Shaken Baby Syndrome: Symptoms, Risk Factors and Treatment

Shaken baby syndrome is a type of abusive brain injury that occurs when the infant or toddler is violently shaken by his arms, shoulder or legs. The repeated acceleration and deceleration force can cause hemorrhage in brain and in retina of eye. Sometimes there may be associated multiple fractures in long bones without any external evidence of head injury.

When the infant is violently shaken the brain inside the skull bounces back and forth. This action can damage to the brain. It leads to swelling and subdural hemorrhage. Shaken baby syndrome is serious as it can cause blindness, hearing loss, mental retardation etc. Most cases of shaken baby syndrome occur because of parents or caregivers who shake the infant violently out of frustration or stress etc. This condition is preventable if parents is counseled and educated about the danger of vigorously shaking their child.

Causes of Shaken Baby Syndrome:

Shaken baby syndrome mostly occurs in infants, especially below 4 to 5 months. In infants the neck muscles are not strong enough and hence the baby struggles to hold his neck.

If the infant is forcefully shaken, his brain may hit against the wall of his skull. This will lead to bruising and hemorrhage in the subdural space. In majority of cases it is either a parent or the caregiver who shakes the child violently. It is often out of anger, irritation and frustration because the child is not stopping crying. Sometimes stress and depression in parents or caregivers may be blamed. The child is at greater risk if the parent is known to have past history of child abuse. According to statistics, men are more blamed to cause shaken baby syndrome, especially young men. However, even mothers and caregivers are also known to be guilty of shaking the baby violently.

Parents having these risk factors are more likely to abuse their infants that may result in shaken baby syndrome.

• Parents have unrealistic expectation from the child
• Parent who lives in social isolation.
• With psychiatric problem.
• Person himself has past history of experiencing child abuse at the hands of others.
• Parent having habit of substance abuse or alcoholism
• The child who is crying constantly in at greater risk of this condition.
• Twin babies or disabled child.

Symptoms of Shaken Baby Syndrome:

The infant or the child who is vigorously shaken and if he has suffered internal brain damage, he may present with following symptoms:

• Repeated profuse vomiting, sometime even projectile vomiting
• Increased irritation
• Feeding problem
• Seizures
• Breathlessness
• Bulging fontanel and large forehead. Fontanel is a soft groove that is felt when you touch baby’s scalp. Due to swelling the fontanel will become pronounced and bulging.
• The child is not able to lift his neck.
• Tremors
• Unconsciousness
• Coma

Shaken baby syndrome can have grave consequences that may be permanent at times. These complications may be caused due to injury to the brain. Mental retardation, blindness due to damage to the retina, seizures, hearing loss, damage to the spinal cord, fracture of long bones etc are some of the complications that may arise from shaken baby syndrome.

Treatment Options:

Shaken baby syndrome is difficult to diagnose as the pediatrician in majority of cases may not know whether violent shaking was involved to produce symptoms of this condition. If suspected several tests will help to recognize the damage and its intensity. MRI of brain, X-ray, retinal examination etc are few important medical and radiological tests that may be useful.

Shaken baby syndrome needs urgent medical attention. The caregiver or parent whoever concerned must take the child to emergency room if the infant has been violently shaken. Most often the adult may not tell the truth. They may inform the doctor that the baby has fallen. Treatment is started depending on the symptoms. In case of acute symptoms the child needs to be admitted and given all the necessary primary treatment to stabilize the vital signs such as breathing, pulse and heart rate etc. If there is severe bleeding in the brain, surgery may be needed to stop the bleeding. Sometimes the symptoms may develop later in life such as attention deficit, behavioral problem etc.