for $7.00, write to NFANC at PO Box 1841, Chicago, IL, 60690.

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 Caregivers
  • 3% or 9 of the Cases Were Stepparents
  • 1% or 4 of the Cases Were Grandparents or Others

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

Who can I talk to in my community about SBS?

Local hospitals, health departments, and your physician can supply information on SBS. Check to see if there is a child abuse prevention center in your area. Many of these locations have materials available for parents on tips to prevent SBS.

If you are interested in helping share the message, check to see if opportunities exist in your area. Education of parents, day-care providers, youth groups, and church groups are needed in almost all communities. Again, check with the above agencies to see if you can assist them.

You can also get information and ideas from the National Information, Support and Referral Service on SBS by emailing capcente@ix.netcom.com, calling (888) 273-007, faxing (801) 393-7019, or writing to the Child Abuse Prevention Center at 2955 Harrison Boulevard, #102, Ogden, Utah 84403.

Stressed Woman

The Shaken Baby Alliance is a network of parents who are willing to discuss their frustrations and circumstances, and offer advice and support to parents and family members of SBS survivors or victims. There are several ways to contact them, including by email at 0003903@Aainnail.net or by mail at PO Box 150734, Fort Worth, Texas 76108.

How can health care and law enforcement workers identify SBS?

The triad of subdural hematoma, cerebral edema, and retinal hemorrhage represents a diagnosis of SBS, but all three 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 who are shaken have been known to child protective services agencies; therefore 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 healthcare workers should be interrogating in suspected SBS cases. Healthcare and law enforcement workers need to plan together how best to explore potential SBS cases.

How can SBS be prevented?

It is important to note that SBS is preventable. Shaking occurs frequently when a frustrated caregiver 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 and deal with colic and 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 knows 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 are available from the Child Abuse Prevention Center's National Information, Support and Referral Service on SBS. It can be obtained by calling (888) 273-0071 or by emailing at capcente@ix.netcom.com.

What is the key information I need to get across?

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 caregiver is often frustrated and loses control. When an infant won't quit crying, there are steps to take to cope with crying. 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 of your parenting skills and doesn't make you a bad parent.