The shaken baby syndrome is a kind of brain injury that happens due to violently shaking an infant. Babies cry very frequently, and at times, this continuous crying might get on a caretaker’s nerves. They might end up shaking the baby vigorously out of frustration. Since babies have soft brains and sensitive neck muscles, vigorous shaking might damage their brains. If not treated at the earliest, it might cause permanent brain damage and increase the chances of mortality. Read on to know more about shaken baby syndrome and ways to deal with it.
What Is Shaken Baby Syndrome?
Shaken baby syndrome (SBS) is a condition where the infant suffers an inflicted head trauma due to violent shaking by a caretaker (parent, babysitter, etc.) (1). It is when someone holds the infant by the arms or shoulders and rattles the baby, making the head bob, or move forward and backward rapidly. The violent jerk of the head resembles the “whiplash effect” and causes injury to the brain. The brain trauma is a direct result of the voluntary aggression of the caretaker. Therefore, the shaken baby syndrome is categorized as a form of child abuse and is thus also called abusive head trauma (2). SBS is always preventable. It is abuse and should never happen.
Are All Infants At Risk Of Shaken Baby Syndrome?
Yes. Infants of any age group can suffer from the shaken baby syndrome, but the one most susceptible are those below the age of one year, especially those below the age of six months. There are some risk factors where these cases occur more often:
Infant factors
Perinatal illness like prematurity or major birth defects Incessant crying is a common trigger, so “colicky” babies are higher risk
Family risk factors
Familial dysfunction like drug or alcohol abuse or a psychiatric illness in young mothers Family disruption and separation Prior history of abuse in the family Economic factors can also play a role
What Causes The Shaken Baby Syndrome?
The violent shaking of the baby and the underlying biomechanics are the primary cause of SBS. Below, we explain why SBS is caused upon shaking the baby (3):
Babies have a softer brain tissue and the skull bones are not fused yet. The muscles of the neck are also not strong enough to absorb any sudden jerking movement of the head. It means babies are susceptible to brain injury from even a low-intensity, sudden movement of the head.
When the baby is shaken, the brain bounces inside the skull, hitting the inner wall of the skull. The part of the brain that bears the impact can get bruised and inflamed.
Blood vessels outside the brain may rupture due to impact and bleed within the skull.
Bleeding, along with injury, may even cause permanent damage to the brain. Functions controlled by the part of the damaged brain are most likely to be affected.
Babies can have SBS when they are shaken even while lying in the crib or when the head is rested on a soft material like a mattress. A few seconds of shaking can also cause head trauma in babies.
What Does Not Cause Shaken Baby Syndrome?
The following activities, incidents, or scenarios do not lead to shaken baby syndrome:
Rocking or swaying the baby in your arms gently. Bouncing the baby in your arms or on your legs. Tossing the baby in the air. Jogging, running, or walking quickly with your baby in your arms. Accidental falls when the baby walks or a fall from furniture of low height. Driving the baby in a car, on a bumpy road. Vaccinating your baby.
Tossing your baby in the air and running around with the baby in the arms is undoubtedly dangerous. Though they may not cause shaken baby syndrome, you must still avoid them. Head trauma due to vaccination is impossible, and medical experts state that it is only a myth (4).
What Are The Symptoms Of The Shaken Baby Syndrome?
The baby may not display any apparent symptoms that can be related to a head injury. Most symptoms occur spontaneously. Here are the external signs of a shaken baby syndrome (5):
An abrupt change in eating patterns. The baby will not feed or eat at the usual times. May also display loss of appetite.
Droopy eyes. It is often the result of injury to the eyeball due to violent movement in the eye socket (intraocular injury). Extreme cases may even cause loss of vision.
Changes in speech. Sudden onset of stuttering while talking.
Change in behavior; development of irritability, fussiness, and acute colic.
Could display lethargy and low energy levels.
May cry and touch the head several times due to pain. Older toddlers may even point to the head to indicate pain in their area.
Diminished hearing abilities and loss of hearing in severe cases.
Also look for signs of trauma to the rest of the body – bruises/bleeds.
When to rush to the doctor?
At any point if abuse is suspected by any caregiver, then the baby should be seen by the medical care provider and they need to be informed of the suspicion. Even in the presence of minimal signs or symptoms – if any abuse is suspected then it must be reported. It can be reported to the doctor, a social worker or the police. The following symptoms of head trauma occur due to a severely violent shaking of the baby:
Seizures and convulsions Bleeding from nose or the eye socket, also called retinal hemorrhage Chronic vomiting Semi-consciousness or repeated loss of consciousness Stops eating entirely Bluish or pale skin especially around the face and the head Shows swelling on the fontanelle (soft spot on top of the head) Displays developmental delay or regresses, which is losing the existing skills
The long-term effects or prognosis of the shaken baby syndrome include physical and cognitive disabilities. Other problems include impaired brain functions, sensory functions, and even neurological disorders like cerebral palsy. It is difficult to diagnose abusive head trauma only through the symptoms accurately.
How Is Shaken Baby Syndrome Diagnosed?
Mild symptoms of change in feeding patterns or behavioral change are not immediately attributable to the shaken baby syndrome. Other symptoms like fussiness and lethargy may go away on their own. More severe indicators such as inflammation, seizures, and bleeding may make the doctor suspect SBS. The doctor will rely on X-rays, computed tomography scan (CT scan) or magnetic resonance imaging (MRI) to detect a fracture and damage to the brain tissue. The doctor will also examine and X-ray other body parts to rule out other injuries.
Is Shaken Baby Syndrome Treatable?
Treatment entirely depends on the extent of the brain damage. In several cases, the damage is reversed due to the brain’s ability to regenerate damaged nerve cells. Even in such cases, the baby’s abilities and skills could be impacted. The following course of treatment can help improve the baby’s condition (6): Therapy is a long-term effort, the duration of which the baby’s doctor will determine depending on the extent of damage caused by SBS. Nearly 80% of babies who suffer abusive head trauma suffer disabilities for the rest of their lives. About 25% of cases result in the death of the infant either immediately or a while after the incident (7). Therefore, you need to prevent SBS. Find out more about it next.
How To Prevent Shaken Baby Syndrome?
To prevent shaken baby syndrome, you have to avoid shaking the baby. And the only way to do it is to control your emotions and be careful with whom you leave the baby. Here is what you can do (8): SBS is always preventable with some extra patience. It is true that babies are difficult to handle and being a parent is perhaps the toughest role in life. But your shaking and rattling will not help. If you feel overwhelmed then get help – one desperate moment of lost control can be life altering. All parents get frustrated, tired and emotionally drained with a new baby. Ask for help if you need it.
Subdural hematoma (collection of blood between the surface of the brain and the outer membrane surrounding it) Subarachnoid hemorrhage (bleeding between the arachnoid and the brain) Retinal hemorrhage Breakage of the nerve cells in the brain Fractures to other body parts
