Shaken Baby Syndrome

Overview

What is shaken baby syndrome?

Shaken baby syndrome is a type of brain injury that occurs when a baby or toddler is shaken violently. This can cause swelling, bruising and bleeding in and around their brain. Shaken baby syndrome may damage a child’s eyes, neck and spine as well. Another name for the condition is abusive head trauma.

Infants’ heads are very large and heavy in proportion to the rest of their bodies. When a child is shaken, their brain bounces back and forth against the sides of their skull. Shaking can cause bleeding in their brain or behind their eyes.

Shaken baby syndrome most often happens when a parent or other caregiver becomes frustrated or angry because of a baby’s crying. It can occur from as little as 5 seconds of shaking. The resulting injuries can lead to brain damage, permanent disabilities and death.

Why does shaken baby syndrome happen?

Parents or caregivers may shake a baby because it’s been crying for a long time. They may think that shaking the baby will make them stop crying. Some parents or caregivers may be under stress for various reasons. They may become frustrated and unable to cope with the responsibilities of caring for a child. Other caregivers may simply not know that shaking a baby can be so dangerous.

Crying is a normal behavior in babies. Your infant may cry inconsolably at times. Shaking, hitting or throwing a baby is never OK.

Who does shaken baby syndrome affect?

Shaken baby syndrome can affect anyone. People who are most likely to shake a baby have a direct connection to the baby (a parent) or an indirect connection (babysitter, secondary family members). Shaken baby syndrome can happen among families of any ethnicity, any income range and with any type of family composition.

Shaken baby syndrome most often affects babies younger than 1 year old. Infants between the ages of 2 and 8 months are most at risk. The condition doesn’t typically occur in children over the age of 2, but children as old as 6 have been victims of this kind of abuse.

How common is shaken baby syndrome?

According to the National Center on Shaken Baby Syndrome, they are between 600 and 1,400 cases of shaken baby syndrome in the U.S. each year. This condition is the most common cause of child abuse death in children younger than 5 years old in the U.S.

How does shaken baby syndrome affect my baby?

Shaken baby syndrome can cause severe medical issues, including:

  • Subdural hematoma: A collection of blood between the surface of your child’s brain and their dura (the tough outer membrane surrounding their brain). This can happen when the veins that bridge your child’s brain to their dura are stretched too far, causing tears and bleeding.
  • Subarachnoid hemorrhage: Bleeding between your child’s brain and arachnoid (the web-like membrane surrounding your child’s brain).
  • Direct brain trauma: This can occur when your child’s brain strikes the inner surfaces of their skull.
  • Brain damage: Brain damage can result from a lack of oxygen if your child stops breathing during shaking.
  • Brain cell damage: This can occur when injured nerve cells release chemicals that add to the oxygen deprivation to your child’s brain.
  • Retinal hemorrhages: Bleeding in the back of your child’s retinas.
  • Neck and spinal cord damage: Injuries to your child’s cervical spinal nerves.
  • Fractures: This may include skull fractures as well as fractures to your baby’s ribs, collarbone, arms and legs.

Symptoms and Causes

How soon do symptoms of shaken baby syndrome appear?

Signs of shaken baby syndrome may appear immediately after the child has been shaken. The signs typically reach their peak within four to six hours. Some symptoms show up right away, but shaken baby syndrome symptoms may not appear until later in life. Some children may have attention and behavior problems later in life from being shaken when they were infants.

What are the symptoms of shaken baby syndrome?

A child or baby who’s been shaken may have an injury to their brain. Severe immediate signs of shaken baby syndrome may include unconsciousness, seizures and shock. Other shaken baby syndrome symptoms may include:

  • Not smiling, babbling or talking.
  • Extreme irritability.
  • Vomiting.
  • Poor appetite or feeding problems.
  • Breathing difficulties.
  • Lethargy (extreme tiredness, lack of movement and/or an inability to stay awake).
  • Pale- or blue-colored skin.
  • Bruises on their arms or chest.
  • A large head or forehead.
  • A bulging soft spot on the top of their head.
  • Inability to lift their head.
  • Widened (dilated) pupils.
  • Inability to focus or follow movement with their eyes.
  • Tremors.
  • Coma.

Can shaken baby syndrome go unnoticed?

Sometimes there are no obvious external signs of physical violence or injury. Caregivers and healthcare providers who aren’t aware a baby’s been shaken may not immediately find internal injuries. They may attribute a baby’s symptoms to another cause, such as a virus.

What causes shaken baby syndrome?

When someone shakes a baby or young child violently, shaken baby syndrome can occur. Hitting the child on the head, throwing them and dropping them on purpose can also cause the condition. Shaking or hitting a child can cause their brain to shake back and forth inside their skull.

Children's brains are softer and their ligaments are weaker. Their neck muscles aren’t fully developed yet. In addition, their heads are large and heavy in proportion to the rest of their bodies. The violent shaking tears the child’s blood vessels, nerves and tissues, causing their brain to swell, bruise and bleed.

Shaken baby syndrome most often happens at the hands of an overwhelmed and frustrated caregiver who can’t cope with a baby’s inconsolable crying. The caregiver gets angry or stressed and loses control. Most times, the caregiver didn’t mean to harm the baby, but it’s still a form of child abuse.

Can bouncing a baby cause shaken baby syndrome?

Shaken baby syndrome is a type of child abuse. It happens when someone violently shakes a baby or small child. It’s not caused by:

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

These activities can be dangerous and therefore aren’t recommended, but they won’t cause the kinds of injuries seen in shaken baby syndrome.

Diagnosis and Tests

How is shaken baby syndrome diagnosed?

Diagnosing shaken baby syndrome may be difficult for several reasons:

  • 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 symptoms of shaken baby syndrome (such as irritability, vomiting or lethargy) are also common in other conditions, such as viral infections.

Therefore, a healthcare provider will use visual clues and tests to diagnose the condition and determine how severe it is. They’ll check your baby’s eyes for bleeding, look for marks on their skull, arms or legs, and check for bruises around their neck and chest.

What tests will be done to diagnose shaken baby syndrome?

Healthcare providers may use certain imaging tests to diagnose shaken baby syndrome. These tests can show signs of swelling or bleeding in your baby’s brain and also show skull or rib fractures. These tests may include:

Your baby’s provider may also perform an eye examination to look for evidence of retinal bleeding (bleeding at the back of their eyes). The bleeding may be above, within or below their retinas. The layers of your baby’s retinas may also be split apart as a result of injury (retinoschisis). The jelly-like filling inside their eyes (vitreous) may also fill with blood.

Management and Treatment

How is shaken baby syndrome treated?

If your baby has any signs of shaken baby syndrome, they need immediate medical treatment. For milder cases, your baby may need medicine and observation at the hospital.

In more severe cases, treatment may include life-saving measures. A healthcare provider may insert a breathing tube down your child’s throat to provide respiratory support. A surgeon may have to perform surgery to stop bleeding or reduce swelling in your baby’s brain.

Prevention

How can shaken baby syndrome be prevented?

Parents or caregivers who shake babies usually say that the shaking occurred when their baby was crying inconsolably. It’s normal for babies to cry, and it can get stressful. Understanding the dangers of shaking your baby and finding support can help prevent shaken baby syndrome. Some things you can do to avoid shaken baby syndrome include:

  • First, make sure that nothing obvious is wrong with your baby. You should check to see that their diaper is clean and ensure your baby isn’t hungry or cold. Make sure there’s no sign of illness, such as fever or swelling, and that nothing is causing pain.
  • If your baby's needs are met, try using noise. You can put on a radio, or sing and talk to your baby. Sometimes, babies like noises like vacuum cleaners, clothes dryers, hair dryers or fans.
  • Offer your baby a toy or pacifier.
  • Try breastfeeding, or offer a bottle to your baby.
  • Swaddle your baby, or try rocking them.
  • Take your baby for a ride in the car (appropriately secured in their car seat).
  • Place your baby in a stroller, and go for a walk.
  • Take your baby for a ride on an outdoor swing.
  • Ask someone else (a friend, a co-worker, a neighbor or a family member) to take over for you for a period of time so you can have a break. It’s very reasonable to ask for help.
  • If no one else is available to take over for you, put your baby safely in their crib and leave the room for a few minutes while you calm down. Remember, crying won’t hurt babies, but shaking will.

Make sure all of your babysitters, nannies and other caregivers know about the dangers of shaking a baby. Ensure they know what to do — and what not to do — if they feel stressed while caring for your child. Always check references and choose your caregivers carefully. Never leave your baby with a caregiver whom you don’t trust completely.

Outlook / Prognosis

What is the outlook (prognosis) for shaken baby syndrome?

Shaken baby syndrome is a very serious condition. The prognosis varies by the severity of your baby’s injuries but is generally poor. About 25% of babies will die due to their injuries. Death is typically caused by:

  • Swelling and pressure within your baby’s skull and brain.
  • Bleeding within your baby’s brain.
  • Tears in your baby’s brain tissue.

Up to 80% of those that survive will experience serious medical problems, severe neurological deficits and lifelong disabilities. Even babies that appear to have only mild shaken baby syndrome injuries may show signs of developmental difficulties. Shaken baby syndrome may cause disabilities including:

A note from Cleveland Clinic

Shaken baby syndrome is a form of severe physical child abuse that occurs when a parent or caregiver violently shakes a baby or child. The condition most often occurs when a caregiver becomes angry or frustrated when a baby won’t stop crying. Shaken baby syndrome is completely preventable. If your baby won’t stop crying, try some of the tips in the Prevention section above, or ask a trusted caregiver for help.

Last reviewed by a Cleveland Clinic medical professional on 08/11/2022.

References

  • American Academy of Family Physicians. Abusive Head Trauma. (https://familydoctor.org/condition/abusive-head-trauma/) Accessed 8/11/2022.
  • American Association for Pediatric Ophthalmology & Strabismus. Shaken Baby Syndrome. (https://www.aapos.org/glossary/shaken-baby-syndrome) Accessed 8/11/2022.
  • American Association of Neurological Surgeons. Shaken Baby Syndrome. (https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Shaken-Baby-Syndrome) Accessed 8/11/2022.
  • Joyce T, Gossman W, Huecker MR. Pediatric Abusive Head Trauma. (https://pubmed.ncbi.nlm.nih.gov/29763011/) 2022 Jul 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Accessed 8/11/2022.
  • Maiese A, Iannaccone F, Scatena A, et al. Pediatric Abusive Head Trauma: A Systematic Review. (https://pubmed.ncbi.nlm.nih.gov/33924220/) Diagnostics (Basel). 2021 Apr 20;11(4):734. Accessed 8/11/2022.
  • National Center on Shaken Baby Syndrome. About SBS/AHT. (https://www.dontshake.org/learn-more) Accessed 8/11/2022.
  • National Institute of Neurological Disorders and Stroke. Shaken Baby Syndrome. (https://www.ninds.nih.gov/Disorders/All-Disorders/Shaken-Baby-Syndrome-Information-Page) Accessed 8/11/2022.
  • National Library of Medicine. Shaken baby syndrome. (https://medlineplus.gov/ency/article/007578.htm) Accessed 8/11/2022.

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