The Leading Cause Of Death In Child Abuse Cases In The U.S.
What is Shaken Baby Syndrome?
Shaken Baby Syndrome (also known as whiplash-shaken infant) is a severe form of head injury caused by the rebound of the baby's brain in its skull when shaken. SBS is the most common and is considered a very serious form of child abuse. The syndrome results from injuries caused by someone vigorously shaking an infant or child back and forth in a "whiplash" motion with repeated force. The average age of victims is between 3 months and 8 months and 60% of shaken babies are male and children of families who live at or below poverty level; however, child abuse occurs in all strata of society.
Although SBS most frequently occurs in children under 1 year of age, there have been documented cases of SBS in children as old as 5 years of age. A baby's head is large and heavy in proportion to the baby's body and there is a space between the brain and the skull to allow for growth and development. When someone forcefully shakes a baby, the child's head rotates about uncontrollably because the infant's neck muscles are not well developed and provide little support for the head. This forceful movement tosses the infant's brain back and forth within the skull causing bruising of the brain, swelling, rupturing of the nerves, tearing of the brain tissue and bleeding. As the blood pools between the skull and a tough fibrous membrane that lies next to the brain, blood collections (or blood clots) are formed. These blood collections produce pressure that along with the natural swelling of the bruised brain causes irreversible damage to the brain cells.
In addition, the swelling and pressure causes the brain to push and squeeze down on the brainstem, which controls vital functions such as breathing and heartbeat. If the swelling and pressure are not controlled, the vital functions will cease and the child will die.
What are the Symptoms?
Symptoms of a child that has been forcefully shaken can range from very mild changes in behavior, irritability, lethargy, loss of consciousness, pale or bluish skin and vomiting to more serious symptoms of breathing difficulties, seizures, coma and death. Children that exhibit any of these symptoms or you suspect has sustained this type of injury should receive immediate medical attention. The earlier the child receives treatment, the better its chances are of surviving.
To diagnose SBS, doctors look for hemorrhages in the retinas of the eyes, skull fractures, swelling of the brain, blood collections pressing on the surface of the brain, rib and long bone (bones in the arms and legs) fractures, and bruises on or around the head, neck and chest. Dr. Allan DeJong, the medical director of the Children at Risk Evaluation (CARE) team at the Alfred I. Du Pont Hospital for Children says, "When you shake your baby hard enough to give them these injuries, you know you've crossed the line. This is something violent."
What are the consequences?
SBS often has irreparable consequences. The death rate is between 1 and 2 in every 4 children. A child who survives may suffer partial or total blindness, hearing loss, seizures, developmental delays, mental retardation, speech and learning difficulties, problems with memory and attention or paralysis. Some particularly traumatic episodes may leave children in a coma.
Even in milder cases, where the baby looks normal immediately after shaking, he may eventually develop one or more of these problems. In some instances the first sign of a problem doesn't turn up until the child is of preschool age and begins to encounter some of the learning difficulties or exhibit behavioral problems. By that time, however, it is hard to link these problems to a shaking incident.
"Because the infant's brain has little stored information and few developed capacities to make up for the deficit, the brain's adaptive abilities are substantially impaired", says Jane Crowley, a rehabilitation psychologist. For example, a child whose vision is severely impaired will not be able to learn through observation, which decreases his ability to learn. The development of language, vision, balance and motor coordination, all of which occur to varying degrees after birth, are particularly vulnerable to SBS. Any such impairment can require extensive therapy to help the child develop the skills that they would have developed on their own had the brain injury not occurred.
Early Childhood Intervention (ECI) is a program for children ages 0-3 years of age that have developmental delays. The hospital social services area should be able to give you the phone number to the ECI office in your area. ECI should be contacted promptly in order to arrange for services for the SBS child. The child will be evaluated in order to determine what services the child is eligible for. After the child turns 3, it is the school district's responsibility to provide additional special educational services.
While the consequences of SBS are horrifying, it is important to remember that the syndrome is completely preventable. Parents or caregivers, are almost always the perpetrators in SBS cases. Usually, this person shakes the baby out of mere frustration because the child will not stop crying. It is estimated that in 65% to 90% of the cases, the usual perpetrators are males generally in their early 20's, either the child's father or mother's boyfriend.
Unfortunately, shaking the baby has the desired effect: although the baby cries more out of fear, he eventually stops crying and suffers permanent or terminal brain damage. An important element of the victim of abuse is helplessness, and the lack of ability to interrupt the process. Young infants tend to receive the most serious injuries when abused, and virtually all of the deaths from abuse of young children occur under 3 years of age.
One approach to preventing maltreatment is to provide preventive sources to families of infants who are at risk for such problems. Finding alternative ways to deal with the caregiver's stress at these critical moments will significantly reduce the risk to the child.
For further information about SBS or a list of alternative ways to console a crying child, go to AllHealthNet.com. This is a global health and medical search engine where you can find numerous links that contain quality health and medical information related to SBS.