shaken baby syndrome

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Shaken Baby Syndrome


Sitting in a chair next to his child’s hospital bed a middle-aged man is crying. Inside the room is dark and quiet except for the occasional beeping alarm from the various machines packed around the bed. The monitor above the bed has different colored lines moving rhythmically across the screen. In the center of it all lies a motionless toddler. He has no cloths on except for a diaper; criss-crossing wires and tubes cover the rest of his exposed skin. One of these tubes originates from the center of the child’s head raising strait up like a horn.


The father occasionally throws a glance my way seemingly interested in engaging in a conversation. As his child’s nurse, I want to assess the father’s knowledge of the situation so I ask him an open-ended question, “what do you think happened that caused such a catastrophic brain injury to your child?” He looks at me as I should be telling him and says, “I was at work and I received a call from the baby sitter saying that my son was not acting right all morning and that he is now not waking up. She told me she called the ambulance and then I rushed in here to find my son like this. They told me my son had a brain injury. My wife and I could not recall the child falling and hitting his head at home recently so we asked his babysitter if she recalled any incidents. She told us the kids were jumping on a bed the day before and my son had fallen off the bed and hit his head.” Since I had already heard this story and knew it could not explain this child’s injuries, I asked the father, “did anyone explain the extent of the brain injury your child received?” He responded, “no, not really.” Taking things slowly and using terms everyone can understand I start to explain the etiology of an injury sustained by violent shaking. The father listens closely and remains calm through the quick 15-min teaching session. I explain how the retina’s in his yr. old boy’s eyes have been ripped from the back of his eyes due to hemorrhaging which can only occur from the violent back and forth movement of severe shaking. I go on to explain how the brain was severely traumatized by back and forth movement inside the unforgiving hard bones found in the skull. Reacting just like any other part of a human body which suffers a traumatic event, the brain is now swelling, but since it is in an enclosed capsule it will eventually crush itself causing death or permanent brain damage. The brain and retinal injuries could never be caused from a fall off a bed. When I’m done with lesson on shaken baby syndrome the father appears confused and upset. He then states “The doctors already told us that the story of my boy falling from a bed did not cause these injuries. My wife and I went back to the baby sitter with this information, and she changed her story and told us when he fell from the bed his head hit a doorknob.” Then he asked, “could that have caused this injury?” He knew the answer but needed to hear it. “100% there is no way.” I respond. The father continues to explain his predicament, he just will not believe the baby sitter would do such a thing. He and his wife have been extremely close friends with her for years, and she has been a full time, state certified baby sitter for 0 years. I make sure to explain that the person who has the story that changes in an attempt to explain a head injury is usually guilty of perpetrating the offense or at least has knowledge of the offense. I can tell he appreciates the explanations, but is still hesitant to believe what I am telling him. It is a lot to believe from someone he has never met before and I point him towards more objective information he can get off the Internet in the parents research room.


The definition of Shaken Baby Syndrome is a collective term for internal head injury; a baby or young child sustains from being violently shaken. First described in medical literature in 17, 50,000 US children are effected each year. SBS is the leading cause of traumatic death in children, and of child abuse cases. It more often occurs in boys, age’s range from birth to 5 years, although the age group most at risk is 6-8 months old. SBS is almost always in response to a crying child (Gale)


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The act of SBS has been described as “so violent that individuals observing would recognize it as dangerous and likely to kill the child.” The injuries are only as a result of violent trauma; they cannot be caused by short falls, seizures or as a consequence of vaccinations (pediatrics). The consequences of being shaken can range widely from death to so mild the parents never sought medical attention. Mortality rates are 0%, 60% among infants who were initially examined when comatose.(pediatrics)


Symptoms of SBS are mostly neurologic and are not always specific. They include convulsions, irritability, fixed pupils, seizures, sleepiness, breathing problems, vomiting, choking, swelling of head, pooling of blood in eyes, and head turned completely to one side. A CAT scan can show multiple brain injuries such as subdural or subarachnoid hemorrhages, diffuse axonal injuries and with severe cases hypoxic-ischemic injuries. Upon exam of the eyes, retinal hemorrhages along with any other of the head injuries justify a positive SBS diagnosis. The arteries of children are more fragile and it is the tearing these veins and arteries in the head causes all these injuries. Children who survive the initial injury may suffer from chonic medical problems like, blindness, spasticity, seizures, profound mental retardation, and severe motor dysfunction. (pediatrics).


As a preventative measure all health care workers should be assessing infant caregivers for stress levels, discipline practices, substance abuse, reactions to crying and knowledge of SBS. Most of the population is lacking in knowledge and some programs are teaching false information things such as SBS can be caused by bouncing a child on a knee, throwing him/her in the air, or even rough play. SBS can victimize any child from any demographic. Males are more often perpetrators, although no gender or person should be ruled out. (Pediatrics). Except for male caregivers there is no other population which needs more attention then another. Every caregiver, including infant and toddler care setting, needs to be addressed just as much as the primary caregivers. (Gale)


Sadly, for the child mentioned above there is no formal research or programs directed at preventing SBS or prosecuting perpetrators (Pediatrics). Finding a babysitter can be a daunting task, which can leave parents feeling responsible later if their child becomes such a victim of child abuse. There is no research that shows any interventions by the parents can prove one babysitter trustworthier (Pediatrics). Even such things as unannounced visits, state licensure, communications with past customers or good references are meaningless when it comes to finding a safer environment for children (Pediatrics). When abuse occurs there is rarely any charges filed or jail time issued, usually there is little evidence unless a confession is given. As with the child above no one was charged, and until the medical community directs more energy and funds toward preventing and prosecuting these cases, children will remain unsafe from SBS.








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