Shaken Baby Syndrome

Shaken Baby Syndrome is also known as Abusive Head Trauma. This can take place within the home by relatives, friends, and Care Givers in a Day Care Situation, or a Home Day Care.

According to Wilkepia: Shaken baby syndrome (SBS), also known as abusive head trauma (AHT), is an injury to a child’s head caused by someone else.[1] Symptoms may range from subtle to obvious.[1] Symptoms may include vomiting or a baby that will not settle.[1] Often there are no visible signs of trauma.[1] Complications include seizures, visual impairment, cerebral palsy, and cognitive impairment.[2][1]

The cause may be blunt trauma or vigorous shaking.[1] Often this occurs as a result of a caregiver becoming frustrated due to the child crying.[3] Diagnosis can be difficult as symptoms may be nonspecific.[1] A CT scan of the head is typically recommended if a concern is present.[1] While retinal bleeding is common, it can also occur in many other conditions.[1] Abusive head trauma is a type of child abuse.[4]

Educating new parents appears to be beneficial in decreasing rates of the condition.[1] Treatment occasionally requires surgery, such as to place a cerebral shunt.[1] SBS is estimated to occur in 3 to 4 per 10,000 babies a year.[1] It occurs most frequently in those less than five years of age.[3] The risk of death is about 25%.[3] The diagnosis includes retinal bleeds, multiple fractures of the long bones, and subdural hematomas (bleeding in the brain).[5] These signs have evolved through the years as the accepted and recognized signs of child abuse. Medical professionals strongly suspect shaking as the cause of injuries when a young child presents with retinal bleed, fractures, soft tissue injuries or subdural hematoma, that cannot be explained by accidental trauma or other medical conditions.[6]

Retinal bleeds occur in around 85% of SBS cases; the type of retinal bleeds are often believed to be particularly characteristic of this condition, making the finding useful in establishing the diagnosis, although this finding is based on circular reasoning and other studies have found that patterns of retinal bleeding cannot be used to make diagnoses.[7] While there are many other causes of retinal bleeds besides SBS, there are usually additional findings (eyes or systemic) which make the alternative diagnoses apparent[citation needed] although again, this claim is based on circular reasoning [8].

Fractures of the vertebrae, long bones, and ribs may also be associated with SBS.[9] Dr. John Caffey reported in 1972 that metaphyseal avulsions (small fragments of bone torn off where the periosteum covering the bone and the cortical bone are tightly bound together) and “bones on both the proximal and distal sides of a single joint are affected, especially at the knee”.[10]

Infants may display irritability, failure to thrive, alterations in eating patterns, lethargy, vomiting, seizures, bulging or tense fontanels (the soft spots on a baby’s head), increased size of the head, altered breathing, and dilated pupils, although all these conditions can have alternative causes, and so cannot be used to make a diagnosis of abuse.[11]

Shaken baby syndrome destroys a child’s brain cells and prevents his or her brain from getting enough oxygen. Shaken baby syndrome is a form of child abuse that can result in permanent brain damage or death. Shaken baby syndrome is preventable. Help is available for parents who are at risk of harming a child. Parents also can educate other caregivers about the dangers of shaken baby syndrome.

Shaken baby syndrome is a serious brain injury caused by forcefully and violently shaking a baby. Other names for this condition include abusive head trauma, shaken impact syndrome, and whiplash shake syndrome. Shaken baby syndrome is a form of child abuse that causes severe brain damage. It can result from as little as five seconds of shaking.

Babies have soft brains and weak neck muscles. They also have delicate blood vessels. Shaking a baby or young child can cause their brain to repeatedly hit the inside of the skull. This impact can trigger bruising in the brain, bleeding in the brain, and brain swelling. Other injuries may include broken bones as well as damage to the baby’s eyes, spine, and neck.

Shaken baby syndrome is more common in children under age 2, but it can affect children up to age 5. Most cases of shaken baby syndrome occur among infants that are 6 to 8 weeks old, which is when babies tend to cry the most.

Playful interaction with an infant, such as bouncing the baby on the lap or tossing the baby up in the air, won’t cause the injuries associated with shaken baby syndrome. Instead, these injuries often happen when someone shakes the baby out of frustration or anger.

You should never shake a baby under any circumstances. Shaking a baby is a serious and deliberate form of abuse. Call 911 right away if you believe that your baby or another baby is a victim of shaken baby syndrome. This is a life-threatening condition that requires immediate medical treatment.
What are the symptoms of Shaken Baby Syndrome?

Symptoms of Shaken Baby Syndrome May Include:

• difficulty staying awake
• body tremors
• trouble breathing
• poor eating
• vomiting
• discolored skin
• seizures
• coma
• paralysis

Call 911 or take your baby to the nearest emergency room immediately if they are experiencing symptoms of shaken baby syndrome. This type of injury is life threatening and can result in permanent brain damage.

What Causes Shaken Baby Syndrome?

Shaken baby syndrome occurs when someone violently shakes an infant or toddler. People may shake an infant out of frustration or anger, often because the child won’t stop crying. Although shaking does eventually make the baby stop crying, it’s usually because the shaking has damaged their brain.
Babies have weak neck muscles and often have difficulty supporting their heads. When an infant is forcefully shaken, their head moves uncontrollably. The violent movement repeatedly throws the baby’s brain against the inside of the skull, causing bruising, swelling, and bleeding.

How is Shaken Baby Syndrome Diagnosed?

To make a diagnosis, the doctor will look for the three conditions that often indicate shaken baby syndrome. These are:

• encephalopathy, or brain swelling
• subdural hemorrhage, or bleeding in the brain
• retinal hemorrhage, or bleeding in a part of the eye called the retina

The doctor will order a variety of tests to check for signs of brain damage and to help confirm the diagnosis. These tests may include:

• MRI scan, which uses powerful magnets and radio waves to produce detailed images of the brain
• CT scan, which creates clear, cross-sectional images of the brain
• skeletal X-ray, which reveals spine, rib, and skull fractures
• ophthalmic exam, which checks for eye injuries and bleeding in the eyes

Before confirming shaken baby syndrome, the doctor will order a blood test to rule out other potential causes. Some symptoms of shaken baby syndrome are similar to those of other conditions. These include bleeding disorders and certain genetic disorders, such as osteogenesis imperfecta. The blood test will determine whether or not another condition is causing your child’s symptoms.

How Is Shaken Baby Syndrome Treated?

Call 911 immediately if you suspect your child has shaken baby syndrome. Some babies will stop breathing after being shaken. If this occurs, CPR can keep your baby breathing while you wait for medical personnel to arrive.

The American Red Cross recommends the following steps to perform CPR:

• Carefully put the baby on their back. If you suspect a spinal injury, it’s best if two people gently move the baby so the head and neck don’t twist.
• Set up your position. If your infant is underage 1, put two fingers on the middle of the breastbone. If your child is over age 1, place one hand on the middle of the breastbone. Put your other hand on the baby’s forehead to keep the head tilted back. For a suspected spinal injury, pull the jaw forward instead of tilting the head, and don’t let the mouth close.
• Perform chest compressions. Press down on the breastbone and push about halfway into the chest. Give 30 chest compressions without pausing while counting out loud. The compressions should be firm and fast.
• Give rescue breaths. Check for breathing after the compressions. If there’s no sign of breathing, tightly cover the baby’s mouth and nose with your mouth. Make sure the airway is open and give two breaths. Each breath should last about one second to make the chest rise.
• Continue CPR. Continue the cycle of 30 compressions and two rescue breaths until help arrives. Be sure to keep checking for breathing.

In some cases, the baby may vomit after being shaken. To prevent choking, gently roll the baby onto their side. Make sure to roll their entire body at the same time. If there’s a spinal cord injury, this method of rolling reduces the risk of further damage to the spine. It’s important that you don’t pick up the baby or give the baby food or water.

There’s no medication to treat shaken baby syndrome. In severe cases, surgery may be required to treat bleeding in the brain. This may involve placement of a shunt, or thin tube, to relieve pressure or to drain excess blood and fluid. Eye surgery may also be needed to remove any blood before it permanently affects vision.

Risk factors

The following things may make parents or caregivers more likely to forcefully shake a baby and cause shaken baby syndrome:

• Unrealistic expectations of babies
• Young or single parenthood
• Stress
• Domestic violence
• Alcohol or substance abuse
• Unstable family situations
• Depression
• A history of mistreatment as a child

Outlook for Children with Shaken Baby Syndrome

Irreversible brain damage from shaken baby syndrome can occur in a matter of seconds. Many babies experience complications, including:

• permanent vision loss (partial or total)
• hearing loss
• seizure disorders
• development delays
• intellectual disabilities
• cerebral palsy, a disorder that affects muscle coordination and speech

How Can Shaken Baby Syndrome Be Prevented?

According to Mayo Clinic: Prevention New parent education classes can help parents better understand the dangers of violent shaking and may provide tips to soothe a crying baby and manage stress. When your crying baby can’t be calmed, you may be tempted to try anything to get the tears to stop — but it’s important to always treat your child gently. Nothing justifies shaking a child. If you’re having trouble managing your emotions or the stress of parenthood, seek help. Your child’s doctor may offer a referral to a counselor or other mental health provider. If other people help take care of your child — whether a hired caregiver, sibling or grandparent — make sure they know the dangers of shaken baby syndrome.

By Mayo Clinic Staff Prevention

New parent education classes can help parents better understand the dangers of violent shaking and may provide tips to soothe a crying baby and manage stress. When your crying baby can’t be calmed, you may be tempted to try anything to get the tears to stop — but it’s important to always treat your child gently. Nothing justifies shaking a child. If you’re having trouble managing your emotions or the stress of parenthood, seek help. Your child’s doctor may offer a referral to a counselor or other mental health provider. If other people help take care of your child — whether a hired caregiver, sibling or grandparent — make sure they know the dangers of shaken baby syndrome.

By Mayo Clinic Staff

Shaken baby syndrome is preventable. You can avoid harming your baby by not shaking them under any circumstances. It’s easy to become frustrated when you can’t get your baby to stop crying. However, crying is a normal behavior in infants, and shaking is never the right responseIt’s important to find ways to relieve your stress when your child cries for extended periods of time. Calling a family member or a friend for support can help when you feel yourself losing control. There are also some hospital-based programs that can teach you how to respond when infants cry and how to manage the stress of parenting. These programs can also help you identify and prevent the injuries associated with shaken baby syndrome. Make sure your family members and caregivers are also aware of the dangers of shaken baby syndrome. If you suspect that a child is the victim of child abuse, do not ignore the problem. Call the local police or the Childhelp National Child Abuse Hotline: 1-800-4-A-CHILD.

Medically reviewed by Janine Kelbach, RNC-OB — Written by Valencia Higuera on January 10, 2016

What is the #1 Reason a Baby is Shaken?

The number one reason given for shaking a baby is, “I just wanted the crying to stop.” Shaking usually occurs when parents, babysitters or other caregivers become frustrated and lose control because of persistent crying.
Canadian research has shown that the babies who are shaken are most often male and under six months of age. The research also identified biological fathers, stepfathers and male partners of biological mothers as more likely to shake an infant. Female babysitters and biological mothers are also known to shake babies.

What is the Witching Hour Baby?

Witching hour usually starts in the late afternoon and lasts into the early evening (5:00 – 11:00pm). It’s when your newborn starts to fuss, and then that fuss turns into crying, and that crying turns into screaming.

What is the Witching Hour?

Before we dive into my top tips for surviving witching hour, let’s talk about what it is. Witching hour usually starts in the late afternoon and lasts into the early evening (5:00 – 11:00pm). It’s when your newborn starts to fuss, and then that fuss turns into crying, and that crying turns into screaming. This can go on for hours…yes, I said hours, and while some little ones can be soothed by eating or being held, others may seem inconsolable.

The witching hour typically begins around 2 – 3 weeks after your baby’s due date, it peaks at 6 weeks, and then it is usually resolved by 3 – 4 months. Some parents interchange the terms colic and the witching hour. Colic is defined as episodes of crying for more than three hours a day, for more than three days a week, for three weeks in a row. The witching hour can be an intense case of the witching hour so some of these tips in this article may help with colicky babies as well. If you cannot seem to soothe your child after trying these tips, and you suspect they are actually colicky then consult further with your pediatrician.

Why Does the Witching Hour Occur?

One good way to get a better grip on this whole witching hour thing is to understand why it happens in the first place. Here are five potential causes.

1. Overstimulation: If your baby had been overstimulated throughout the day, it can cause fussiness and irritability. Newborns can only handle so much stimulation at one time, so too much noise, or even too much light can make the witching hour worse.
2. Overtired: An overtired baby is often an unhappy baby, and at the end of the day, your little bundle of joy may be completely overtired from the events of the day. If your baby has missed a nap or two over the previous days, this can lead to exhaustion which can quickly lead to fussing at the end of the day.
3. Stomach Discomfort: Gas or acid reflux can certainly contribute to the witching hour, and this is especially true for very young babies with immature digestive systems.
4. Cluster Feeding: Newborns tend to cluster feed at night as a way to prepare for a longer stretch of sleep. Your baby may become fussy during the evening when they are demanding what seems like one feed right after another. Remember that this phase may be frustrating, but it is also temporary!
5. The Busy Evening Routine: Typically evening routines get busy. The older kids get home from school, both parents are home from work, and dinner needs to be made. With everything that needs to get done, your baby may feel like he or she needs to demand more attention from mom or dad leading to that evening fussy behavior.

Getting fresh air can help during witching hours.

6 Tips on Surviving the Witching Hour

Now that we know what witching hour is, and some of the reasons it may be happening, let’s take a look at my tips on how you can survive it all while keeping your sanity!

1. Focus in on Your Current Nap Schedule: Nap schedules change frequently as your baby gets older, but if your newborn tends to scream for hours on end in the evening, it may have something to do with how long they nap. It’s important to keep your baby well rested, as a well-rested baby sleeps better. If your baby missed a nap, and you have things that need to be done around the house, try baby wearing. Your little one can catch a quick nap while you carry on with your evening routine.
2. Eliminate Background Noise: If your baby is overstimulated, reducing background noise may be just the trick to creating a calming environment to help relax your baby. Dim the lights, turn off the TV and go to a quiet room to feed. A calming environment and a full belly may be just what your baby needs during the witching hour.
3. Go with the flow: When it comes to having a newborn, letting go of certain expectations, and just going with the flow can help reduce some of the pressure new moms put on themselves. Accept that cluster feeding will happen and that it’s totally normal! Cluster feeding can help comfort your baby, and you may even get more sleep after your baby tanks up on milk for the evening.
4. Evaluate Your Diet: For breastfeeding moms, if you suspect that witching hour is the result of tummy issues, then looking at the foods you are eating may be helpful. Things like milk, caffeine, or spicy foods may cause tummy upset. Frequent burping during and after feeds can also be very helpful for gassy babies.
5. Use White Noise: White noise isn’t only great for sleep, but it can also work wonders during those witching hours. White noise mimics all that noise your little one heard in the womb, so it can be very calming for them. Haven’t you heard the stories about putting on the vacuum or turning on the dryer/washer so your baby calms? These tactics have the same effect baby’s.
6. Go outside: Sometimes just going outside for fresh air and a change of scenery will help your little one. I have seen babies go from crying non-stop during witching hour, to completely calm when outside taking a walk while Mom/Dad baby wears or puts the baby in a stroller.

If you have tried implementing these steps, and are still struggling during those late afternoon and early evening hours, then ask yourself, does your baby seem unhappy most of the time? Is she constantly crying and refusing to eat? Does she seem uncomfortable? If you said yes, then these could be signs of reflux. My advice: contact your pediatrician immediately. Lastly, take a breath, and repeat after me. Witching hour does not last forever! While you are in the thick of it, it may seem like it will never end, but it does. This is just a phase. The nervous system is immature and this too shall pass.

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