Shaken Baby Syndrome

Child abuse remains a horrific public health and social problem in the U.S. In 1999, approximately 3 million children were reported to state and local child protective services agencies for suspected child abuse and neglect. Nearly 100 U.S. children die each month as a result of abuse or neglect, and thousands suffer physical and mental consequences, sometimes for the rest of their lives.

Child abuse includes physical abuse, sexual abuse, emotional abuse, and child neglect. The leading cause of death from physical abuse in the U.S. is Shaken Baby Syndrome (SBS). Some studies indicate that approximately 15 percent of children's deaths from abuse are due to battering or shaking, and an additional 15 percent are possible cases of shaking. SBS is a particularly devastating form of abuse. The victims of SBS range in age from a few days to five years, with an average age of 6-8 months. SBS results from injuries caused by vigorous shaking of an infant or young child by the arms, legs, chest, or shoulders, with resulting injuries roughly comparable to falling from a third story window. In some cases, the shaking is followed by a final impact to the baby's head against a bed, chair, wall, or other hard surface.

Although SBS is not limited to one specific group of people, males tend to be the perpetrators in 65-90 percent of the cases. In the U.S., adult males in their early 20s who are the baby's father or the mother's boyfriend generally are at higher risk for shaking babies. Females who injure babies are more likely to be childcare providers or babysitters than mothers.

Why is shaking a baby so dangerous? A baby's muscles are very underdeveloped; they give little or no support for the head. When someone shakes a baby, the head moves back and forth, and the violent movement jars the baby's brain against the skull. This movement tears blood vessels and nerves in the brain, causing the brain to swell. Pressure in the skull then squeezes the blood vessels, leading to more injury. The consequences of SBS are devastating. Shaking a baby can cause one or more of the following: mental retardation, autism, speech and learning disabilities, behavioral problems, cerebral palsy, paralysis, seizures, hearing loss, blindness, permanent vegetative state, and even death.

SBS can display a wide spectrum of symptoms. If a baby or young child shows any of the following symptoms, immediately call 911:

• Dilated pupils
• Difficulty breathing
• Altered consciousness
• Seizures (rolling of eyes upward into head)
• Blood spots or pooling of blood in the eyes

In addition, even common conditions like lethargy, vomiting, irritability, and constipation can be signs of shaken baby syndrome. Children with these symptoms should be watched closely and may need medical attention.

Babies and young children should never be shaken for any reason! Babies and young children are extremely vulnerable to head and neck injuries because their heads are large and their neck muscles are weak. In addition, their brains and blood vessels are very fragile and are easily damaged by whiplash motions, such as shaking, jerking, and jarring. Never toss a baby or young child into the air! This can lead to head and neck injuries as well as injuries from hitting a hard surface (e.g., ceiling, ceiling fan, wall, floor, etc.). Also, it is important to remember that extreme bouncing of a baby on the knee is jarring and can cause head or neck injury. It is ineffective for calming a crying/fussy baby, and instead can cause much worse problems!

Shaking a baby is not first aid! If a baby is not breathing, shaking will not help. The appropriate treatment is correctly administered rescue breathing or if necessary, infant CPR). Many community organizations, such as Red Cross, and local hospitals offer inexpensive or free courses for these first-aid skills.

Shaken Baby Syndrome is 100 percent preventable! Education is one of the best tools for the prevention of SBS. Childcare providers can play an important role in helping to save lives and prevent needless deaths and disabilities from SBS. Here are some prevention strategies that childcare providers can implement throughout the year:

• Conduct regular staff training on the prevention of child abuse and neglect that includes specific information about the prevention of SBS.
• Display information about SBS in the childcare facility to inform staff and parents.
• Educate parents and other caregivers about SBS. Use information from credible resources and share the information in meetings and/or through newsletters, bulletin boards, etc.
• Print information about how to cope with a crying baby and display it on bulletin boards; also, send copies home with parents.
• Hold parent education classes at your center in the evenings or on the weekends. These classes can cover important topics such as child development, anger management, stress management, and appropriate discipline techniques.
• Share resource information with parents. Let parents know that there are resources and professionals who can help them in difficult times.
• Volunteer in your community to educate others about SBS. People who may need education include other childcare workers, parents or guardians, grandparents and relatives, siblings, babysitters, and any person who cares for children.
• Help support legislation mandating that hospitals inform parents of the dangers of shaking babies and that middle schools and high schools educate students about the dangers of shaking babies.
• If you have concerns or questions, talk to your pediatrician, family physician, childcare health consultant, or public health nurse. Also, look for local, state, and national resources that support parents and caregivers (see resource section of this article).

Everyone who cares for young children must know the dangers of SBS and educate others about it. Children are one of the most vulnerable groups in our society. Everyone is a stakeholder in helping to ensure that they have the opportunity to grow up healthy, safe, and well nurtured.

Marilyn Massey-Stokes, Ed.D., CHES,
Associate Professor
Texas Tech University

ChildhelpUSA®, 15757 N. 78th St., Scottsdale, AS 85260; 480-922-8212; www.childhelpusa.org ChildhelpUSA® National Child Abuse Hotline: 800-422-4453

National Center on Shaken Baby Syndrome, 2955 Harrison Blvd. #102, Ogden, UT 88403; 888- 273-0071; www.dontshake.com

National Committee to Prevent Child Abuse, 2950 Tennyson St., Denver, CO 80212-3029; 877-224-8223: www.childabuse.org

Prevent Child Abuse America, 200 S. Michigan Ave., 17th Fl., Chicago, IL 60604-2404; 312- 663-3520; www.preventchildabuse.org

The Shaken Baby Alliance, PO Box 150734, Ft. Worth, TX 76108; 877-6-ENDSBS; www.shakenbaby.com

For additional information concerning preventing abuse and recognizing and reporting abuse, see the August-September 2002 and October-November 2002 issues of Healthy Childcare.