syndrome (SBS) is a form of child abuse. It refers to brain injury that happens
to the child. It occurs 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
Some experts use the term shaken-impact syndrome,
because injury from throwing a child against a surface can equal that of
shaking. Many doctors use the term "abusive head trauma" or "intentional head
Shaken baby syndrome often occurs when a baby won't stop
crying and a caregiver who is frustrated shakes the baby. 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
Shaken baby syndrome occurs mostly in children younger
than 3. It 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
Shaking or throwing
a child, or slamming a 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:
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
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.
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. Sadly, you may not find out that shaken
baby syndrome caused your child’s injury until repeated abuse or more severe
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
CT scan, or an
MRI can look for bleeding problems or other
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
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.
A child with shaken baby
syndrome needs to be in the hospital, sometimes in an intensive care unit
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
Depending on the symptoms, doctors may try seizure
medicine, physical therapy, or other treatments.
Children can die from their injuries. Those who survive
may have brain and vision problems that can last forever. These problems can
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shaken baby syndrome may appear right away or within
several days. The child's age, the number of abusive episodes, and degree of
force used are the main factors that affect when symptoms appear and how severe
they are. Trust your instincts if something doesn't seem right with your
Vague symptoms may include
irritability, sluggishness, vomiting, and a poor appetite. At first, caregivers
and doctors may assume that these symptoms are related to a common illness such
flu. If these symptoms are more severe,
meningitis may be suspected.
In the most severe cases, a child
loses consciousness or stops breathing right after
being shaken or thrown. The caregiver may attempt to perform
cardiopulmonary resuscitation (CPR) and later claim
that the CPR caused the child's injuries. The caregiver responsible for the
abuse may put the child to bed, hoping the condition will improve after the
child rests. By the time the caregiver seeks medical attention, the child may
be comatose and unable to suck, swallow, smile, make sounds, or follow the
movement of an object with his or her eyes. The child may also have great
difficulty breathing or may completely stop breathing, have a slow
heart rate, and require CPR. These children usually
either die or have long-lasting problems from severe brain injury.
Bleeding inside one or both eyes is
a common symptom of shaken baby syndrome that can be detected by a pediatric
eye specialist (ophthalmologist). Also, a child may have broken bones, often in
the ribs or arms and legs, from violent shaking. Sometimes a child will have
signs of other types of physical abuse, such as bruises or burns.
Sadly, some children who are
forcefully shaken or thrown die from their injuries. Those who live may have
brain damage and one or more of the following problems:
Shaken baby syndrome can be difficult to diagnose. The diagnosis can be complicated
Doctors may suspect shaken baby syndrome when the adults
are vague or misleading about what has happened to the child, especially when
symptoms are severe and indicate intentional head injury. Diagnosis is
A child may have blood tests to rule out other conditions,
such as rare blood disorders and metabolic conditions, or to check for internal injuries.
Each state has its own reporting
child abuse or neglect, which includes shaken baby
syndrome. In general, a doctor who suspects shaken baby
syndrome must notify local child welfare officials and law enforcement
agencies. The person who is suspected of injuring the baby is then questioned
and evaluated along with anyone else who provided care for the child. Any other
children who were cared for by the suspect should be examined. Older children
are interviewed. Children age 3 years and younger should have skeletal X-rays
The authorities' primary goal is to protect the baby and
other children in the home from further injury. The person who caused the
injury may be legally charged and tried for assault.
A child with
shaken baby syndrome is admitted to a hospital for
observation and treatment. Doctors will closely monitor the child. They watch
for signs of brain swelling and difficulty breathing, which can lead to the
death of brain cells or a
stroke. If signs of these problems occur, the child is
admitted to an intensive care unit (ICU) where he or she is treated with
oxygen therapy and/or a
neurosurgeon may treat the bleeding and swelling in
the brain. Sometimes surgery is needed.
Other treatment depends on
the child's specific injuries. For example, a cast is applied to any broken
bones and cuts are stitched or bandaged. A child who has
seizures is evaluated by a
neurologist who may prescribe anticonvulsant medicine.
Other types of specialists assess, treat, and monitor children who have
long-term care issues, such as those related to
intellectual disabilities or physical disabilities.
Other children in the care of the suspected abuser must be protected and
examined for injury.
A wide variety of
counseling therapies may be used for both children and
parents. Specific treatment depends on the type of abuse, who inflicted it, in
what setting it occurred, and the child's age. Health and legal professionals
work as a team to develop the most effective program using their training,
experience, judgment, and creativity.
Parents may regain custody
of their children after they have lost guardianship because of child abuse or
neglect. Whether they do so depends on the severity of the abuse or neglect and
a professional evaluation of their rehabilitation progress. In severe cases,
future contact between parent and child must be supervised. Sometimes parents
lose all parental rights.
Intentional injury is a crime. Police
perform site investigations and interview other caregivers. If intentional
injury is suspected, the child's caregiver will be charged and tried in a
Keep in mind that the types of falls that occur during
normal play, from an infant swing, from a low surface such as an adult bed or
couch, or even down stairs, will not cause shaken baby syndrome. It is the
violent shaking, throwing, or slamming of a child that results in this type of
injury. Although caregivers often first state that these types of scenarios
have caused a child's injuries, most later confess to having shaken or slammed
a baby against an object.
The National Center on Shaken Baby Syndrome is a
worldwide nonprofit organization that provides information to professionals and
parents about recognizing and preventing this form of child abuse.
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders.
The American Academy of Pediatrics (AAP) offers a
variety of educational materials about parenting,
general growth and development, immunizations, safety, disease prevention, and more. AAP guidelines for various conditions and links to other
organizations are also available.
The Child Welfare Information Gateway is a national
resource for people seeking information about how to prevent, identify, and
treat child abuse and neglect. The Web site has information about family
support services, fostering and adopting a child, and child welfare issues.
There are also links for many toll-free crisis hotline numbers.
The Shaken Baby Alliance supports families and
professionals in the fight against Shaken Baby Syndrome/Abusive Head Trauma and
other forms of child abuse. The Alliance offers printed materials and support
services by phone.
Other Works ConsultedAmerican Academy of Pediatrics (2007, reaffirmed 2012). Evaluation of suspected child physical abuse. Pediatrics, 119(6): 1232–1241. Also available online: http://pediatrics.aappublications.org/content/119/6/1232.full.American Academy of Pediatrics (2008). Promoting mental health. In Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd ed., pp. 77–107. Elk Grove Village, IL: American Academy of Pediatrics.Braverman RS (2012). Eye. In WW Hay Jr et al., eds., Current Diagnosis and Treatment: Pediatrics, 21st ed., pp. 424–464. New York: McGraw-Hill.Saunders BE, et al., eds. (2004). Child Physical and Sexual Abuse: Guidelines for Treatment (Revised). Charleston, SC: National Crime Victims Research and Treatment Center. Also available online: http://academicdepartments.musc.edu/ncvc/resources_prof/ovc_guidelines04-26-04.pdf.The Arc (accessed October 2012). Shaken Baby Syndrome. Silver Spring. MD: The Arc. Available online: http://www.thearc.org/page.aspx?pid=2549.
February 16, 2011
John Pope, MD - Pediatrics & Thomas Emmett Francoeur, MD, MDCM, CSPQ, FRCPC - Pediatrics
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