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    Shaken Baby Syndrome (SBS): Symptoms, Causes And Diagnosis

    Shaken baby syndrome (SBS) is also termed as abusive head trauma (AHT). Shaken baby syndrome is an injury caused to the baby's head by external forces. The brain injury is caused by violently or forcefully shaking an infant. Shaken baby syndrome is also known by terms such as shaken impact syndrome, and whiplash shake syndrome. The syndrome is viewed as a form of child abuse, resulting in severe damage to the child's brain [1] .

    The condition causes the brain cells' destruction, thereby preventing the brain from getting the required amount of oxygen. Shaken baby syndrome can cause permanent brain damage or even in some cases, death. The condition [2]  can develop from shaking a baby for even as less as five seconds, stressing on the importance of carefully handling an infant.

    shaken baby

    Infants and toddlers have weak neck muscles, soft brain and delicate blood vessels. When an infant is repeatedly and violently shaken, it will cause their brain to hit the inside of the skull. In case of the movement continuing for a period longer than five seconds, it will cause bruising, bleeding and swelling in the brain [3] . The aggressive shaking can also cause damage to the baby's eyes, neck and spine.

    Shaken baby syndrome is more common in children aged under 2, but is not limited to that. The condition can also develop till the age of 5 [4] . It is commonly viewed in infants that are between 6 to 8 weeks old. In the United States, shaken baby syndrome is the leading cause of infant deaths. And in most cases, the victims of the shaken baby syndrome are 1 year old or younger [5] .

    However, playfully tossing your baby in the air or balancing them on your legs will not lead to shaken baby syndrome. But, it is critical that the adults take extreme care while handling an infant [6] .

    Symptoms Of Shaken Baby Syndrome

    An infant will not be able to use words to express what they might be going through. If you notice any of the following symptoms, make sure that you immediately take the infant to the nearest hospital. The symptoms are [7]

    • discoloured skin,
    • difficulty staying awake,
    • irritability and fussiness,
    • paralysis,
    • unequal pupil size,
    • trouble breathing,
    • poor eating,
    • vomiting,
    • seizures,
    • an unusual larger size of the forehead or a bulging soft spot, 
    • an inability to lift the head,
    • body tremors, and 
    • coma.

    If a child is suffering from Shaken baby syndrome, it is not necessary that you will find any external physical injuries. In some cases, you may notice bruises on the face. The internal injuries such as spinal cord damage, bleeding in the eyes and brain, and fractures of the skull, legs, ribs and other bones will not be immediately understood or even visible externally [8] .

    Causes Of Shaken Baby Syndrome

    The condition usually develops when the parent or the caregiver shakes the child out of frustration or anger. This mostly happens when the child cries for a longer period of time and the adult may get frustrated and shakes the baby as a means to get the baby to stop crying[9] .

    Shaken baby syndrome is mostly viewed in children who have been victims of child abuse. Infants from families with unstable and violent setting [10]  tend to be attacked by the adults, who are often unaware of the extents the abuse could lead to.

    The condition does not develop from a minor fall or even from rough play. A child has to be mishandled severely for the internal injuries to develop [11] . In many cases, the inattentiveness of the caregivers has caused the child to develop the syndrome. They also shake the babies as a trick to get them to stop crying, but this causes severe internal damages in the infant's brain.

    As the head and the neck muscles of infants are not fully developed, the muscles are not able to give proper support. With the baby's head rotating uncontrollably due to the violent movements, the lack of support results in severe internal issues [12] .

    Risks Of Shaken Baby Syndrome

    An infant is at the risk of developing the condition due to various reasons. The central reason for shaken baby syndrome is irresponsible adults. The following reasons act as contributing factors. They are [13]

    • young or single parenthood,
    • depression,
    • young or single parenthood,
    • unrealistic expectations of babies,
    • domestic violence,
    • unstable family situations,
    • stress,
    • alcohol or substance abuse, and
    • a history of mistreatment as a child [14] .

    Complications Of Shaken Baby Syndrome

    The condition is irreversible. That is, once the damage is caused to the infant's brain it can lead to various complications in the near future, restricting a healthy future to the child. In most cases reported of shaken baby syndrome, the infants experience complications such as [15]

    • hearing loss,
    • permanent vision loss (partial or total),
    • intellectual disabilities,
    • development delays [16] ,
    • seizure disorders, and 
    • cerebral palsy (a disorder that affects muscle coordination and speech).

    Diagnosis Of Shaken Baby Syndrome

    A child with the condition will be examined by different medical specialists, including an expert in child abuse. If the child is able to speak, the doctor may treat them without the adult present, so as to understand if the injury is forcibly caused [17] .

    The doctor will examine the child and will ask the adult about the child's medical history. In order to detect the injuries, the medical practitioner will carry out the following tests.

    1. Eye exam

    An ophthalmic exam will help the doctor to understand if there is any injury or bleeding in the eyes.

    2. Skeletal survey

    Under this one, the doctor will take x-rays of the bones in the arms, legs, hands, feet, ribs, spine and skull. The x-ray reports will be used to understand whether the fractures are accidental or induced. This will also help in examining if there are any previous injuries.

    3. Blood tests

    The bleeding and clotting caused by shaken baby syndrome pose similarities with the symptoms of certain genetic and metabolic disorders. Carrying out the blood tests will help the doctor rule out the possibilities of any disorders.

    4. Computerized tomography (CT) scan

    A CT scan will make use of the x-ray images, which will develop the cross-sectional images of the infant's body. By carrying out a CT scan, the doctor will be able to detect any severe injuries. A CT scan of the abdomen will also be done, to determine if there are any injuries.

    5. Magnetic resonance imaging (MRI)

    The MRI scans will use radio waves and magnetic fields to develop detailed images of the infant's brain. An MRI scan will help the doctor understand if there are any bruising or bleeding in the brain, also signs of decreased levels of oxygen [18] .

    Treatments For Shaken Baby Syndrome

    1. Surgery

    As there is no medication to treat shaken baby syndrome, surgery is the only option in severe cases. The surgery will involve placing a shunt, or a thin tube to remove the pressure and to drain the excess amount of fluid and blood. In some cases, eye surgery will be required [19] .

    2. Cardiopulmonary resuscitation (CPR)

    The other method advised is a CPR, which is required when the baby suddenly stops breathing in the event of shaking. A CPR is performed while waiting for the medical team to arrive or before reaching the hospital as an attempt to retrieve the baby's breathing. One can learn to do CPR by learning basic first aid tips [20] .

    Prevention

    Yes, the condition can be prevented. By providing proper guidance and related measures, the shaken baby syndrome can be prevented [21] .

    • Be invested in finding measures to relieve your stress, as it is not to be taken out on a crying infant.
    • Be aware of the fact that an infant will cry, which is nothing but normal behaviour.
    • Enrol in programs that teach how to respond effectively when an infant begins to cry, as well as how to manage the stress associated with parenting.
    • Advocate the people around you about the severity of shaking a baby [22] .
    • Before hiring a care provider, make sure that you do multiple background checks and test his/her knowledge in the aspect of proper childcare.
    • Learn the five S's approach (shushing, stomach positioning, sucking, swaddling and swinging gently) [23] .

    So, instead of losing your temper when the baby cries, check and see if the baby is hungry, if there are any signs of illness, offer a pacifier, sing or talk to the baby, or lightly pat the baby's back. You can also

    • rock and walk with the baby,
    • take the baby for a car ride or a stroller ride,
    • hold the baby close to your body while breathing slowly and calmly,
    • call a friend or relative to take over for some time, or
    • give the baby a bath in warm water.
    View Article References
    1. [1] Duhaime, A. C., Christian, C. W., Rorke, L. B., & Zimmerman, R. A. (1998). Nonaccidental head injury in infants—the “shaken-baby syndrome”.New England Journal of Medicine,338(25), 1822-1829.
    2. [2] Duhaime, A. C., Gennarelli, T. A., Thibault, L. E., Bruce, D. A., Margulies, S. S., & Wiser, R. (1987). The shaken baby syndrome: a clinical, pathological, and biomechanical study.Journal of Neurosurgery,66(3), 409-415.
    3. [3] Ludwig, S., & Warman, M. (1984). Shaken baby syndrome: a review of 20 cases.Annals of Emergency Medicine,13(2), 104-107.
    4. [4] King, W. J., MacKay, M., & Sirnick, A. (2003). Shaken baby syndrome in Canada: clinical characteristics and outcomes of hospital cases.Canadian Medical Association Journal,168(2), 155-159.
    5. [5] Committee on Child Abuse and Neglect. (2001). Shaken baby syndrome: rotational cranial injuries—technical report.Pediatrics,108(1), 206-210.
    6. [6] Blumenthal, I. (2002). Shaken baby syndrome.Postgraduate Medical Journal,78(926), 732-735.
    7. [7] Bonnier, C., Nassogne, M. C., Saint-Martin, C., Mesples, B., Kadhim, H., & Sébire, G. (2003). Neuroimaging of intraparenchymal lesions predicts outcome in shaken baby syndrome.Pediatrics,112(4), 808-814.
    8. [8] Carbaugh, S. F. (2004). Understanding shaken baby syndrome.Advances in Neonatal Care,4(2), 105-117.
    9. [9] Kivlin, J. D., Simons, K. B., Lazoritz, S., & Ruttum, M. S. (2000). Shaken baby syndrome1.Ophthalmology,107(7), 1246-1254.
    10. [10] Hansen, K. K. (1998). Folk remedies and child abuse: a review with emphasis on caida de mollera and its relationship to shaken baby syndrome.Child Abuse & Neglect,22(2), 117-127.
    11. [11] Becker, J. C., Liersch, R., Tautz, C., Schlueter, B., & Andler, W. (1998). Shaken baby syndrome: report on four pairs of twins.Child Abuse and Neglect,22, 931-938.
    12. [12] Kivlin, J. D. (2001). Manifestations of the shaken baby syndrome.Current Opinion in Ophthalmology,12(3), 158-163.
    13. [13] Cobley, C., & Sanders, T. (2003). ‘Shaken Baby Syndrome’: child protection issues when children sustain a subdural haemorrhage.Journal of Social Welfare and Family Law,25(2), 101-119.
    14. [14] Hennes, H., Kini, N., & Palusci, V. J. (2001). Chapter Three: The Epidemiology, Clinical Characteristics and Public Health Implications of Shaken Baby Syndrome.Journal of Aggression, Maltreatment & Trauma,5(1), 19-40.
    15. [15] Wilkinson, W. S., Han, D. P., Rappley, M. D., & Owings, C. L. (1989). Retinal hemorrhage predicts neurologic injury in the shaken baby syndrome.Archives of Ophthalmology,107(10), 1472-1474.
    16. [16] Betz, P., Püschel, K., Miltner, E., Lignitz, E., & Eisenmenger, W. (1996). Morphometrical analysis of retinal hemorrhages in the shaken baby syndrome.Forensic Science International,78(1), 71-80.
    17. [17] Donohoe, M. (2003). Evidence-based medicine and shaken baby syndrome: part I: literature review, 1966–1998.The American Journal of Forensic Medicine and Pathology,24(3), 239-242.
    18. [18] Biousse, V., Suh, D. Y., Newman, N. J., Davis, P. C., Mapstone, T., & Lambert, S. R. (2002). Diffusion-weighted magnetic resonance imaging in shaken baby syndrome.American Journal of Ophthalmology,133(2), 249-255.
    19. [19] Cho, D. Y., Wang, Y. C., & Chi, C. S. (1995). Decompressive craniotomy for acute shaken/impact baby syndrome.Pediatric Neurosurgery,23(4), 192-198.
    20. [20] Feldman, K. W., & Brewer, D. K. (1984). Child abuse, cardiopulmonary resuscitation, and rib fractures.Pediatrics,73(3), 339-342.
    21. [21] Goulet, C., Frappier, J. Y., Fortin, S., Déziel, L., Lampron, A., & Boulanger, M. (2009). Development and evaluation of a shaken baby syndrome prevention program.Journal of Obstetric, Gynecologic, & Neonatal Nursing,38(1), 7-21.
    22. [22] Wyszynski, M. E. (1999). Shaken baby syndrome: identification, intervention, and prevention.Clinical Excellence for Nurse Practitioners: The International Journal of NPACE,3(5), 262-267.
    23. [23] Dubinsky, D. (2018, December). Harvey Karp's "Happiest Baby" method for baby sleep and soothing [Blog post]. Babycenter. Retrieved from https://www.babycenter.com/0_harvey-karps-happiest-baby-method-for-baby-sleep-and-soothin_10373838.bc

    Story first published: Wednesday, February 6, 2019, 17:46 [IST]
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