Shaken baby syndrome, abusive head trauma

Overview  

Shaken baby syndrome, also known as abusive head trauma, shaken impact syndrome, inflicted head injury, or whiplash shaken infant syndrome, is a severe brain injury that occurs when an infant or toddler is forcefully shaken. The condition can lead to swelling, bruising, and bleeding around the brain and may also affect the child’s eyes, neck, and spine. 

Due to their disproportionately large and heavy heads, infants are especially vulnerable. When shaken, their brain moves back and forth within the skull, potentially causing bleeding in the brain or behind the eyes. 

This condition is entirely preventable and often results from a caregiver’s frustration or anger over a child’s crying. Education about the dangers of shaking a baby and available support for at–risk parents can help prevent these tragic incidents, which can cause brain damage, permanent disabilities, or even death from as little as five seconds of shaking.  

Symptoms  

Shaken baby syndrome can manifest signs and symptoms immediately after a child is shaken, typically peaking within four to six hours. Symptoms include: 

• Difficulty breathing. 
• Bruising on the arms or chest. 
• A bulging soft spot on the top of the head. 
• Coma. 
• Extreme irritability or fussiness. 
• Lethargy or an inability to stay awake. 
• Pale or bluish skin discoloration. 
• Paralysis. 
• Poor appetite or feeding difficulties. 
• Dilated or widened pupils. 
• Seizures. 
• Vomiting. 

Sometimes, visible facial bruises may be apparent, but more severe internal injuries like cerebral hemorrhage, spinal cord damage, and fractures to the ribs, skull, legs, and other bones might not be immediately visible. Signs of previous abuse are often present. In less severe cases, a child might initially seem fine but later develop behavioral or physical problems. 

If you suspect your child has been severely shaken, it’s crucial to seek immediate medical help or go to the nearest emergency room. Prompt medical attention can be life–saving and help prevent severe complications. Healthcare providers are legally required to report suspected cases of child abuse. 

Causes  

Shaken baby syndrome typically arises when a parent or caregiver forcefully shakes a baby or toddler out of frustration or anger, often triggered by the child’s continuous crying. Babies have underdeveloped neck muscles and cannot support their head weight, leading to their delicate brain moving back and forth within the skull, which can result in bruising, swelling, and bleeding. This condition is generally not caused by gentler actions like bouncing a child on your knee or minor falls.

Risk factors  

The following factors might make it more likely for parents or other caregivers to shake a newborn violently, which can result in shaken infant syndrome:  

• Baby expectations that are unrealistic.  
• Single or young parenthood.  
• Stress or depression.  
• Domestic violence or history of maltreatment as a child.   
• Alcohol or substance abuse  
• Unhappy family condition. 

Shaken baby syndrome is also more common in men than in women.