What is shaken baby syndrome (SBS)?

Shaken baby syndrome refers to a type of brain injury that happens when a baby or a toddler is shaken violently. Shaking can cause bleeding in the brain (subdural hemorrhages) or bleeding in the retinas (retinal hemorrhages). Additional injury happens when the shaken baby is thrown down onto a surface, resulting in shaken impact syndrome.

When a child is shaken, the brain bounces back and forth against the sides of the skull. Infants’ heads are very large and heavy in proportion to the rest of their bodies. This causes swelling, bruising, and bleeding in the brain.

The potential consequences of shaking babies or toddlers are extreme. They include:

  • Brain damage
  • Blindness
  • Hearing loss
  • Speech and learning disorders, including mental retardation
  • Seizures
  • Neck and spinal cord damage, which can lead to motor dysfunction ranging in severity from clumsiness to paralysis
  • Death

What are the symptoms of SBS?

A child or baby who has been shaken and has pressure on the brain may have symptoms such as these:

  • Extreme irritability
  • Vomiting
  • Poor appetite or feeding problems
  • Breathing difficulties
  • Convulsions (seizures)
  • Lethargy (extreme tiredness, lack of movement, inability to stay awake)
  • Pale- or blue-colored skin
  • Bruising, such as grab marks, on the arms or chest
  • A forehead that appears larger than usual, or a soft spot that seems to be bulging
  • Inability to lift his or her head
  • Tremors (the shakes)
  • Inability to focus or follow movement with his or her eyes
  • Unconsciousness
  • Coma

Who is most at risk for SBS?

SBS happens most often in infants up to one year, with infants aged two to four months being most at risk. SBS does not usually happen after age two, but children as old as five or six can be damaged in this way if the shaking is extremely violent.

Why do people shake babies?

Parents or caregivers may think that shaking a baby will make the baby stop crying. Parents or caregivers may be unable to cope with the reality of caring for a child and take their frustration out on the child. Some may not know that the results of shaking can be as devastating as they really are. However, shaking babies or children is never okay.

Who shakes babies?

Statistics indicate that two-thirds to three-fourths of the people found guilty of shaking babies are male. While the age range is great, generally men who shake babies are in their twenties.

It is not true that only males shake babies. Mothers and other female caregivers have also been found to have shaken babies. SBS can happen among families of any ethnicity, any income range, and with any type of family composition.

How is SBS treated?

SBS should be treated immediately. Parents or caregivers need to take the child for emergency medical attention as soon as they are aware that the baby has been shaken. The adults should also tell the health care provider that the baby has been shaken. Caregivers who are not telling the truth may say that the child has fallen. Depending on the severity of the symptoms, children may require treatment such as respiratory support or surgery to stop bleeding.

Some symptoms show up right away, but others may not show up until later. Some children may experience attention problems and behavior problems later in life due to being shaken when they were infants.

How is SBS diagnosed?

Health care providers do not always get the truth about whether or not shaking was involved in an injury. Also, babies and very small children cannot tell doctors or nurses what happened or what hurts. Many symptoms of SBS (such as irritability, vomiting, or lethargy) are also common for minor conditions like viral infections.

It has been suggested that doctors should use additional tests when a brain injury appears possible. X-rays can show skull fractures and doctors may suggest magnetic resonance imaging (MRI) tests or computed tomography (CT) scans. Special attention should be given to evidence of retinal bleeding (bleeding at the back of the eyes).

Is SBS preventable?

Yes. Do not shake babies or children, EVER.

What can parents or caregivers do when babies cry?

When truthful answers are given about shaking babies, the parent or caregiver most often says that the shaking occurred when the baby was crying inconsolably. There are some things that you can do to avoid the likelihood of becoming angry and shaking the baby.

  • First, check to make sure that nothing obvious is wrong with the child. You should check to see if diapers are clean and if the baby is hungry or cold. Make sure there is no sign of illness, such as fever or swelling. You should also check that there is no situation that is causing pain.
  • If the baby's needs are met, try using noise. You can put on a radio, or sing and talk to the baby. Sometimes babies like noises like vacuum cleaners, clothes dryers, hair dryers or fans.
  • Offer the baby a toy or pacifier.
  • Take the baby or child for a ride in the car, appropriately secured in his or her car seat.
  • Try a swing.
  • Ask someone else to take over for you for a period of time so you can have a break and calm down. This person who may take over can be a friend, a coworker, a neighbor, or a family member. It is very reasonable to ask for help. Babies cry an estimated one to three hours per day.
  • If no one else is available to take over for you, put the baby safely in the crib and leave the room for ten minutes or so while you calm down. Remember, crying won’t hurt babies, but shaking will.


This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 1/5/2011…#13779

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