Shaken Baby Syndrome (Abusive Head Trauma)

Abusive head trauma (AHT) refers to head and brain injuries that babies and toddlers can develop if someone shakes them forcefully or violently. It can cause brain bruising, swelling or bleeding, plus eye and spine injuries. Shaken baby syndrome (SBS) is a better-known — but outdated — name for this condition.

Symptoms of shaken baby syndrome

Abusive head trauma can cause symptoms like:

• Bruises on their arms or chest
• Bulging of the soft spot on the crown of their head
• Extreme irritability
• Eyes that can’t focus or follow movement
• Pupils that are dilated (widened) or different sizes
• Lethargy (extreme tiredness, not moving or not being able to stay awake)
• Not being able to lift their head
• Not smiling, babbling or talking
• Not wanting to feed or trouble feeding
• Pale or blue-tinged skin
• Seizures
• Shock
• Tremors
• Trouble breathing or grunting sounds with breathing
• Unconsciousness or coma
• Vomiting

Shaken baby syndrome causes

Abusive head trauma happens because babies’ and younger kids’ brains can’t handle the strain from someone shaking them. That’s why it usually happens to children under 2 years old (though it can happen up to age 5).

Infants’ heads are large compared to their body size. And their weaker neck muscles can’t handle a lot of stress from movement. This can also happen from being struck, or if you throw or drop them on purpose.

There are a few main ways the most severe injuries from abusive head trauma happen:

• Impacts: Babies can have brain injuries from their brain striking the inside of their skull. And throwing or dropping them can cause blunt force injuries like broken bones, skull fractures or internal bleeding.
• Shearing: Shaking can cause strain that makes blood vessels or nerves tear or break. That can cause internal bleeding, retinal hemorrhages, and nerve or spinal cord injuries.
• Pressure: Bleeding inside the skull doesn’t have anywhere to go. Pressure from blood building up around the brain can cause permanent damage.

Why does shaken baby syndrome happen?

Abusive head trauma is most likely to happen when a child’s caregiver feels frustrated, angry or overwhelmed with an infant who won’t stop crying. They might shake the baby, thinking it will stop the crying or because they lose control of their emotions. But even just a few seconds of shaking can cause devastating injuries.

Crying is normal for babies because that’s the only way they can tell you they need something. AHT is more likely to happen to babies during the purple crying period, which happens within the first several months of life. That’s when babies cry the most.

Abusive head trauma can also happen if a caregiver doesn’t know that shaking a baby is dangerous. But this isn’t common.

It is NEVER safe or OK to shake, hit or throw a baby.

Complications of shaken baby syndrome

AHT can cause several severe complications. Many of them are permanent. They include:

• Cerebral palsy
• Developmental delays
• Hearing loss and deafness
• Intellectual disability
• Seizures
• Vision problems and blindness

Abusive head trauma is often fatal. It’s the top cause of abuse-related deaths in children.

How doctors diagnose abusive head trauma

Healthcare providers use several tools to diagnose AHT. They’ll check your baby’s eyes for bleeding and look for any other signs of injury on their body, especially their head, neck and chest.

But diagnosing abusive head trauma is still difficult in some cases. That’s because:

• Healthcare providers don’t always get the truth about whether or not shaking was involved in an infant’s injury.
• Babies and very small children can’t tell healthcare providers what happened or what hurts.
• Many AHT symptoms (like irritability, vomiting or lethargy) are also common in other conditions, such as viral infections.

Tests used for diagnosing shaken baby syndrome

Tests used to diagnose AHT are for finding how severe injuries are or ruling out other conditions. Checking for other conditions is important to avoid mistakenly suspecting child abuse.

Imaging tests are the main way to diagnose abusive head trauma. They include:

• X-rays
• CT scans
• MRIs

Healthcare providers may also use X-rays or a bone scan to look for evidence of other injuries, past or present.

Non-imaging tests can include:

• An eye exam, with emphasis on looking for signs of bleeding inside your baby’s eye
• A lumbar puncture (spinal tap) to look for blood in the cerebrospinal fluid and rule out other severe conditions, like meningitis
• Lab tests, including ones to find blood disorders that could explain severe bleeding and bruising

How is shaken baby syndrome treated?

Abusive head trauma is an emergency and needs immediate medical care. Children with milder cases may need to stay in the hospital for observation and treatment.

In severe cases, life-saving treatments are necessary. They include having a breathing tube inserted, surgery to relieve pressure on the brain and medicines to manage effects like seizures. Other treatments can vary depending on the case. Your healthcare provider is the best source of information about treatments.

What’s the outlook for this condition?

Abusive head trauma is a very serious condition. The outlook (prognosis) for it depends on many factors, especially how severe any injuries are. But in general, the outlook is usually not good. About 1 in 4 children die from AHT. Most of those who survive will have lifelong complications. Your child’s healthcare provider can tell you more about what to expect.

Can shaken baby syndrome be prevented?

Abusive head trauma is 100% preventable. The ways to prevent it generally revolve around:

• Things you can try to comfort and calm your baby
• Recognizing and managing your emotions and reactions
• Making sure your baby is safe with other caregivers (if any)

Comforting your baby

When your baby starts crying, first confirm that they’re OK and there isn’t a reason to call their pediatrician. Make sure their diaper is clean, they’ve eaten and that they don’t have any illness symptoms, like a fever. Also, make sure their surroundings are clear of anything that might cause pain or discomfort (like whether they’re warm enough or too warm).

Once you’ve checked all those, you can encourage self-soothing techniques. You can also try things like the cry-it-out method of sleep training.

Recognizing and managing your emotions and reactions

Having a newborn is often exhausting. And when you’re tired, it can be harder to control your reactions. That’s why it’s important not to try to tough it out until you’re hanging by a thread. Taking action earlier can help you cope better.

Some things you can try include:

• Ask for resources. Your child’s pediatrician may be able to provide brochures, books or videos. These can help you learn how to cope when caring for an inconsolable baby.
• Reach out for help. There’s nothing wrong with asking a loved one to help you through this. Having them step in for a couple hours or more to watch your baby can help immensely.
• Pause when you need. Put your child down somewhere safe, like their crib. Once they’re safe, walk away for a few minutes (10 or 15 at most). Crying for a few more minutes won’t hurt them. Taking a much-needed breather like that is ultimately good for both you and your baby.
• Make a call. This can make a huge difference if you feel like you’re losing control. Talking to someone over the phone (or similar means) can help you regain your composure.

Making sure your baby is safe with others

Preparing ahead can help you protect your baby even when they’re with others. Some things you can do include:

• Think carefully about who you ask for help. Don’t leave your baby with someone who gets angry or frustrated easily.
• Make sure they know the danger. Don’t assume everyone knows shaking a baby is dangerous, and don’t hesitate to tell them. If you have resources like brochures or videos, have other caregivers review them. They should do that before they care for your baby on their own.
• Don’t feel bad about monitoring other caregivers. Check their references beforehand and check in on them. This kind of oversight can help you protect your baby.

It’s important to start planning for this sooner rather than later. Taking your time when choosing who cares for your baby can make a huge difference.

Can shaken baby syndrome go unnoticed?

Abusive head trauma can go unnoticed in some cases. That’s possible when there aren’t any visible signs of an injury. It can also happen when providers misinterpret symptoms like vomiting or irritability as coming from another condition, like a virus.

Can bouncing a baby cause shaken baby syndrome?

No, bouncing a baby gently on your knee won’t cause abusive head trauma.

Other things that won’t cause abusive head trauma include:

• Tossing a baby in the air
• Bicycling with your baby
• Accidental falls off furniture
• Sudden stops or going over bumps while driving