Shaken Baby Syndrome: A Preventable Tragedy
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Updated April 2002 — Despite increased public awareness, a surprising number of babies are still victimized each year by shaken baby syndrome (SBS), a form of brain injury caused by shaking an infant so severely that the end result is physical harm or death.
According to the National Center on Shaken Baby Syndrome, statistics on the prevalence of SBS vary, ranging from 600 to 1,400 cases annually. However, SBS is undisputedly a major cause of infant injury and mortality, and what makes it all the more poignant is that most of these tragedies could have been avoided.
The Fragility of the Brain
To understand why infants are so vulnerable to brain damage, it is important to consider the top-heavy design of the infant physique.
When measured against the body of an adult, a baby's head is disproportionately large compared to the body. The neck muscles are not fully developed, and the baby's small brain resides in the skull with plenty of extra room to allow for growth.
Because of these physical factors, vigorous shaking can cause a baby's brain to bang violently against the inner skull, causing bruising, bleeding and swelling that can lead to permanent paralysis, blindness and retardation. To illustrate the extent of damage to the brain, many child abuse educators actually demonstrate before audiences by shaking raw eggs or gelatin desserts in oversized plastic containers until the foods break and lose their shape.
Unlike babies who have been beaten or burned, babies who have been shaken usually show few external signs of trauma says Eileen Watkins, nurse clinician, Pediatric Intensive Care Unit (PICU) at Joe DiMaggio Children's Hospital.
Indeed, while some babies have seizures or become unconscious after being shaken, many others exhibit more subtle signs of injury, such as an unusual breathing pattern, prolonged lethargy, poor feeding or a slight swelling in the fontanel, the soft spot at the top of the skull. Ironically, another symptom of injury is incessant crying - the very behavior that may have inspired the parent or caregiver to shake the baby in the first place.
Once a baby is admitted to the hospital, X-rays and physical exams can reveal other indications of abuse, according to Watkins.
"Sometimes we'll discover retinal hemorrhaging," she says. "Other times, we'll see fractures on the long bones of the arms and legs, indicating that the baby may have been held by the limbs and shaken."
Signs and symptoms aside, diagnosing SBS is a challenge requiring the assistance of law enforcement officials.
"Shaken baby syndrome is a diagnosis of exclusion, meaning that we have to rule out other causes and eliminate other possibilities for the infant's condition," says Scott Lazar, MD, a PICU physician at Joe DiMaggio Children's Hospital.
While many cases stem from a parent or caregiver's frustration ("The baby just wouldn't stop crying, so I shook him!"), there have also been reports of babies who were injured as a result of innocent horseplay with adults. These types of accidents do happen, but they are rare, according to Watkins. More often than not, loss of control or anger plays some role in the injury. "It takes quite a bit of force to hurt babies," she says.
Preventing Harm
Whether accidental or deliberate, most instances of SBS are entirely preventable. Parents and caregivers simply need to avoid horseplay and control their tempers on those days when the baby seems difficult. If that seems easier said than done, just remember that most of the time, it is perfectly normal for babies to cry, and when it happens, it is no reflection on an adult's caregiving skills.
Adults who are challenged by crying babies should learn to develop specific coping techniques so they never express their anger in the form of violence.
"When the baby cries, just put him in the crib and walk away for a few minutes or get someone to come and help out," says Watkins. "Whatever you do, don't shake him. It can alter lives forever."