What Is Shaken Baby Syndrome?

Shaken baby syndrome is a type of severe child abuse when a parent or caregiver shakes a baby. The shaking is usually done out of frustration when the baby cries for an extended period. 

When an infant is shaken, its head bobs back and forth, causing the brain to move around inside the skull. This can lead to severe brain injury, especially if the infant’s head hits a hard surface as well.  Shaken baby syndrome may cause bleeding, bruising, swelling, long-term brain damage, and even death. It can happen in as little as five seconds of shaking.

This article discusses the symptoms, diagnosis, treatment, and prognosis of shaken baby syndrome,

Types of Shaken Baby Syndrome Injuries

Shaken baby syndrome is dangerous and leads to several potential injuries. Shaking an infant or young child causes their brain to move back and forth inside the skull, striking the sides on the skill. This movement can tear blood vessels, leading to bleeding and nerve damage. It can also lead to brain swelling, which increases the pressure in the skull. 

Possible injuries from shaken baby syndrome include:

• Subdural hematoma: A collection of blood between the surface of the brain and the outer membrane (dura)
• Subarachnoid hemorrhage: Bleeding between the brain and membrane that is filled with spinal fluid (arachnoid)
• Brain trauma: Injury to the brain when it hits the inner surface of the skull
• Nerve damage: The breakage of nerve cell branches in the brain
• Hypoxia: A lack of oxygen to the brain
• Retinal hemorrhage: Bleeding in the retina of the eye
• Skull fracture: Bone fracture resulting from the impact of the baby’s head hitting a hard surface

Shaken Baby Syndrome Symptoms

The symptoms of shaken baby syndrome may be challenging to detect. They can occur right away or hours later. Shaken baby syndrome is often not reported.

Symptoms of shaken baby syndrome vary depending on the severity of the injury and may include:

• Drowsiness
• Irritability 
• Seizures
• Vomiting
• Loss of appetite 
• Trouble sucking or swallowing
• Slow or stiff movements 
• Dilated pupils
• Trouble focusing eyes 
• Inability to lift head 
• Arched back
• Trouble breathing 
• Pale or blue skin 
• Coma 

Causes

Shaken baby syndrome is caused by a parent or caregiver shaking an infant or young child. It can occur in children of all ages but is usually seen before age 1. The average age of an infant with shaken baby syndrome is between 3 and 8 months.

Shaken baby syndrome usually occurs when a parent or caregiver becomes frustrated by a baby’s prolonged crying. In most cases, the caregiver does not intend to harm the child. Families who are at higher risk of shaken baby syndrome may have the following:

• A baby with special needs
• A baby who cries a lot because of a health condition like colic or gastroesophageal reflux disease (GERD)
• Parents experiencing high levels of stress
• Parents experiencing domestic abuse 
• Parents experiencing substance use disorder

Diagnosis

Diagnosing shaken baby syndrome may be difficult because it often goes unreported. To determine if an infant or young child experienced this type of abuse, a healthcare provider will perform the following tests:

• Physical exam: To look for signs of trauma, such as bruising
• Eye exam: To look for bleeding in the retinas of the eyes 
• X-ray: To look for bone breaks or fractures 
• Computed tomography (CT) scan of the head: To look for swelling or brain injury
• Magnetic resonance imaging (MRI) of the brain: To look for swelling or brain injury

Treatment

Treatment for shaken baby syndrome depends on what type of injury was sustained and how severe it is. If there is swelling in the brain, surgery may be needed.

Several healthcare providers may be involved in treating shaken baby syndrome, including:

• Neurologist
• Neurosurgeon
  
• Ophthalmologist
• Endocrinologist
• Speech pathologist
• Physical therapist
• Occupational therapist

Prevention

Preventing abuse is the only way to protect a baby from shaken baby syndrome. For parents and caregivers, it can help to have a list of coping strategies to try whenever they are feeling stressed or angry. These include:

• Deep breathing for a few minutes 
• Slowly counting to 10
• Swaddling, rocking, or singing to the baby 
• Putting the baby in a safe place (like the crib) and walking away for a few minutes
• Placing the baby down when arguing or feeling upset
• Calling a trusted friend for help
• Calling a healthcare provider 
• Contacting a local crisis line 
• Only leaving the baby with a trusted caregiver
• Taking parenting classes
• Meeting with a mental health provider 

It may be helpful for caregivers to remember that crying is normal. It is the only way that babies have to communicate. 

Another way parents can prevent shaken baby syndrome is by carefully choosing the caregivers they leave their child with when they are away. When meeting with a potential caregiver, take the following steps:

• Observe how the caregiver interacts with your baby.
• Request a background check.
• Verify that the caregiver is certified or licensed.
• Check the caregiver’s references.

Prognosis 

The prognosis for shaken baby syndrome depends on how severe the injuries are. Shaken baby syndrome is serious, and the prognosis is usually poor. Possible complications of shaken baby syndrome include:

• Seizures
• Vision loss
• Hearing loss
• Speech difficulties 
• Delayed development 
• Weakness 
• Hormonal imbalance 
• Cerebral palsy
• Paralysis 
• Death 

Summary 

Shaken baby syndrome is a severe form of child abuse. It occurs when a parent or caregiver shakes a baby out of frustration or anger. When shaken, a baby’s brain moves back and forth, hitting the skull. This can lead to several serious injuries and cause long-term brain damage or even death.

Shaken baby syndrome may be difficult to diagnose because it often goes unreported. Treatment depends on the severity of the injuries. To prevent shaken baby syndrome, never shake an infant or young child.