Shaken baby syndrome

Overview

Shaken baby syndrome is a serious brain injury resulting from forcefully shaking an infant or toddler. It's also known as abusive head trauma, shaken impact syndrome, inflicted head injury or whiplash shaken infant syndrome.

Shaken baby syndrome destroys a child's brain cells and prevents his or her brain from getting enough oxygen. This form of child abuse can cause permanent brain damage or death.

Shaken baby syndrome is preventable. Help is available for parents who are at risk of harming a child. Parents also can educate other caregivers about the dangers of shaken baby syndrome.

Symptoms

Shaken baby syndrome symptoms and signs include:

• Extreme fussiness or irritability
• Difficulty staying awake
• Breathing problems
• Poor eating
• Vomiting
• Pale or bluish skin
• Seizures
• Paralysis
• Coma

While sometimes there's bruising on the face, you may not see signs of physical injury to the child's outer body. Injuries that might not be immediately seen include bleeding in the brain and eyes, spinal cord damage, and fractures of the ribs, skull, legs and other bones. Many children with shaken baby syndrome show signs and symptoms of prior child abuse.

In mild cases of shaken baby syndrome, a child may appear normal after being shaken, but over time they may develop health or behavioral problems.

When to see a doctor

Seek immediate help if you suspect your child has been injured by violent shaking. Call 911 or emergency medical help, or take your child to the nearest emergency room. Getting medical care right away may save your child's life or prevent serious health problems.

Health care professionals are legally required to report all suspected cases of child abuse to state authorities.

Causes

Babies have weak neck muscles and can't support the weight of their heads. If a baby is forcefully shaken, their fragile brain moves back and forth inside the skull. This causes bruising, swelling and bleeding.

Shaken baby syndrome usually occurs when a parent or caregiver severely shakes a baby or toddler due to frustration or anger — often because the child won't stop crying.

Shaken baby syndrome isn't usually caused by bouncing a child on your knee or minor falls.

Risk factors

The following things may increase the risk that parents or caregivers are more likely to forcefully shake a baby and cause shaken baby syndrome:

• Unrealistic expectations of babies
• Young or single parenthood
• Stress
• Domestic violence
• Alcohol or substance abuse
• Unstable family situations
• Depression
• A history of mistreatment as a child

Also, men are more likely to cause shaken baby syndrome than are women.

Complications

Even brief shaking of an infant can cause irreversible brain damage. Many children affected by shaken baby syndrome die.

Survivors of shaken baby syndrome may require lifelong medical care for conditions such as:

• Partial or total blindness
• Developmental delays, learning problems or behavior issues
• Intellectual disability
• Seizure disorders
• Cerebral palsy, a disorder that affects movement and muscle coordination

Prevention

New parent education classes can help parents better understand the dangers of violent shaking and may provide tips to soothe a crying baby and manage stress.

When your crying baby can't be calmed, you may be tempted to try anything to get the tears to stop — but it's important to always treat your child gently. Nothing justifies shaking a child.

If you're having trouble managing your emotions or the stress of parenthood, seek help. Your child's doctor may offer a referral to a counselor or other mental health provider.

If other people help take care of your child — whether a hired caregiver, sibling or grandparent — make sure they know the dangers of shaken baby syndrome.

Diagnosis

A child who's been forcefully shaken will need to be examined by many different medical specialists, as well as an expert in child abuse.

The doctor will examine the child and ask questions about the child's medical history. Various tests may be needed to detect injuries, including:

• Skeletal survey. Several X-rays of the bones — possibly including the arms, hands, legs, feet, spine, ribs and skull — may be used to determine whether fractures are accidental or purposeful. Such testing can also help find previous fractures.
• Eye exam. An eye exam can reveal bleeding in the eye and other eye injuries.
• Blood tests. Some metabolic and genetic disorders, as well as bleeding and clotting disorders, can cause symptoms similar to shaken baby syndrome. Blood tests can help rule out some of these conditions.
• Magnetic resonance imaging (MRI). MRI uses a powerful magnetic field and radio waves to create detailed images of a child's brain and spine. It can show brain bruising, bleeding and signs of decreased oxygen. Because an MRI is difficult to perform on a child who's unstable, it's usually done two to three days after the injury.
• Computerized tomography (CT) scan. A CT scan uses X-ray images to provide cross-sectional images of the body. A CT scan of the brain can help detect injuries that need urgent treatment. A CT scan of the abdomen may also be done to determine if there are additional injuries.

Depending on the extent of the injuries, the baby may need to be monitored in a pediatric intensive care unit.

Treatment

Emergency treatment for a child who has been shaken may include breathing support and surgery to stop bleeding in the brain. Some children may require medications to reduce brain swelling and prevent seizures.