Global InformationShaken baby syndrome information
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| Shaken baby syndrome | |
|---|---|
| Other names | abusive head trauma, non-accidental head injury, non-accidental trauma |
 | |
| An intraparenchymal bleed with overlying skull fracture from shaken baby syndrome | |
| Specialty | Pediatrics |
| Symptoms | Variable[1] |
| Complications | Seizures, visual impairment, cerebral palsy, cognitive impairment[2][1] |
| Usual onset | Less than 5 years old[3] |
| Causes | Blunt trauma, vigorous shaking[1] |
| Diagnostic method | CT scan[1] |
| Prevention | Educating new parents[1] |
| Prognosis | Long term health problems common[3] |
| Frequency | 3 per 10,000 babies per year (US)[1] |
| Deaths | ≈25% risk of death[3] |
Shaken baby syndrome (SBS), also known as abusive head trauma (AHT), is a medical condition in children younger than five years old,[3] generally caused by blunt trauma, vigorous shaking, or a combination of both.[1] SBS is the leading cause of fatal head injuries in children under two,[4] with a risk of death of about 25%.[3] The most common symptoms include retinal bleeds, multiple fractures of the long bones, and subdural hematomas (bleeding in the brain).[5]
The condition is often caused as a result of a parent or 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] If there are concerning findings on the CT scan, a full work-up for child abuse should occur, including an eye exam and skeletal survey. Retinal hemorrhage is highly associated with AHT, occurring in 78% of cases of AHT versus 5% of cases of non-abusive head trauma.[6][7]
Diagnosing the syndrome has proven to be both challenging and contentious for medical professionals because objective witnesses to the initial trauma are generally unavailable.[8] This is said to be particularly problematic when the trauma is deemed 'non-accidental'.[9] Some medical professionals propose that SBS is the result of respiratory abnormalities leading to hypoxia and swelling of the brain.[10] The courtroom has become a forum for conflicting theories with which generally accepted medical literature has not been reconciled.[4] Often there are no outwardly visible signs of trauma, despite the presence of severe internal brain and eye injury.[1] Complications include seizures, visual impairment, cerebral palsy, cognitive impairment, and death.[2][1]
Educating new parents appears to be beneficial in decreasing rates of the condition.[1] SBS is estimated to occur in three to four per 10,000 babies a year.[1] These signs have evolved through the years as 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.[11]
Retinal hemorrhage (bleeding) occurs in around 85% of SBS cases and the severity of retinal hemorrhage correlates with severity of head injury.[6] The type of retinal bleeds are often believed to be particularly characteristic of this condition, making the finding useful in establishing the diagnosis.[12]
Fractures of the vertebrae, long bones, and ribs may also be associated with SBS.[13] 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".[14]
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.
- ^ a b c d e f g h i j k l m Shaahinfar A, Whitelaw KD, Mansour KM (June 2015). "Update on abusive head trauma". Current Opinion in Pediatrics. 27 (3): 308–14. doi:10.1097/mop.0000000000000207. PMID 25768258. S2CID 38035821.
- ^ a b Advanced Pediatric Assessment, Second Edition (2 ed.). Springer Publishing Company. 2014. p. 484. ISBN 9780826161765. Archived from the original on 5 November 2017.
- ^ a b c d e f "Preventing Abusive Head Trauma in Children". www.cdc.gov. 4 April 2017. Archived from the original on 11 June 2017. Retrieved 9 June 2017.
- ^ a b "Consensus Statement: Abusive Head Trauma in Infants and Young Children". Pediatrics. 142 (2). 1 August 2018. doi:10.1542/peds.2018-1504. ISSN 0031-4005. PMID 30061300. S2CID 51878771.
- ^ "NINDS Shaken Baby Syndrome information page". National Institute of Neurological Disorders and Stroke. 14 February 2014. Archived from the original on 29 May 2014. Retrieved 23 June 2008.
- ^ a b Maguire SA, Watts PO, Shaw AD, Holden S, Taylor RH, Watkins WJ, Mann MK, Tempest V, Kemp AM (January 2013). "Retinal haemorrhages and related findings in abusive and non-abusive head trauma: a systematic review". Eye. 27 (1): 28–36. doi:10.1038/eye.2012.213. ISSN 0950-222X. PMC 3545381. PMID 23079748.
- ^ Christian CW, Block R (May 2009). "Abusive head trauma in infants and children". Pediatrics. 123 (5): 1409–11. doi:10.1542/peds.2009-0408. PMID 19403508. S2CID 23001705.
- ^ Vinchon M (2017). "Shaken Baby Syndrome: What Certainty Do We Have?". Child's Nervous System. 33 (10): 1727–1733. doi:10.1007/s00381-017-3517-8. PMID 29149395. S2CID 22053709.
- ^ Vinchon M (2017). "Shaken Baby Syndrome: What Certainty Do We Have?". Child's Nervous System. 33 (10): 1727–1733. doi:10.1007/s00381-017-3517-8. PMID 29149395. S2CID 22053709.
- ^ Dural hemorrhage in non-traumatic infant deaths: does it explain the bleeding in 'shaken baby syndrome'? Neuropathol Appl Neurobiol. 2003 Feb;29(1):14-22. doi: 10.1046/j.1365-2990.2003.00434.x. Erratum in: Neuropathol Appl Neurobiol. 2003 Jun;29(3):322. PMID 12581336.";>
- ^ B.G.Brogdon, Tor Shwayder, Jamie Elifritz Child Abuse and its Mimics in Skin and Bone
- ^ Levin AV (November 2010). "Retinal hemorrhage in abusive head trauma". Pediatrics. 126 (5): 961–70. doi:10.1542/peds.2010-1220. PMID 20921069. S2CID 11456829. Archived from the original on 20 October 2014.
- ^ Kempe CH, Silverman FN, Steele BF, Droegemueller W, Silver HK (July 1962). "The battered-child syndrome". JAMA. 181: 17–24. CiteSeerX 10.1.1.589.5168. doi:10.1001/jama.1962.03050270019004. PMID 14455086.
- ^ Cite error: The named reference
Caffey J 1972 161–9was invoked but never defined (see the help page).