Shaken Baby Syndrome (Abusive Head Trauma) (cont.)
John Mersch, MD, FAAP
Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.
Roxanne Dryden-Edwards, MD
Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
In this Article
- Shaken baby syndrome facts
- What is shaken baby syndrome?
- What causes shaken baby syndrome?
- What are the risk factors for shaken baby syndrome?
- What are shaken baby syndrome symptoms and signs?
- How do physicians diagnose shaken baby syndrome?
- What is the treatment for shaken baby syndrome?
- What are complications and long-term effects of shaken baby syndrome?
- What is the prognosis of shaken baby syndrome?
- Is it possible to prevent shaken baby syndrome?
- What can caregivers or parents do to calm a crying baby?
What is the prognosis of shaken baby syndrome?
The primary predictor for an optimal prognosis is establishing the diagnosis and thus removing the child (and any siblings) from the abusive home. The nature of the neurological injuries help shape realistic prognostic expectations. The "plastic" nature of the immature brain and peripheral nervous system allow those counseling caregivers of children who have sustained shaken baby syndrome to be more optimistic than those counseling after adult traumatic brain injury. One study found that approximately one-third of those who suffered abusive head injury have no discernable side effect; unfortunately, such a statistic implies that two-thirds of such victims will have residual long-term complications.
Is it possible to prevent shaken baby syndrome?
Many studies have determined that what is felt to be incessant crying is the primary stimulus leading to a frustrated caregiver loosing control. Expectant parents must be counseled regarding the nature of crying and various management strategies for both the infant and themselves. It is important to underscore that many times there is no obvious or discernable cause for the infant's crying. Likewise, it is important for parents and all caregivers to understand that allowing an infant to cry for a reasonably short period (10-15 minutes) does not lead to short- or long-term physical or emotional-health issues. Most importantly, those caring for children must be assured that asking for help is an excellent strategy when they find themselves "at the end of their rope."
What can caregivers or parents do to calm a crying baby?
Most caregivers will initiate a series of approaches in an effort to address a crying infant. Reviewing the feeding schedule and checking for a soiled diaper are common. Consideration of health problems (an ear infection or upper respiratory infection), the need to burp the child, or infant tiredness or boredom can all be considered. For infants who seem to have crying in association with feeding or evidence of gastroesophageal reflux (GER), a discussion with their pediatrician is in order. Breastfed infants may cry in response to certain foods (for example, caffeinated beverages) ingested by their mother. Rarely, infants will have continuous crying if a long hair (most commonly from a parent) has accidently wrapped around a toe or finger. Diagnosis is considered if prominent swelling and skin discoloration is noted at the site of the ligature.
Various approaches to the crying infant are commonplace. These include picking up the baby and socially interacting with the child, walking and rocking the child, addressing the possibility of hunger or a soiled diaper, and a quick visual survey of the infant to confirm no unusual changes exist. It is important for parents to accept that the majority of the time their investigation will be fruitless in determining causation of their infant's crying. The fact that he or she cries is not an indictment of their parenting skills. There is generally no hidden management secret other than time and patience.
Christian, Cindy, V. Jordan Greenbaum. "Child Abuse: Epidemiology, mechanisms, and types of abusive head trauma in infants and children." UptoDate.com. Oct. 8, 2013. <http://www.uptodate.com/contents/child-abuse-epidemiology-mechanisms-and-types-of-abusive-head-trauma-in-infants-and-children>.
Christian, C.W., R. Block, Committee on Child Abuse and Neglect, American Academy of Pediatrics. "Abusive head trauma in infants and children." Pediatrics 123.5 May 2009: 1409-1411.
National Center on Shaken Baby Syndrome. <http://dontshake.org>.
United States. Centers for Disease Control and Prevention. "Child Maltreatment: Facts at a Glance." (2013) <http://www.cdc.gov/violenceprevention/pdf/cm-data-sheet--2013.pdf>.
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