Shaken baby 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 shoulders.
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 injury."
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 syndrome.
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 problems.
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 away.
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.
Doctors 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 harm occurs.
Doctors check for shaken baby syndrome in several ways. They ask for a child’s medical history. They may also do a physical examination and blood tests. Imaging tests such as X-rays, a CT scan, or an MRI can look for bleeding problems or other injury.
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 injury.
Although each province has its own reporting procedure, a health professional who suspects shaken baby syndrome is required to notify local child welfare officials, social services, or the police.
If you suspect child abuse and the child is not in immediate danger, call your local child protection agency 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 (ICU). 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 surgery.
Depending on the symptoms, doctors may try seizure medicine, physiotherapy, 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 include:
Frequently Asked Questions
Learning about shaken baby syndrome:
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Symptoms of 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 child.
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 as the 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 by:
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 confirmed by:
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 province has its own reporting procedures for 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 taken.
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 ventilator. 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 disability or physical disabilities.
Other children in the care of the suspected abuser must be protected and examined for injury.
A wide variety of counselling 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 criminal court.
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.
|Canadian Paediatric Society|
|2305 Saint Laurent Boulevard|
|Ottawa, ON K1G 4J8|
The Canadian Paediatric Society (CPS) promotes quality health care for Canadian children and establishes guidelines for paediatric care. The organization offers educational materials on a variety of topics, including information on immunizations, pregnancy, safety issues, and teen health.
|Ottawa, ON K1A 0K9|
|National Center on Shaken Baby Syndrome|
|1433 North Highway 89|
|Farmington, UT 84025|
Sometimes babies cry at more times than at others. This website from the National Center on Shaken Baby Syndrome (U.S.) offers information to help parents and caregivers understand normal crying behaviour and offers soothing options.
|Public Health Agency of Canada: National Clearinghouse on Family Violence|
|Family Violence Prevention Unit, Public Health Agency of Canada|
|200 Eglantine Driveway, 9th Floor, Jeanne Mance Building|
|Address Locator: 1909D1|
|Ottawa, ON K1A 0K9|
The National Clearinghouse on Family Violence (NCFV) provides information on violence and abuse within the family. Its goal is to increase awareness of family violence so that it can be prevented.
Other Works Consulted
- 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.
- American Academy of Pediatrics (2007). Evaluation of suspected child physical abuse. Pediatrics, 119(6): 1232–1241.
- American Academy of Pediatrics (2008). Shaken baby syndrome section of Promoting mental health. In Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd ed., p. 83. Elk Grove Village, IL: American Academy of Pediatrics.
- Bennett S, et al. (2007). Multidisciplinary Guidelines of the Identification, Investigation and Management of Suspected Abusive Head Trauma, pp. 1–20. Ottawa: Canadian Paediatric Society.
- Braverman RS (2011). Abusive head trauma and nonaccidental trauma. In WW Hay Jr et al., eds., Current Diagnosis and Treatment: Pediatrics, 20th ed., pp 412. New York: McGraw-Hill.
- Public Health Agency of Canada (2002). Joint statement on shaken baby syndrome. Available online: http://www.phac-aspc.gc.ca/dca-dea/publications/jointstatement_web-eng.php.
- The Arc (2004). Shaken Baby Syndrome. Silver Spring, MD: The Arc. Available online: http://www.thearc.org/document.doc?&id=150.
|Primary Medical Reviewer||John Pope, MD - Pediatrics|
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Specialist Medical Reviewer||Thomas Emmett Francoeur, MD, MDCM, CSPQ, FRCPC - Pediatrics|
|Last Revised||April 13, 2011|
Last Revised: April 13, 2012
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