Shaken Baby/Shaken Impact Syndrome

Shaken baby/shaken impact syndrome (SBS) is a form of inflicted head trauma. Head injury, as a form of child abuse, can be caused by direct blows to the head, dropping or throwing the child, or shaking the child. Head trauma is the leading cause of death in child abuse cases in the United States.

How Does SBS Happen?

Unlike other forms of inflicted head trauma, SBS results from injuries caused by someone vigorously shaking an infant. Because of the anatomy of infants, they're at particular risk for injury from this kind of action. Therefore, the vast majority of incidents occur in infants who are younger than 1 year old. The average age of victims is between 3 and 8 months, although SBS is occasionally seen in children up to 4 years old.

The perpetrators in SBS cases are almost always parents or caregivers, who shake the baby out of frustration or stress when the little one is crying inconsolably. Sadly, the shaking has the desired effect: although at first the baby cries more out of fear, it eventually stops crying as the brain is damaged.

Approximately 60% of shaken babies are male, and children of families who live at or below the poverty level are at an increased risk for SBS as well as any type of child abuse. And it's estimated that the perpetrators in 65% to 90% of cases are males — usually either the baby's father or the mother's boyfriend, often someone in his early 20s.

When someone forcefully shakes a baby, the child's head rotates about uncontrollably because infants' neck muscles aren't well developed and provide little support for their heads. The violent movement pitches the infant's blindness

How Is It Diagnosed?

Many cases of SBS are brought in for medical care as "silent injuries." In other words, parents or caregivers don't often provide a history that the child has had abusive head trauma or a shaking injury, so doctors don't know to look for subtle or physical signs. This "silent epidemic" can result in children having injuries that aren't identified in the medical system.

And again, in many cases, babies who don't have severe symptoms may never be brought to a doctor.

Unfortunately, unless a doctor has reason to suspect SBS, mild cases (in which the infant seems lethargic, fussy, or perhaps isn't feeding well) are often misdiagnosed as a viral illness or

• Shushing (using "white noise," or rhythmic sounds that mimic the constant whir of noise in the womb, with things like vacuum cleaners, hair dryers, clothes dryers, a running tub, or a white noise CD)
• Side/stomach positioning (placing the baby on the left side — to help digestion — or on the belly while holding him or her, then putting the sleeping baby in the crib or bassinet on his or her back)
• Sucking (letting the baby
• Make sure the baby's basic needs are met (for example, he or she isn't hungry and doesn't need to be changed).
• Check for signs of illness, like back in the crib, close the door, and check on the baby in 10 minutes.
• Call your child's doctor if nothing seems to be helping your infant, in case there is a medical reason for the fussiness.

To prevent potential SBS, parents and caregivers of infants need help with responding to their own stress. It's important to talk to anyone caring for your baby about the dangers of shaking and how it can be prevented.

Reviewed by: Steven Dowshen, MD, and Jane Crowley, PsyD