Frequently Asked Questions
Back What is Shaken Baby Syndrome/Abusive Head Trauma (SBS/AHT)?
The American Academy of Pediatrics describes Shaken Baby Syndrome as: a term often used by physicians and the public to describe abusive head trauma inflicted on infants and young children. Although shaking an infant has the potential to cause neurologic injury, blunt impact or a combination of shaking and blunt impact cause injury as well.
What happens to the brain during a shaking event?
An infant's brain has a higher water content and less myelination than an adult brain and is more gelatinous and is easily compressed and distorted within the skull during a shaking episode. When shaken, the brain rotates relative to a more stationary skull, creating rotational and angular forces of the head. The lag time between the movement of the skull and the brain creates stress and tearing of blood vessels. The vessel injury leads to brain bleeding, or subdural hemorrhages.
What are subdural hemorrhages?
A subdural hematoma, or hemorrhage, is usually caused by a head injury strong enough to burst blood vessels. This can cause pooled blood to push on the brain. Trauma to the head tears blood vessels that run along the surface of the brain.
How much force is necessary to cause injuries in Shaken Baby Syndrome/Abusive Head Trauma (SBS/AHT)? How many times do you have to shake an infant or young child to cause damage?
The injuries seen in cases of SBS/AHT are caused by violent shaking and, in some cases, impact. This is due to the rapid and repeated acceleration and deceleration of the victim's head whipping back and forth and side to side. Shaking injuries are not caused by casual or accidental handling of children. Shaking injuries require massive, violent force. One shake is all it takes to cause traumatic brain injuries in an infant.
What is the retina of the eye?
The retina is a light-sensitive layer at the back of the eye that covers about 65 percent of its interior surface. Photosensitive cells calls rods and cones in the retina convert light energy into signals that are carried to the brain by the optic nerve. In the simplest terms, the retina is the lining of the inside of the eyes.
What happens to the eyes during a shaking event?
The same kind of violent motion that happens in the brain during shaking also occurs in the eye. When a child is violently shaken, the eyeball and its contents move back and forth in many different directions within the eye socket. The forces produced during a shaking episode may cause the layers of the retina to slide across each other creating stretching and shearing of the retinal vessels resulting in hemorrhages.
What are retinal hemorrhages and what is their relationship to Shaken Baby Syndrome/Abusive Head Trauma (SBS/AHT)?
Bleeding in the layers of the retina are called retinal hemorrhages. Retinal hemorrhages, especially those at the ora serrata and those involving many layers of the retina are frequently seen in SBS/AHT victims and are uncommon in other types of head injury. Retina hemorrhages typically happen in both eyes (bilateral) but can also be unilateral (one eye). This type of bleeding can only be viewed by a doctor using specialized equipment.
What other types of injuries might occur as a result of shaking?
Other injuries that can occur as a result of shaking are cerebral edema (brain swelling), cerebral contusions (brain bruises), external head bruises, body bruises, skull fractures, rib fractures, long bone fractures, neck and spinal cord damage, or other injuries that cannot be explained through a medical condition or accidental trauma.
Do falls cause injuries similar to Shaken Baby Syndrome/Abusive Head Trauma (SBS/AHT)?
Accidental falls, even down stairways, are not generally the cause of brain injuries in infants. Household falls from furniture or down stairs most commonly result in minor trauma. High-velocity impact injuries, falls from extreme heights, or falls onto extremely hard surfaces provide the opportunities for more severe injuries, like those seen in SBS/AHT injuries.
Predisposing factors in Shaken Baby Syndrome/Abusive Head Trauma (SBS/AHT)?
Common factors associated with increased risk of child abuse are often individual characteristics, substance abuse, and young age of the parent or caregivers; the age, health, physical, mental, emotional, and social development of the child; history of violence within the family structure; poverty and economic conditions, social attitudes, promotion of violence, and cultural norms of the community; lack of education and resources for the family.
What are CT scans and MRIs and how are they used to diagnose Shaken Baby Syndrome/Abusive Head Trauma (SBS/AHT)?
A CT (computed tomography) scan is an X-ray technique that produces a detailed cross-section of tissue structure. An MRI (magnetic resonance imaging) is medical imagining that gives pictures of organs and different structures of the body which gives different information about the body than can be seen with an X-ray, ultrasound, or CT scan.
A CT scan gives sufficient resolution and detail to allow a physician to evaluate an acute brain injury in an abused child. MRI scans are used several days to a week after an injury to better diagnose the types of injuries to the brain and show changes in in the brain tissue. Most skull fractures can be best shown with an X-ray.
How can the injuries be dated and the time of injuries be determined?
Clinical history, physiologic data, and imaging are the three (3) sources physicians use to establish the timing of head injuries.
What is the outcome or prognosis of victims of Shaken Baby Syndrome/Abusive Head Trauma (SBS/AHT)?
The outcomes for victims of SBS/AHT largely depend on the severity of the abuse. One third (1/3) of SBS/AHT victims who develop symptoms either do not have significant disabling conditions or the outcomes are less well-defined. Mild injuries might include learning disabilities, personality changes, or behavior problems. Other children have seizure disorders, developmental, or mental delays. Many children are left with blindness, profound reduced mental capacity, spastic diplegia (paralysis of both sides), or quadriplegia (all sides). Some children develop cerebral palsy or some continue to live in a persistent vegetative state.
How can Shaken Baby Syndrome/Abusive Head Trauma (AHT) be prevented?
Child abuse, and specifically SBS/AHT, is prevented through parent/caregiver education classes about normal infant crying patterns, increased general public awareness, respite care for overwhelmed parents/caretakers, parents having a plan of action for when they become upset or exhausted while taking care of an infant/child, a parent putting the infant/child down in a safe place and walking away until they regain composure, parents/caregivers asking for help from family members or friends, and having the infant/child evaluated by a doctor if there are concerns about the baby's physical condition.
Contact
National Center on Shaken Baby Syndrome
1433 N 1075 W, Suite 110
Farmington, Utah 84025
office: (801) 447-9360
fax: (801) 447-9364
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How Much Force Does It Take to Cause Shaken Baby Syndrome?
Source: https://www.dontshake.org/learn-more/item/91-frequently-asked-questions
