Shaken Baby Syndrome

What's the Problem?

Shaken Baby Syndrome (SBS) is a severe form of physical child abuse. SBS may be caused from vigorously shaking an infant by the shoulders, arms, or legs. The "whiplash" effect can cause intracranial (within the brain) or intraocular (within the eyes) bleeding. Often there is no obvious external head trauma. Still, children with SBS may display some outward signs:

• Change in sleeping pattern or inability to be awakened
• Confused, restless, or agitated state
• Convulsions or seizures
• Loss of energy or motivation
• Slurred speech
• Uncontrollable crying
• Inability to be consoled
• Inability to nurse or eat

SBS can result in death, mental retardation or developmental delays, paralysis, severe motor dysfunction, spasticity, blindness, and seizures.

Who's at Risk?

Small children are especially vulnerable to this type of abuse. Their heads are large in comparison to their bodies, and their neck muscles are weak. Children under one year of age are at highest risk, but SBS has been reported in children up to five years of age. Shaking often occurs in response to a baby crying or having a toilet-training accident. The perpetrator tends to be male and is primarily the biological father or the mother's boyfriend or partner. Caregivers are responsible for about 9%-21% of cases. The explanation typically provided by the caregiver—"I was playing with the baby"—does not begin to account for the severity of trauma. Many times there is also a history of child abuse.

Can It Be Prevented?

SBS is completely preventable. However, it is not known whether educational efforts will effectively prevent this type of abuse. Home visitation programs are shown to prevent child abuse in general. Because the child's father or the mother's partner often causes SBS, they should be included in home visitation programs. Home visits bring community resources to families in their homes. Health professionals provide information, healthcare, psychological support, and other services that can help people to be more effective parents and care-givers.

The Bottom Line

• Shaking a baby can cause death or permanent brain damage. It can result in life-long disability.
• Healthy strategies for dealing with a crying baby include: finding the reason for the crying; checking for signs of illness or discomfort, such as diaper rash, teething, tight clothing; feeding or burping; soothing the baby by rubbing its back; gently rocking; offering a pacifier; singing or talking; taking a walk using a stroller or a drive in a properly-secured car seat; or calling the doctor if sickness is suspected.
• All babies cry. Caregivers often feel overwhelmed by a crying baby. Calling a friend, relative, or neighbor for support or assistance let's the caregiver take a break from the situation. If immediate support is not available, the caregiver could place the baby in a crib (making sure the baby is safe), close the door, and check on the baby every five minutes.

Case Examples

1. Devin was 4 months old when he was violently shaken by a caregiver at his day care center. He started vomiting after meals a few days later and became very tired and lacked motivation. Doctors initially diagnosed a viral infection, however, after 11 days, when he became dehydrated, he was hospitalized. A CT scan revealed a hemorrhage (bleeding) in his brain and subsequent X-rays showed he had a few broken ribs and a broken shin bone. The parents were questioned by police and the Department of Children and Families. A review of the child's previous days led to them to the day care center. His abuser is now serving a 9-year prison sentence. Devin has permanent brain damage and receives therapy. (This is a true story. To read more about it and other victims, visit The Shaken Baby Alliance )
2. Mikey was hospitalized at 9 weeks old and diagnosed with Shaken Baby Syndrome. His injuries were bilateral retinal hemorrhages (bleeding in his eyes), subdural hematoma (bleeding on the brain), and subarachnoid hemorrhage (swelling within the brain), as well as a healing broken rib. His mother's live-in boyfriend and biological father was the perpetrator. At age two, Mikey does not yet walk or talk, although his vision has improved. He takes medicine to prevent seizures and continues receiving physical therapy. (This is a true story. To read more about it and other victims, visit The Shaken Baby Alliance .)