You Can Prevent Shaken Baby Syndrome

1. You Can Prevent Shaken Baby Syndrome • A user-friendly guide for Moms, Dads, Child Care Providers, Babysitters and • ANYONE WHO TOUCHES A CHILD’S LIFE

2. Shaken Baby Syndrome or Abusive Head Trauma • Definition: the consequences which occur when a baby/ young child’s head is whiplashed back and forth during shaking or other imposed trauma. • Syndrome may include blunt force trauma resulting from the child being thrown or slammed against a solid surface • The older the child the more severe the shaking • In the US, approximately 1,300 infants a year are hospitalized or die from shaken baby syndrome.  About 80% of the children who survive suffer brain injury, fractures, paralysis, blindness, deafness and other disabilities. 

3. Uniqueness of SBS • Usually done in private • No witnesses • Motive exists in the mind of the perp • ‘Murder’ weapon is the hands • Subtle presentation in the E.R. may lead to mis- diagnosis or missed -diagnosis.

4. Shaken Baby Syndrome • child abuse--when someone shakes a baby or slams or throws a baby against an object. A child could be shaken by the arms, legs, chest, or shoulders. • Some experts use the term shaken-impact syndrome, or abusive head trauma, because injury from throwing a child against a surface can equal that of shaking.1 • Shaken baby syndrome often occurs when a baby won't stop crying and a caregiver shakes a baby out of frustration. To help prevent this problem, learn healthy ways to relieve stress and anger, and carefully choose your child care providers. • Normal play, such as bouncing a child on a knee or gently tossing a child in the air, does not cause shaken baby syndrome.

5. Shaken Baby Syndrome • Trauma is the leading cause of death during childhood. • Inflicted head trauma is the leading cause of traumatic death during infancy. • Shaken baby syndrome occurs mostly in children younger than 3, and is most common in babies younger than 1 year of age. But it also can affect children up to age 5. Shaken baby syndrome can cause serious long-term problems.

6. Child deaths in Virginia 2010 64 child abuse deaths in 2001, 78 in 2010 26 babies under 1 year old died in 2010 of child abuse 16 shaken baby deaths in 2010

7. Shaken Baby • Includes pediatric traumatic cranial injuries inflicted by violent shaking and/or impact • Infant or child  3 years of age • Bleeding over the surface of the brain • Bleeding in the back of the eyes • Acute brain swelling • Rib and extremity fractures • Death or Disability

8. Why babies? • Large heavy heads • Weak neck muscles • Fragile central nervous system

9. Shaken Baby Syndrome • Shaking or throwing a child, or slamming the child against an object causes uncontrollable forward, backward, and twisting head movement. Brain tissue, blood vessels, and nerves tear. The child’s skull can hit the brain with force, causing brain tissue to bleed and swell. • Young children are most likely to have brain injury when they are shaken or thrown because they have: • Heavy, large heads for their body size. • Weak neck muscles that do not hold up the head well. • Delicate blood vessels in their brains.

10. Shaken Baby Syndrome • According to a 10-year review of hospital data from the National Pediatric Trauma Registry • Child abuse accounted for 10.6% of all blunt trauma, but 36.6% of all fatalities, in children under 5 years of age.

11. Why are babies shaken? • STRESS AND FRUSTRATION • Lack of parenting skills • Lack of support • FATIGUE • Lack of connection to the infant (boyfriend of mother)

12. Profile of abusers/ perps • 70+% males; fathers / boyfriend of mother • average age 22 yrs • 60+% babies shaken are males • Day care providers: licensed and unlicensed

13. Triggers for shaking • CRYING, CRYING, CRYING • COLIC, REFLUX, FEEDING PROBLEMS • PREMATURITY • TOILET TRAINING • TODDLER BEHAVIORS

14. Common presenting symptoms • Extreme irritability • Decreased appetite/ feeding • Vomiting • Lethargy • All of these are ‘flu-like ’ symptoms leading to delays in diagnosis or misdiagnosis

15. Common presenting symptoms • Inability to follow movements • No smiling or vocalization • Rigidity • Seizures • Difficulty breathing • Comatose

16. Symptoms • Symptoms vary among kids based on their age, how often they've been abused, how long they were abused each time, and how much force was used. • Mild injuries may cause subtle symptoms. A child may vomit or be fussy or grouchy, sluggish, or not very hungry. More severe injuries may cause seizures, a slow heartbeat, trouble hearing, or bleeding inside one or both eyes. • It is important to get help if something doesn't seem right with your baby. Shaken baby syndrome may cause only mild symptoms at first, but any head injury in a young child can be dangerous. A child who has trouble breathing, is unconscious, or has seizures needs hospital care right away. • Symptoms can start quickly, especially in a badly injured child. Other times, it may take a few days for brain swelling to show symptoms. Often the caregiver who shook the child puts the child to bed in the hope that symptoms will get better with rest. By the time the child gets to a doctor, the child needs urgent care. In some cases, the child may be in a coma before a caregiver seeks help. • Shaken children may also have other signs of abuse, such as broken bones, bruises, or burns.

17. What we know • Bleeding in the eyes occurs in 70-80% of children who are shaken • Fractures of ribs, skull and extremities • Shaking alone is sufficient to cause brain injury • Falls from less than 20 feet do not cause Shaken Baby Syndrome

18. Diagnosis • Doctors may first suspect shaken baby syndrome when caregivers give vague or changing information about what has happened to the sick child. For example, the caregiver may tell a doctor that the child fell out of bed and then later say that a sibling or a pet caused the injury. • Shaken baby syndrome can be hard to detect because often there aren't clear signs of abuse. A baby may vomit, have a poor appetite, or be fussy or sluggish. These symptoms may at first seem related to an infection, such as the flu or meningitis. SBS may not be diagnosed at the first ER visit • Doctors check for shaken baby syndrome in several ways. They ask for a child’s medical history. They may also do a physical exam and blood tests. Imaging tests such as X-rays, a CT scan, or an MRI can look for bleeding problems or other injury. • A doctor may also do tests to rule out other conditions. For example, a lumbar puncture checks a baby's spinal fluid for signs of meningitis. Blood found in this sample could point to a shaking injury. • A doctor who suspects shaken baby syndrome must report it to the local child welfare office and police. • If you suspect child abuse and the child is not in immediate danger, call local child protective services or the police. Do not confront the person who may have abused the child. This may cause more harm to the child.

19. What you have to remember • Those babies who survive become ‘million dollar babies’. • Cost family AND community $4.5 million dollars to age 18. • HMO’s not necessarily the best insurance for these families.

20. Treatment • A child with shaken baby syndrome needs to be in the hospital, sometimes in an intensive care unit (ICU). Oxygen therapy may be used to help the child breathe. Doctors may give the child medicine to help ease brain swelling. Sometimes a cooling mattress will help lower the child's body temperature and reduce brain swelling too. A child who has severe bleeding in the brain may need surgery. • Depending on the symptoms, doctors may try seizure medicine, physical therapy, or other treatments. • Long term therapy if baby survives

21. Long Term • About 1 out of 4 children who are forcefully shaken or thrown against an object die from their injuries. Those who survive may have brain and vision problems that can last forever. These problems can include: • Seizures, which are sudden bursts of abnormal electrical activity in the brain. A baby may have uncontrolled muscle movement and be unable to speak, see, or interact normally. • Muscle stiffness (spasticity) that results in stiff, awkward movements. • Mental retardation that can affect every area of a child's life, such as learning to talk or being able to care for himself or herself in the future. • Blindness or trouble seeing. • Physical or emotional growth delays. • Learning or behavior problems that may not appear until the child starts school.

22. How do you handle non-stop crying • Hugs, cuddles, talks • Warm bath • Mozart/ soft music • Car ride • Singing • Put baby in bed and leave the room

23. How do you handle non-stop crying? • TAKE A BREAK, • BUT NEVER SHAKE A BABY

24. Legalities • Act is not considered child abuse unless ‘intent to kill/ harm’ • These cases are difficult to prosecute • Sentences given are usually not long • No central registry to collect statistics

25. What can you do? • Tell anyone you know about Shaken Baby Syndrome • Contact your local resource person if you have questions or concerns • Tell other parents/ day care providers / males who care for babies /young children about Shaken Baby Syndrome