What is shaken baby syndrome?

Shaken baby syndrome can occur from as little as 5 seconds of shaking. Shaken baby syndrome (SBS) is a  brain injury that happens when an adult violently shakes a baby or young child. It is also also known as abusive head trauma, shaken impact syndrome, inflicted head injury or whiplash shake syndrome — is a serious brain injury resulting from forcefully shaking an infant or toddler. 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 might result in permanent brain damage or death.

Shaken baby injuries usually occur in children younger than 2 years old but may be seen in children up to the age of 5.

When an infant or toddler is shaken, the brain bounces back and forth against the skull. As the brain hits against the skull, it can cause bruising of the brain (cerebral contusion), swelling, pressure, and bleeding in as well as around the brain. The large veins along the outside of the brain may tear, leading to further bleeding, swelling, and increased pressure. This can easily cause permanent brain damage or death.

Shaking an infant or small child may cause other injuries, such as damage to the neck, spine, and eyes. The impact often causes bleeding in the retina — the light-sensitive portion of the eye that transmits images to the brain. A child with SBS may also have a damaged spinal cord or neck, as well as bone fractures. The amount of damage depends on how long and hard the child is shaken, but in just five to ten seconds a child can suffer permanent, severe damage or even death.

Could SBS could happen accidentally while you're playing with your baby? Fortunately not. The normal ways that most parents interact with their infants don't cause SBS: Bouncing your baby on your leg, swinging him in his baby swing, jiggling your baby in your arms, or tossing him gently in the air are not going to cause shaken baby syndrome. SBS is also extremely unlikely to happen because of an accidental fall. 

It takes deliberate, violent back-and-forth motion to produce SBS. Unfortunately, an angry adult can quickly unleash that degree of violence on a baby or a small child.

How common is SBS?

A study presented in May 2010 at the annual meeting of the Pediatric Academic Societies looked at data from children's hospitals in three states and found a worrisome increase in the number of  SBS brain injuries since the beginning of the economic recession in December 2007. Poverty and stress are risk factors for child abuse, which may may explain the rise in SBS during hard economic times.

There are no accurate statistics, but experts estimate the incidence to be between 1,000 to 1,500 infants per year. According to the Centers for Disease Control and Prevention, of the almost 2,000 children who die from abuse or neglect each year, shaken baby syndrome accounts for 10%-12% of them. Most commonly, the victim of shaken baby syndrome is between 3 and 8 months old; however, it has been reported in newborns and in children up to 4 years of age. In addition, 25% of all children diagnosed with shaken baby syndrome die from their injuries.

Causes

In most cases, an angry parent or caregiver shakes the baby to punish or quiet the child. Such shaking usually takes place when the infant is crying inconsolably and the frustrated caregiver loses control. Many times the caregiver did not intend to harm the baby. Still, it is a form of child abuse.

Injuries are most likely to happen when the baby is shaken and then the baby's head hits something. Even hitting a soft object, such as a mattress or pillow, may be enough to injure newborns and small infants. Children's brains are softer, their neck muscles and ligaments are weak, and their heads are large and heavy in proportion to their bodies. The result is a type of whiplash, similar to what occurs in some auto accidents. It also is very unlikely to occur from accidents such as falling off chairs or down stairs, or accidentally being dropped from a caregiver's arms. Short falls may cause other types of head injuries, although these are often minor.

Unlike other forms of inflicted head trauma, abusive head trauma results from injuries caused by someone vigorously shaking a child. Because the anatomy of infants puts them at particular risk for injury from this kind of action, the majority of victims are infants younger than 1 year old. The perpetrators in these cases are most often parents or caregivers. Common triggers are frustration or stress when the child is crying. Unfortunately, the shaking may have the desired effect: although at first the baby cries more, he or she may stop crying as the brain is damaged.

When someone forcefully shakes a baby, the child's head rotates about the neck uncontrollably because infants' neck muscles aren't well developed and provide little support for their heads. This violent movement pitches the infant's brain back and forth within the skull, sometimes rupturing blood vessels and nerves throughout the brain and tearing the brain tissue. The brain may strike the inside of the skull, causing bruising and bleeding to the brain.

The damage can be even greater when a shaking episode ends with an impact (hitting a wall or a crib mattress, for example), because the forces of acceleration and deceleration associated with an impact are so strong. After the shaking, swelling in the brain can cause enormous pressure within the skull, compressing blood vessels and increasing overall injury to its delicate structure. Normal interaction with a child, like bouncing the baby on a knee, will not cause these injuries. It's important to never shake a baby under any circumstances.

Babies have weak neck muscles and often struggle to support their heavy heads. If a baby is forcefully shaken, his or her fragile brain moves back and forth inside the skull. This causes bruising, swelling and bleeding. Shaken baby syndrome usually occurs when a parent or caregiver severely shakes a baby or toddler due to frustration or anger — often because the child won't stop crying. Nothing justifies shaking a child. Shaken baby syndrome isn't usually caused by bouncing a child on your knee, minor falls or even rough play.

Symptoms

The symptoms can vary from mild to severe. They may include:

• Convulsions (seizures)
• Decreased alertness
• Extreme irritability or other changes in behavior
• Lethargy, sleepiness, not smiling
• Loss of consciousness
• Loss of vision
• No breathing
• Pale or bluish skin
• Poor feeding, lack of appetite
• Vomiting

There may not be any physical signs of injury, such as bruising, bleeding, or swelling. In some cases, the condition can be difficult to diagnose and may not be identified during an office visit. However, rib fractures are common and can be seen on x-ray. An eye doctor may find bleeding behind the baby's eye or retinal detachment. There are, however, other causes of bleeding behind the eye and they should be ruled out before diagnosing shaken baby syndrome. Other factors must be considered.

Other shaken baby syndrome symptoms and signs include:

• Difficulty staying awake
• Tremors
• Paralysis
• Coma

Other injuries that may not be noticeable include bleeding in the brain and eye, damage to the spinal cord and neck, and fractures of the ribs, skull and bones. In mild cases of shaken baby syndrome, a child may appear normal after being shaken, but over time he or she may develop health, learning or behavior problems.

When to see a doctor

Contact your child's doctor or take your child to the nearest emergency room if you find abnormal behavior or action. Getting medical care right away may save your child's life or prevent serious health problems. Health care professionals are legally required to report all suspected cases of child abuse to state authorities.

In any abusive head trauma case, the duration and force of the shaking, the number of episodes, and whether impact is involved all affect the severity of the infant's injuries. In the most violent cases, children may arrive at the emergency room unconscious, suffering seizures, or in shock. But in many cases, infants may never be brought to medical attention if they don't exhibit such severe symptoms.

In less severe cases, a child who has been shaken may experience:

• lethargy
• irritability
• vomiting
• poor sucking or swallowing
• decreased appetite
• lack of smiling or vocalizing
• rigidity
• seizures
• difficulty breathing
• altered consciousness
• unequal pupil size
• an inability to lift the head
• an inability to focus the eyes or track movement

Effects

AHT often causes irreversible damage. In the worst cases, children die due to their injuries. Children who survive may have:

• partial or total blindness
• hearing loss
• seizures
• developmental delays
• impaired intellect
• speech and learning difficulties
• problems with memory and attention
• severe mental retardation
• cerebral palsy

Even in milder cases, in which babies looks normal immediately after the shaking, they may eventually develop one or more of these problems. Sometimes the first sign of a problem isn't noticed until the child enters the school system and exhibits behavioral problems or learning difficulties. But by that time, it's more difficult to link these problems to a shaking incident from several years before.

Some of other effects including:

• damage to the neck and spine
• behavioral problems
• permanent vegetative state
• paralysis
• death

Prevention

• NEVER shake a baby or child in play or in anger. Even gentle shaking can become violent shaking when you are angry.
• Do not hold your baby during an argument.
• If you find yourself becoming annoyed or angry with your baby, put him in the crib and leave the room. Try to calm down. Call someone for support.
• Call a friend or relative to come and stay with the child if you feel out of control.
• Contact a local crisis hotline or child abuse hotline for help and guidance.
• Seek the help of a counselor and attend parenting classes.
• Do not ignore the signs if you suspect child abuse in your home or in the home of someone you know.

Abusive head trauma is 100% preventable. A key aspect of prevention is increasing awareness of the potential dangers of shaking.
Finding ways to alleviate the parent or caregiver's stress at the critical moments when a baby is crying can significantly reduce the risk to the child. Some hospital-based programs have helped new parents identify and prevent shaking injuries and understand how to respond when infants cry.

The National Center on Shaken Baby Syndrome offers a prevention program, the Period of Purple Crying, which seeks to help parents and other caregivers understand crying in normal infants. By defining and describing the sometimes inconsolable infant crying that can sometimes cause stress, anger, and frustration in parents and caregivers, the program hopes to educate and empower people to prevent AHT.
Another method that may help is author Dr. Harvey Karp's "five S's":

1. 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)
2. 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)
3. Sucking (letting the baby breastfeed or bottle-feed, or giving the baby a pacifier or finger to suck on)
4. Swaddling (wrapping the baby up snugly in a blanket to help him or her feel more secure)
5. Swinging gently (rocking in a chair, using an infant swing, or taking a car ride to help duplicate the constant motion the baby felt in the womb)

If a baby in your care won't stop crying, you can also try the following:

• 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 fever or swollen gums.
• Rock or walk with the baby.
• Sing or talk to the baby.
• Offer the baby a pacifier or a noisy toy.
• Take the baby for a ride in a stroller or strapped into a child safety seat in the car.
• Hold the baby close against your body and breathe calmly and slowly.
• Call a friend or relative for support or to take care of the baby while you take a break.
• If nothing else works, put the baby on his or her back in the crib, close the door, and check on the baby in 10 minutes.
• Call your doctor if nothing seems to be helping your infant, in case there is a medical reason for the fussiness.

To prevent potential AHT, parents and caregivers of infants need to learn how to respond 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.

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. It only takes a few seconds of shaking to cause irreversible brain damage in an infant. 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.

Courtesy sources :
http://www.babycenter.com/0_shaken-baby-syndrome_1501729.bc
http://www.nlm.nih.gov/medlineplus/ency/article/000004.htm
http://kidshealth.org/parent/medical/brain/shaken.html#
http://www.mayoclinic.com/health/shaken-baby-syndrome/DS01157/DSECTION=treatments-and-drugs