Shaken baby syndrome is a potentially fatal form of child abuse. It occurs when a baby is forcefully shaken leading to damage within the child’s skull. The syndrome rose to prominence during the trial of a au pair who was found guilty of shaking a baby to death. 75% of babies who suffer brain injuries from shaking will die or suffer permanent disability.

What is it?

It occurs when an infant is forcefully shaken, usually by the shoulders, causing the child’s head to flop back and forth. It is not an injury that occurs from casually playing with a child.

A baby’s head is large and heavy. It makes up about 25% of the infant’s total body weight. Its neck muscles are too weak to support such a disproportionately large head. The force of the head movement can tear blood vessels that bridge the brain and skull, because these are fragile and immature.

What happens when a baby is shaken?

When shaking occurs, the brain bounces within the skull cavity, bruising the brain tissue.

The brain swells, creating pressure and leading to bleeding at the back of the eye. This can cause blindness. Some blood vessels that feed the brain are torn, which leads to additional brain damage or abnormalities.

Blood collects inside the skull, creating more pressure. Immediate effects include seizures, lethargy, vomiting, and irritability, or in extreme cases, coma or even death.

Infants can also sustain eye injuries, such as detached retinas or retinal bleeding, from the violent shaking. Long-term effects include learning disabilities, physical disabilities, seizures and, in extreme cases, death.

Who is responsible for shaken baby syndrome?

The injuries are usually caused by parents or carers who have become frustrated by their inability to stop a baby who is crying constantly.

Adults who were victims of abuse themselves and have low frustration levels may be more likely to shake a baby to hush its crying. Typical victims of this abuse are infants with colic who will not stop crying.

Almost 80% of the perpetrators of the syndrome are male and more than 60% of the victims are male.

Shaken baby syndrome has been referred to as a hidden form of child abuse because doctors evaluating the baby often do not see outward signs of injury on the head or old fractures or burns that are common to abused children.

What are the signs that a baby has been shaken?

The most common complaints presented to a doctor in shaken baby cases are:

• Lethargy;

• Seizures;

• Decreased muscle tone;

• Reduced appetite;

• Breathing problems;

• Vomiting;

• Irritability;

• A large head at four months.

Doctors should also look out for bruises to the shoulder and neck, bruises in children who have not yet started to crawl, bone injuries and signs that the body’s vital systems are failing, such as the onset of hypothermia

How can it be avoided?

Stress management is the key. Parents and carers must control their frustration and seek help if appropriate.

“If nothing works, put the baby on his or her back in bed, close the door and turn up the TV or radio. Check on the baby every 10-15 minutes.”

It also advises checking a constantly crying baby for signs of illness and asking a friend or relative to take over caring for a while if the pressure becomes too much

The combination of a crying baby and a frustrated parent or caregiver CAN BE DEADLY.

Why do babies CRY?

Crying is the only way babies have to tell us that they need something. They might need to eat, to have their diaper changed or to be held. The baby could be too hot or too cold or in pain. Sometimes babies cry because they need to release some tension of their own. Crying is normal. The amount of time a baby spends crying varies with age, health and temperament.

Why do parents and caregivers become FRUSTRATED and ANGRY?

Crying is an annoying sound. It is supposed to be. If it was a pleasant sound, crying would be easy to ignore and the baby’s needs would never be met. Unfortunately, parents and caregivers are not always able to stop the crying. When a baby cries a lot and is not easily consoled, the parent or caregiver may start to doubt their own abilities to care for the baby. Lack of sleep and other life stresses can increase the feelings of helplessness and frustration. Sometimes parents or caregivers believe that a crying baby is misbehaving on purpose.

What can a parent or caregiver do?

Stay calm. A frustrated or angry parent or caregiver will have a hard time getting a baby to settle down. If feeding, changing, walking, rocking and cuddling have not worked, the baby should be gently placed in a safe place and allowed to “cry it out” for a few minutes. The parent or caregiver can use the time to relax and calm down before making another attempt to console the baby.

NEVER SHAKE A BABY!

Shaking a baby in a moment of frustration can cause serious harm or death. When an infant is shaken, the head jerks back and forth rapidly causing the brain to slam repeatedly against the inside of the skull. Blood vessels in and around the brain are damaged and begin to bleed into the brain and into the space between the brain and the skull. The bleeding and swelling of the brain causes pressure to build up inside the child’s head. The resulting damage can cause permanent disability or even death. Because babies have weak neck muscles and heavy heads, even a few seconds of forceful shaking can cause serious damage to babies and small children.  Children under one year of age, especially baby boys, are most at risk. Older children can also be hurt if they are shaken hard.