By Susan Palmer, Ph.D.
What Is Shaken Baby Syndrome (SBS)? Shaken baby syndrome (or SBS) is caused by vigorous shaking of an infant or young child by the arms, legs, chest or shoulders. Forceful shaking can result in brain damage leading to intellectual or developmental disabilities, speech and learning disabilities, paralysis, seizures, hearing loss and even death. It may cause bleeding around the brain and eyes, resulting in blindness. A baby’s head and neck are especially vulnerable to injury because the head is so large and the neck muscles are still weak. In addition, What Is The Arc’s Position? the baby’s brain and blood vessels are very fragile and easily damaged by whiplash mo- tions, such as shaking, jerking and jolting. Shaken baby syndrome has been identified The nation must continue to investigate the causes, by other names such as abusive head trauma, shaken brain trauma, pediatric traumatic reduce the incidence, and brain injury, whiplash shaken infant syndrome and shaken impact syndrome. limit the consequences of intellectual and/or developmental disabilities How Is SBS Diagnosed? through education, research, advocacy, technical Shaken baby syndrome is difficult to diagnose, unless someone accurately de- assistance and support. Read scribes what happens. Physicians often report that a child with possible shaken baby the entire Position Statement syndrome is brought for medical attention due to falls, difficulty breathing, seizures, at www.thearc.org. vomiting, altered consciousness or choking. The caregiver may report that the child was shaken to try to resuscitate it. Babies with severe or lethal shaken baby syndrome are typically brought to the hospital unconscious with a closed head injury. Find Out More: National Center on Shaken To diagnose shaken baby syndrome, physicians look for retinal hemorrhages (bleed- Baby Syndrome, 1-888-273- ing in the retina of the eyes), subdural hematoma (blood in the brain) and increased 0071, www.dontshake.org. head size indicating excessive accumulation of fluid in the tissues of the brain. Damage to the spinal cord and broken ribs from grasping the baby too hard are other signs of shaken baby syndrome. Computed tomography (CT) and magnetic resonance imag- ing (MRI) scans can assist in showing injuries in the brain, but are not regularly used because of their expense. A milder form of this syndrome can also be observed and may be missed or misdiag- The Arc 1825 K Street NW nosed. Subtle symptoms which may be the result of shaken baby syndrome are often Suite 1200 attributed to mild viral illnesses, feeding dysfunction or infant colic. These include a Washington, D. C. 20006 history of poor feeding, vomiting or flu-like symptoms with no accompanying fever Phone: 202.534.3700 Toll free: 800.433.5255 or diarrhea, lethargy and irritability over a period of time. Often the visit to the medi- Fax: 202.534.3731 cal facility does not occur immediately after the initial injury. Without early medical www.thearc.org intervention, the child may be at risk early 20s who are the baby’s father or and language therapy, therapy, physi- for further damage or even death, the mother’s boyfriend are typically cal therapy, occupational therapy and depending on the continued occur- the shaker. Females who injure babies special education services. Some may rences of shaking. by shaking them are more likely to need the assistance of feeding experts be baby-sitters or child care providers and behavioral consultants (Showers, How Many Children Are than mothers (Showers, 1997). Frus- 1997). Affected by SBS? tration from a baby’s incessant crying The true incidence is not known, and toileting problems have been How Is the Problem Be- but estimates range from an annual described as events leading to severe ing Addressed? figure as low as 600 cases per year in shaking. The adult shaker also may Dr. John Caffey who first described the United States to as high as 1400. be jealous of the attention which the shaken baby syndrome in 1972 What is known is that Shaken Baby child receives from his or her partner. called for a massive public education Syndrome is the most common cause program to describe the dangers of of mortality and accounts for the What Happens to a Child shaking infants. Experts’ views vary most long-term disability in infants Who Has Been Severely on the effectiveness of education. and young children due to physical Shaken? Some experts believe that shaking is abuse (Reece & Kirschner, 1998). One There are high mortality rates primarily the result of anger felt by shaken baby in four dies as a result of (chance of dying from the injury) an adult, combined with a loss of this abuse (Poissaint & Linn, 1997). among infant victims, ranging from impulse control, and that the perpe- Head trauma is the most frequent 15% to 38%, with a median of 20% to trator is aware of the potential harm cause of permanent damage or death 25% (American Academy of Pediatrics, to the child. They say that shaken among abused infants and children, 2001). Immediate medical attention baby syndrome requires a great deal and shaking accounts for a significant can help reduce the impact of shak- of force by the shaker, such that the number of those cases (Showers, ing, but many children are left with ordinary person would recognize the 1992). Some studies estimate that 15 permanent damage from the shaking. action as harmful to a child (Showers, percent of children’s deaths are due to Approximately 25% of shaken babies 1997). Other experts believe lack of battering or shaking and an additional die from their injuries (Torpy, Lynm & knowledge about the dangers of shak- 15 percent are possible cases of shak- Glass, 2003). Of those who survive, ing is a contributing factor and that ing (Showers, 1997). The victims of 80% acquire various permanent dis- most people don’t intend to harm or shaken baby syndrome range in age abilities, including intellectual disabili- kill children by shaking them. Thus, from a few days to five years but most ties and/or developmental disabilities, they believe physicians, social work- often involve children younger than vision loss, hearing impairments, ers, educators, attorneys, families and 2 years of age (American Academy of seizure disorders, cerebral palsy, suck- others should collaborate to educate Pediatrics, 2001). ing and swallowing disorders, autism, the public about preventing shaken impaired cognitive and/or motor skills, baby syndrome. In addition to public Who Is Responsible for behavior problems and permanent education, other proposed strategies Shaking Babies? vegetative state (National Center on to reduce the problem include iden- While shaken baby abuse is not Shaken Baby Syndrome, 2011). The tifying families at high risk for abuse limited to any special group of people, treatment of survivors falls into three and providing supports to reduce males tend to predominate as perpe- major categories: medical, behavioral stress and funding and monitoring trators in 65 to 90 percent of cases. In and educational. In addition to medi- high quality child care, so that parents the United States, adult males in their cal care, children may need speech leave children with safe caregivers.
For more information on this and other topics, visit www.thearc.org How Can People Be Edu- Child Abuse Hotline (1-800-422-4453 References: or 1-800-4-ACHILD). For more infor- American Academy of Pediatrics: Commit- cated about the Dangers tee on Child Abuse and Neglect. (July 2001). of Shaking Babies? mation about Shaken Baby Syndrome, Shaken Baby Syndrome: Rotational cranial Parents should receive informa- contact the National Center on Shaken injuries – Technical report. Pediatrics, 108 (1) Baby Syndrome toll free at 1-888-273- 206-210. tion about shaken baby syndrome National Center on Shaken Baby Syndrome, prevention in the hospital and/or at 0071 or visit their web site at www. retrieved online February 2011: www.dont- their child’s two-month immunization dontshake.org. shake.org. Torpy, J., Lynm, C. & Glass, R. (2003). Inflict- appointment. Pediatricians and nurses ed brain injury in children. JAMA, 290, p. 698. should talk to parents about their level Message to Caregivers: Poissaint, A. & Linn, S. (1997). Fragile: of stress and how they respond to a Prevent Shaken Baby Handle with Care. Newsweek, Special Edition, Syndrome Spring/Summer, 33. crying infant who cannot be readily Phillips, Mary Beth. (1996, November). Ten calmed. They can discuss adequate Don’t shake a baby! Do not handle things parents of children with SBS want you care for infants and how the family is a baby if you are angry. Shaking can to know. Information presented at the National cause brain damage, vision loss and Conference on Shaken Baby Syndrome, Salt adjusting to the new family member. Lake City, UT. Guidance can be given to let parents other injuries. If you are afraid you Reece, R. & Kirschner, R. (1998). Shaken Baby know that a crying infant should might hurt your child, follow these Syndrome/Shaken Impact Syndrome. National three simple steps: Information, Support and Referral Service on never be shaken and what to do when Shaken Baby Syndrome. SBS Quarterly, Summer their frustration is overwhelming. Any 1.STOP 1998. The National Center on Shaken Baby professional or experienced caregiver - Place the baby in a safe place such Syndrome. as a playpen or a crib. Showers, J. (1992). “Don’t Shake the Baby”: who interacts with parents of new- The effectiveness of a prevention program. borns and young children can assist in Child Abuse & Neglect, 16, 11-18. this effort. 2.CALM DOWN Showers, J. (1997). Executive Summary: The - Sit down or walk out of the room- National Conference on Shaken Baby Syn- Child caregivers, teenage baby drome. Alexandria, VA: National Association of sitters and respite workers should -but not too far away that you can’t Children’s Hospitals and Related Institutions. be warned by parents and others of hear the child. When a baby cries: What should you know, - Listen to music for a short time. Call what can you do. Online: http://www.yccanc. the dangers of shaking a child. Day org/What_you_should_know.htm. Kennebunk, care centers should train staff and a friend or relative for support and ME: York County Child Abuse and Neglect display shaken baby information in advice. Council. - Run the vacuum cleaner to drown their facilities to inform both workers Resource: and parents. All child care providers out crying noise. This noise also calms The Shaken Baby Syndrome: A multidisciplinary should be screened by the parent to some babies. approach (2002) published by The Haworth - Remember that crying may indicate Maltreatment & Trauma Press. Order on line at determine the potential caregiver’s the American Academy of Pediatrics web site at ability to understand infant behav- hunger, pain or illness, discomfort, www.aap.org or call 1-847-434-4000. ior and how he or she might handle teething, earache or other problems. stressful situations, such as incessant If you can’t calm the baby the cry- crying. Social service agencies, state ing continues for a long time, call the and national agencies and hospitals doctor. The Arc thanks Susan Palmer, Ph.D., need to educate the public as well. University of Kansas and former staff Some agencies can assist parents or 3.TRY AGAIN member of The Arc. caregivers who may have a strong or - When you have calmed down, re- recurrent impulse to shake their chil- sume trying to help the baby. Last rev. 8/2009 dren, such as CHILDHELP’s National
For more information on this and other topics, visit www.thearc.org