Introduction:
Shaken Baby Syndrome was termed ‘Whiplash shaken-baby syndrome’ by John Caffey in 1946. It is also called ‘Abusive head trauma’ and ‘Shaken Impact Syndrome.’ This occurs when a parent or caretaker brutally shakes a child, causing the brain cells to swell, limiting the oxygen supply, and resulting in bleeding. It can be fatal.
What Are the Reasons for Shaken Baby Syndrome?
Crying in babies is normal. A parent or caretaker may shake a child forcibly due to stress or frustration to stop the baby from crying. Though it can be unknowingly done, frequent acts are child abuse. The gentle tossing of a baby in the air, bouncing on knees, or sudden jolt of a car does not cause Shaken Baby Syndrome, but it is always better to be careful.
What Are the Risk Factors Associated With Shaken Baby Syndrome?
Infants under two years are at risk, especially those between 2-4 months of age, are at a greater risk. However, the harm caused can also extend to kids up to 5 years. The following are the risk factors posed by a parent or caretaker that leads to certain actions resulting in Shaken Baby Syndrome:
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Lack of knowledge about child care.
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Incidents of abuse or neglect during childhood.
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Single parent.
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Witnessed or been a victim of domestic violence.
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Young parents.
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Having experienced improper prenatal care.
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Alcohol or substance abuse.
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Family issues.
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Affected mental health.
Risk factors that may put a baby at risk are:
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Previous history of child abuse.
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Premature baby.
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Infants with disabilities.
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Being one of the multiple siblings.
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Inconsolable, intolerant, and frequent crying.
How Does Shaken Baby Syndrome Affect the Baby?
The head of the baby is large compared to the body and hence moves a lot when shaken. The neck is also underdeveloped and has poor strength. Shaken Baby Syndrome causes the following impact:
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Violent shaking of the baby causes the brain to move front and back as it turns on the central axis.
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This violent movement stretches and tears the connecting veins in the subdural space (the tough outer membrane surrounding the brain is called the dura).
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This leads to a collection of blood in the subdural space. Bleeding can also extend into the sub-arachnoid space which is a web-like membrane around the brain.
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As a result, the brain cells swell (cerebral edema), and there is increased pressure in the brain (intracranial pressure).
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The rise in intracranial pressure reduces blood and oxygen supply to the brain.
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If the condition is not treated immediately, it could be fatal.
How to Diagnose Shaken Baby Syndrome?
The baby’s history and symptoms will be evaluated, followed by a physical examination for any signs and symptoms by a physician. Brain scans such as Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) may be required. Other body parts such as arms, skull, legs, and spine may be examined for fractures using X-ray. In case of trauma in the eye or bleeding, an eye examination will be required. Blood tests may be required to rule out other disorders resembling Shaken Baby Syndrome, like osteogenesis imperfecta (an inherited disorder characterized by defective genes that causes the bones to break easily).
What Are the Signs and Symptoms of Shaken Baby Syndrome?
Unconsciousness, shock, and seizures may be the immediate signs in severe cases, and irreversible brain damage can happen within seconds. The cardinal signs and symptoms include:
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Bleeding in the retina (retinal hemorrhage).
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Breathing difficulty.
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Convulsions (rapid, uncontrollable shaking and limb movement).
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Lethargy.
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Extreme irritability.
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Inability to lift the head.
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Pale or bluish skin.
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Widened pupils.
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Limited eye movements.
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Less food intake and difficulty in sucking.
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Lack of focus.
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Infants do not smile or make sounds.
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Tremors.
Physical signs include
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Bruises on the face, head, arms, back, and abdomen.
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Contusions, lacerations, and concussions (bruises of the brain).
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Neck, chest, and abdominal injuries.
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Large head or forehead with a soft bulge on the top.
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Soft tissue swelling denotes a fracture to the skull or other bones.
What Are the Treatments for Shaken Baby Syndrome?
Mild cases may require medical intervention and observation at the hospital. If the signs and symptoms are noted, it is important to seek medical help immediately. Surgery might be needed in severe cases to stop swelling and bleeding in the brain. Respiratory support and CPR will be performed on babies with breathing difficulty. Supportive care will be provided by a group of doctors, such as:
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Pediatrician (Child specialist).
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Brain doctor (Neurologist).
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Brain surgeon (Neurosurgeon).
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Eye doctor (Ophthalmologist).
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Hormone doctor (Endocrinologist).
Later, follow-up will be done by a speech therapist, occupational therapist, speech-language therapist, and rehab medicine.
What Are the Complications of Shaken Baby Syndrome?
The likely outcome of the syndrome is usually poor and can be fatal in most cases since there is increased pressure in the brain accompanied by bleeding. In addition, surviving babies may show the following disabilities:
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Blindness and impaired vision.
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Epilepsy (a brain disorder where the brain’s activity is abnormal and results in unusual behavior and sensations and sometimes accompanied by loss of consciousness).
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Hearing difficulties.
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Physical and intellectual disabilities.
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Cerebral palsy (brain damage that causes loss of control over balance and posture).
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Stiffness of muscles, thereby affecting movement and speech and causing discomfort and pain (spasticity).
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Paralysis.
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Developmental delays (delayed learning, speaking, and other activities).
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Learning disabilities.
How to Prevent Shaken Baby Syndrome?
First and foremost, parents and caretakers must understand the hazards of shaking the baby. It is normal for the baby to cry frequently during the initial months of life. However, if the crying is very frequent, consult a pediatrician to check the underlying cause. As stated by The National Center for Shaken Baby Syndrome, the frequent crying of babies is called ‘PURPLE Crying.’ PURPLE crying stands for:
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Peak pattern: Babies cry the most between 2-3 months.
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Unpredictable: Crying can start and stop for no specific reason.
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Resistant to soothing: Babies are inconsolable.
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Pain-like look on face: Babies cry as if they are in pain, but actually, they are not.
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Long bouts of crying: Babies can cry for a longer duration.
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Evening crying: Crying can be more during noon and in the evening.
Parents and caretakers need to understand the above pattern and calm the baby in the following ways:
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Rock the baby gently and rub their back softly.
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Wrap the baby in a blanket and keep them warm.
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Talk or sing softly to the baby.
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Take the baby for a walk or a drive.
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Provide the baby with a pacifier.
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Caretakers and other family members must be made aware that frequent crying in babies is normal, and they must be taught the safe ways of handling the baby.
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If the parent, caretaker, or family member is stressed or tired, it is normal to call a friend, neighbor, or other reliable people to look after the baby and take a short break.
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In case of being alone, put the baby in a safe place like a crib, calm down, and take a small stroll, but keep an eye on the baby every 5 to 10 minutes.
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Consult a health care provider in case of disturbed mental health.
Conclusion:
Shaken Baby Syndrome is 100% preventable if one knows the ill effects of shaking a baby, as mentioned above. It is normal for infants to cry during the first few months of life though it sometimes can be frustrating. If the crying is persistent, seek medical help. If a parent, caretaker, or family member cannot calm the baby, it does not mean they are incapable or bad at handling it. We as individuals can help new parents in our family or community by ensuring them that crying is normal in babies and offering support by giving them a break if needed. If Shaken Baby Syndrome is suspected of abuse, kindly report the issue to the local police or contact the child abuse helpline.
