Statistics
An estimated 1,500-3,000 children are diagnosed  each year.  However, it is important to note that it has been found that 30% of the cases are initially missed.   In addition, there currently isn't a national data base collection system to record cases., although a few states have implemented their own through their state Department of Health.     Therefore, it is difficult to know how many actual cases have occurred. 

Mechanism of Injury
Children are typically held by the arms or trunk and shaken in a back and forth motion with repeated force. (4,5) When a child is shaken, delicate veins between the brain and skull are ruptured and begin to bleed. As blood pools between the skull and the dura (a tough fibrous membrane that lies next to the brain), subdural hematomas are formed. The subdural hematomas produce pressure that along with the natural swelling (edema) of the  brain causes damage to brain cells. Once brain cells are damaged, they are never regenerated or replaced. 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 by getting emergency medical care, the child can die. 

The American Academy of Pediatrics, has stated that "the act of shaking leading to shaken baby syndrome is so violent that individuals observing it would recognize it as dangerous and likely to kill the child...injuries are the result of violent trauma." (6)
 

Symptoms
The symptoms can range from very mild forms of irritability, poor feeding, vomiting, and lethargy to the more serious symptoms of breathing difficulties, seizures, coma, and death. Children that have any of these symptoms, should receive immediate medical attention. In one study, it was found that even the most serious  cases were missed up to 30% of the time by physicians.(7) If a child continues to exhibit any of the symptoms above and visits have been made to the pediatrician with no resolution, it is important that parents or other caregivers  be assertive in requesting that the  child have the proper tests to rule out the possibility of shaken baby syndrome.

 Diagnosis
A CT (computerized tomography) scan or MRI (magnetic resonance imaging), both imaging of the head, are used to detect the presence of subdural hematomas. A physician will be looking for old bleeding (chronic subdural hematomas) as well as new bleeding (acute subdural hematoma). An eye exam, which includes dilating the eyes and examining them, is also used to detect any bleeding within the eye (retinal hemorrhages). The presence of brain injury, intracranial bleeding, and retinal hemorrhages in the absence of a credible history of severe accidental head trauma confirm the diagnosis of SBS.  In all cases, x-rays (skeletal surveys) should be done on the rest of the body to determine if there are any past or present bone fractures.

 Prognosis
Previous studies suggest that 15-30% of the children die (5,6) and it is estimated that only about 15% escape without any type of permanent damage (8), but a few long-term studies suggest that no child truly escapes shaken baby syndrome.    The remaining survivors often suffer from varying degrees of cerebral palsy, paralysis, mental retardation, epilepsy, visual/hearing impairments, as well as learning and behavioral difficulties. Shaken baby syndrome is a lifetime sentence of disabilities.

 Information Sources
The National Clearinghouse on Child Abuse and Neglect Information (NCCAN) has articles and abstracts on shaken baby syndrome.    For more information, contact our Shaken Baby Syndrome Council member organizations.

References:

1   Mierrisch R.F., Frasier, L.D., Braddock,S.R., Giangiacoma J., Berkenbosch, J.W. "Retinal hemorrhages in an 8-year-old child: an uncommon presentation of abusive injury." Pediatric Emergency Care. Februrary 2004, Vol. 20, No. 2, 118-120.

2  Sandberg M, Barr R: The National Center on Shaken Baby Syndrome research on victim and perpetrator profiles. Presented to the 4th National Conference on Shaken Baby Syndrome. Salt Lake City, UT, September 12, 2002

3  Medoff-Cooper B. "Temperament in very low birth weight infants.  Nurs Res 1986; 35:139-143.

4   Levitt, Carolyn J. M.D., Wilbur L. Smith, Randell C. Alexander. "Abusive Head Trauma." In Child Abuse: Medical Diagnosis and Management. Ed. Robert M. Reece. Pennsylvania: Lea & Febiger. 1994.

5 Chiocca, Ellen M. "Shaken Baby Syndrome: A Nursing Perspective." Pediatric Nursing, January-February 1995, Vol. 21, No. 1, 33-38.

6 Committee on Child Abuse and Neglect, 2001. "Shaken Baby Syndrome: Rotational Cranial Injuries--Technical Report," Pediatrics, July 2001, Vol. 108, No. 1, 206-210.

7 Carole Jenny, MD, MBA; Lt Col Kent P. Hymel, MD, USAF, MC; Alene Ritzen, MD, JD; Steven E. Reinert, MS; Thomas C. Hay, DO. "Analysis of Missed Cases of Abusive Head Trauma," Journal of the American Medical Assn. (JAMA),  Vol. 281, No. 7, February 17, 1999, 621-626.

8  Showers, Jacy EdD, "The National Conference on Shaken Baby Syndrome:   A Medical, Legal, and Prevention Challenge Executive Summary,"  September 1996, 20.

Kim Kang
Copyright 2005