Shaken Baby Syndrome:

It is a form of child abuse that occurs when an abuser violently shakes an infant or small child, creating a whiplash-type motion that causes acceleration-deceleration injuries. SBS, a major cause of death in infants, is often fatal and can cause severe brain damage, resulting in lifelong disability. Estimated death rates among infants with SBS range from 15 to 38. 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. It can also be used the term "abusive head trauma" or "intentional head injury."

This is a severe form of head injury caused by violently shaking an infant. It usually occurs in children younger than 2 years old, but may be seen in children up to the age of 5. The violent shaking may result in severe injuries to the infant including permanent brain damage or death. Shaken Baby Syndrome mainly occurs from shaking or hitting the head of an infant or small child. SBS occurs when an abuser violently shakes an infant to create whiplash that causes blindness, seizures, learning, physical disabilities and death. SBS usually goes together with smacking of the infant against a hard object, and in several cases, it is known as the shaken impact syndrome.

A baby's head is large and heavy in proportion to their body. For this reason, when a baby is dropped or thrown, he will tend to land on his head. There is space between the brain and skull to allow for growth and development. The baby's neck muscles and ligaments are weak and underdeveloped. All of these factors make infants highly vulnerable to whiplash forces.

When an infant or young toddler is shaken, the soft, pliable skull is not yet strong enough to absorb much of the force. The forces are thus transmitted to the brain, which then rebounds against the skull causing bruising of the brain (cerebral contusion), swelling, pressure, and bleeding (intracerebral hemorrhage).

The large veins along the outside of the brain are also vulnerable to tear with these injuries which can lead to further bleeding, swelling, and increased pressure (subdural hematoma). This can easily cause permanent, severe brain damage or death.

Causes of SBS

SBS/AHT is a used to describe the constellation of signs and symptoms resulting from violent shaking or shaking and impacting of the head of an infant or small child. Any of these injuries can lead to severe disability or death. For such cases seeking medical attention is must immediately

Symptoms

Symptoms vary among kids based on their age .Shaking may produce no visible symptoms in the baby even when extensive damage has occurred within the brain. Internal (inside) bleeding within the skull may cause the brain to swell. If the swollen brain pushes against the skull, damage to nerves and other parts of the brain may occur. Such damage can cause serious problems including blindness, hearing loss, paralysis, speech impairment, mental retardation, learning disabilities, and death.

Common Symptoms of Shaken Baby Syndrome:

* Lethargy / decreased muscle tone

* Extreme irritability

* Decreased appetite, poor feeding or vomiting for no apparent reason

* Grab-type bruises on arms or chest are rare

* No smiling or vocalization

* Poor sucking or swallowing

* Rigidity or posturing

* Difficulty breathing

* Seizures

* Head or forehead appears larger than usual or soft-spot on head appears to be bulging

* Inability to lift head

* Inability of eyes to focus or track movement or unequal size of pupils

SBS is accompanied by a variety of signs, which range from mild to severe and nonspecific to obviously head trauma-related. The characteristic injuries associated with SBS include retinal hemorrhages, multiple fractures of the long bones, and subdural hematomas (bleeding in the brain). These signs have evolved through the years as the accepted and recognized signs of child abuse and the shaken baby syndrome. Medical professionals strongly suspect shaking as the cause of injuries when a baby or small child presents with retinal hemorrhage, fractures, soft tissue injuries or subdural hematoma that cannot be explained by accidental trauma or other medical conditions. Other effects of SBS are diffuse axonal injury, oxygen deprivation and swelling of the brain, which can raise intracranial pressure and damage delicate brain tissue. Victims of SBS may display irritability, failure to thrive, alterations in eating patterns, lethargy, vomiting, seizures, bulging or tense fontanels, increased size of the head, altered respirations, and dilated pupils.

Fractures of the vertebrae and ribs may also be associated with SBS

* Change in behavior, irritability

* Lethargy, sleepiness, or loss of consciousness

* Pale or bluish skin

* Vomiting

* Convulsions (seizures)

* Poor eating

* Not breathing (apnea)

Diagnosis

There are usually no witnesses to the shaking. The baby may seem to be normal for a period of time after shaking. Babies who act abnormally may be diagnosed with some other medical disorder. Some changes in behavior that may suggest SBS include vomiting, seizures, or loss of consciousness. A baby may also have difficulty breathing, sucking, swallowing, or making sounds. Shaken baby syndrome is often difficult to diagnose.

Additional clues about SBS sometimes come from interviews with the baby's parents. The parents may offer other reasons for the baby's unusual behavior. The explanations offered may not seem reasonable to a doctor. Diagnosis may do on child's medical history or with physical exam and blood tests. Imaging tests such as X-rays, a CT scan, or an MRI can look for bleeding problems or other injury.

Immediate Consequences:

* Breathing may stop or be compromised

* Extreme irritability

* Seizures

* Limp arms and legs or rigidity/posturing

* Decreased level of consciousness

* Vomiting; poor feeding

* Inability to suck or swallow

* Heart may stop

* Death

Long-Term Consequences:

* Learning disabilities

* Physical disabilities

* Visual disabilities or blindness

* Hearing impairment

* Speech disabilities

* Cerebral Palsy

* Seizures

* Behavior disorders

* Cognitive impairment

* Death

Prevention

To prevent shaken baby syndrome is by only creating awareness and educating

* Never shake a baby or child, whether in play or in anger.

* Do not hold baby during an argument.

* Utilize the resources such as a local crisis hotline or child abuse hotline.

* Try to calm down the tension or anger

Role of Social Worker in SBS

Prevention is similar to the prevention of child abuse in general and in giving counseling to the care taker. New parents, babysitters, and other caregivers can be making aware about the dangers of shaking infants.

It is important to get help if something doesn't seem right with 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. Caregivers need strategies to cope with their own frustrations and tension which should not cause any injuries physically or psychologically to the babies.

* Counseling to avoid SBS

* Learn the essentials to maintain a healthy baby

* Teaching Safety and care for baby

* Affordable child-care options

* Care and treatment

* Professional Training

Providing scientific information regarding SBS to the care givers of the child and by creating awareness and information to parents, baby sitters and care givers about the effects of shaking the baby hall extended to mass media level too.

Sources

* American Academy of Pediatrics. Committee on Child Abuse and Neglect. Shaken baby syndrome:

* Committee on Child Abuse and Neglect, American Academy of Pediatrics (2001). Shaken baby syndrome: Rotational cranial injuries-Technical report. Pediatrics, 108(1): 206–210

* David TJ (1999). "Shaken baby (shaken impact) syndrome: non-accidental head injury in infancy" (PDF). J R Soc Med 92 (11): 556–61. PMID 10703491

* National Center for Injury Prevention and Control (7 September 2006). "Child Maltreatment: Fact Sheet". Centers for Disease Control and Prevention (CDC). Retrieved on 2006-10-09

* Swenson MS, Levitt C. Shaken baby syndrome: Diagnosis and prevention. Minnesota Med 1997;80:41–44.

* Showers J. "Don't shake the baby": The effectiveness of a prevention program. Child Abuse Negl 1992;16:11–18.

* The Shaken Baby Syndrome: A Multidisciplinary Approach by Stephen Lazoritz, Vincent J. Palusci Published by Haworth Press, 2002

* The Arc (2004). Shaken Baby Syndrome. Silver Spring, MD: The Arc. Available online:

KeyWords: SBS – shaken Baby Syndrome, AHT- A head Trauma, symptoms and SocialWorkers.