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David Baxter PhD

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Shaken Baby Syndrome: A Real Danger on the Rise
By Leoni Benghiat,

Awareness is key to prevention. Few parents realize that even mild shaking of a baby or child can cause shockingly extensive, long-lasting or life-threatening damage.

Few parents realize the real danger that excessive shaking can cause to a baby's soft skull, under-developed brain, and weak neck muscles. Consequently, neither are they aware of the existence of Shaken Baby Syndrome (SBS) - something all parents and caregivers should know about.

This warning comes from Dr. Susan Palmer, Project Director, Department of Research and Program Services at The Arc, a national organization for people with mental retardation and related development disabilities and their families.

According to Palmer, SBS is caused by the vigorous shaking of an infant or young child by the arms, legs, chest, or shoulders. Forceful shaking can result in brain damage leading to mental retardation, 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 still very weak," explains Dr. Palmer. "In addition, the baby's brain and blood vessels are very fragile and easily damaged by whiplash motions, such as shaking, jerking, and jolting."

The statistics paint a grim picture. Every year there are an estimated 50,000 cases of SBS in the United States, and studies have indicated at least 7,500 to 15,000 infants and children die as a result. SBS most often occurs in babies less than six months old, however it can occur up to the age of five. SBS is now the fastest growing occurrence of traumatic brain injury (TBI) in children under the age of one.

"What we do know about these injuries is that they are often a result of frustration and anger," says Dr. Emalee Flaherty, Medical Director, Protective Services Team at Children's Memorial Hospital in Chicago. She adds, "Crying is the event that most commonly triggers the abuse."

"The confessions I have reviewed of caretakers who have shaken a child and caused these injuries basically contain the same ingredients. Many have unrealistic expectations for the child. Some have little child care experience. Some caretakers are under stress such as sleep deprivation, depression, or anger with the parent who has left them to care for this child."

Many parents and caretakers feel that shaking a baby is a harmless way to make a baby stop crying. "This could not be further from the truth," says Dr. Flaherty.

Kimberlin West was six weeks old when her father shook her vigorously to stop her insistent crying. Her grandmother, Janet Goree from Florida, remembers the night of May 6, 1993, when a comatose Kimberlin was admitted to the intensive care unit. "She was not expected to live through that night, but she did. She 'lived' for three more years - blind, 67 percent brain damaged, and she had to be fed through a tube surgically inserted into her stomach. She died just a couple of days short of her third birthday "a victim of SBS."

Most people think SBS only happens in isolated cases. Some US studies estimate that 15 percent of children's deaths are due to battering or shaking, and an additional 15 percent are possible cases of shaking.
Towards the end of the 1990s, two high profile court cases focused the world's attention on SBS. In 1997, British au pair, Louise Woodward, was found guilty of culpable homicide after she literally shook an American baby in her care, Matthew Eappen, to death. A second highly-publicized case happened in England in January 1999 - an Australian au pair, Louise Sullivan, admitted to shaking a six-month old baby girl so severely that the baby died of serious head injuries.

"SBS is usually diagnosed after babies have been shaken by their parents or caregivers to discipline them," says Dr. Palmer. "Even though a parent thinks he's shaking the child only mildly, he doesn't realize what damage he can cause. Shaking a newborn is akin to having the same effect as when a boxer receives a very hard blow to his head - the brain knocks against the back of the skull."

"With shaking, the blood vessels between the brain's surface and the sinuses will tear and cause hemorrhaging of the brain and/or bleeding behind the eyes. Bleeding in the membrane space around the brain, fractures, and bruising also appear in SBS cases. The minds of children who are constantly shaken are fuddled, they get convulsions very easily, and they become irritable and inconsolable."

Immediate emergency treatment is necessary with SBS, usually including life-sustaining measures such as stopping internal bleeding and relieving pressure within the skull. Treatment includes medical, behavioral, and educational services. In addition to medical care, the child may need speech and language therapy, vision therapy, physical therapy, occupational therapy, as well as other special education services from feeding experts and behavioral consultants.

The implementation of the Kimberlin West Act of 2002 in California requires SBS education for parents at the time of a baby's birth. The rest of the states have followed California's example and implemented their own SBS prevention programs. Dr. Flaherty points out that some prevention strategies are now focusing on normalizing crying for caretakers by letting them know how much an infant may cry, giving them strategies that may help alleviate the crying, and letting them know that it's OK to put the baby in his crib, close the door and take a breather if all else fails. "Remember that no infant ever died from crying," she says.

By no means does this mean parents need to refrain from playing with their baby. "There's no proof that bouncing a baby gently on your knee or other normal play activities would cause any harm," says a spokesperson for the Maryland Department of Health and Mental Hygiene's Office of Injury and Disability Prevention. But he warns: "You can imagine scenarios that might produce the damage without it being deliberately inflicted. It would have to involve vigorous unsupported movement of the head." So this effectively rules out rough play, at least until your baby is crawling. It also means taking care to support a newborn's head if you're walking with them in your arms.

Tossing a baby up into the air - a favorite pastime of proud fathers - should be avoided. "Children should not be tossed up into the air before they have reached the age where they have good head control," says Dr. Flaherty. "At a very young age their neck muscles are still very weak and their brains immature and more susceptible to permanent damage."

The prognosis for recovery from SBS is poor. Most children that experience SBS will suffer considerable disabilities. If the child survives, he or she may require lifelong medical care. Fewer than ten to fifteen percent of children who experience SBS are believed to recover completely.

SBS Facts
  • Twenty-five percent of all babies with SBS die - one in every four.
  • Shaking a baby violently for even two to three seconds can cause bleeding in and around the baby's brain and can destroy brain cells.
  • SBS victims range in age from a few days to five years; the average age is six to eight months.
  • An infant may spend two to three hours each day crying, and 20 to 30 percent of infants exceed that amount of time, sometimes substantially.
  • Crying becomes particularly problematic during the six-week to four-month age bracket, an age period that coincides with peak incidence of SBS.
  • Head trauma is the most frequent cause of permanent damage or death among abused infants and children, and shaking accounts for a significant number of those cases.

Signs and Symptoms
If a child shows any of these symptoms after being shaken, take him to the hospital immediately:
  • Lethargy
  • Vomiting
  • Irritability
  • Constipation
  • Decreased appetite
  • Difficulty breathing
  • Seizures
  • Semi-consciousness
  • Dilated pupils
  • Blood spots or pooling of blood in the eyes
Simple Techniques to Calm a Crying Baby

  • Calm down: crying is normal and can last 15 minutes to several hours. Young infants cry an average of three hours per day. This is how an infant communicates. Place the baby in a safe place such as a playpen or crib. Call a friend or relative for support and advice.
  • Check to see if the infant is hungry or needs a diaper change. Discomfort, such as too tight clothing or being too hot or cold can also cause crying.
  • T.L.C.: provide tender, loving care. Soothe the infant with gentle motions and a steady, calm voice. Put your hands behind your back if you become angry, it helps to remind yourself not to touch the infant in frustration or anger. Infants will often calm down when they hear the low hum of a clothes dryer or vacuum cleaner. They're also easily soothed by a car ride, being held by an adult while walking or rocking, or going for a ride in a stroller.
  • Try again: When you have calmed down, resume trying to help the baby.
  • Never yell at, hit, or shake your baby.

Where to Get Help
Childhelp USA: 800-4-ACHILD
Child-At-Risk Hotline:1-800-792-5200
National Child Abuse Hotline: 800-422-4453
National Committee to Prevent Child Abuse: 800-CHILDREN
Parental Stress Hotline: 1-800-632-8188
Shaken Baby Alliance:1-877-6ENDSBS
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