Shaken Baby Syndrome

Overview

What is shaken baby syndrome (SBS)?

Shaken baby syndrome (SBS) is a type of brain injury that occurs when a baby or a toddler is shaken violently. This causes swelling, bruising and bleeding in the brain. The child may be further injured if he or she is thrown down onto a surface, which is known as shaken impact syndrome.

Infants’ heads are very large and heavy in proportion to the rest of their bodies. When a child is shaken, his or her brain bounces back and forth against the sides of the skull. Shaking can cause bleeding in the brain (subdural hemorrhages, or hematomas) or in the retinas (retinal hemorrhages).

Why do people shake babies?

Parents or caregivers may shake a baby because it is crying for a long time, and they may think that shaking the baby will make him or her stop crying. Some parents or caregivers may be under stress for various reasons, and 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.

Who shakes babies?

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

Symptoms and Causes

What are the symptoms of shaken baby syndrome (SBS)?

A child or baby who has been shaken and has had an injury to the brain may have symptoms such as:

  • 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.
  • Bruises on the arms or chest.
  • A large head or forehead.
  • A soft spot on top of the head that is bulging.
  • Inability to lift his or her head.
  • Dilated (widened) pupils.
  • Tremors (the shakes).
  • Inability to focus or follow movement with his or her eyes.
  • Coma (unconsciousness).

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

Babies and children who are shaken face serious medical problems as they grow older, including:

  • Brain damage.
  • Blindness.
  • Hearing loss.
  • Cerebral palsy.
  • Speech and learning disorders.
  • Seizures.
  • Neck and spinal cord damage, which can lead to problems with movement ranging from clumsiness to paralysis.
  • Death.

Who is most at risk for shaken baby syndrome (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.

Diagnosis and Tests

How is shaken baby syndrome (SBS) diagnosed?

Diagnosing shaken baby syndrome (SBS) may be difficult for several reasons:

  • Healthcare providers do not always get the truth about whether or not shaking was involved in an infant’s injury.
  • Babies and very small children cannot tell doctors or nurses 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.

Healthcare providers may use certain tests when a brain injury appears possible, including:

Management and Treatment

How is shaken baby syndrome (SBS) treated?

Shaken baby syndrome 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 healthcare provider that the baby has been shaken. Caregivers who are not telling the truth may say that the child has fallen.

Depending on how severe the symptoms are and the child’s condition, the child may need respiratory (breathing) support or surgery to stop bleeding in the brain.

Prevention

How can shaken baby syndrome (SBS) be prevented?

Parents or caregivers who shake babies usually say that the shaking occurred when the baby was crying inconsolably.

Babies cry from one to three hours per day. Here are some things you can do to avoid becoming angry and shaking the baby:

  • First, 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, and that nothing 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).
  • Take your baby for a ride on an outdoor swing.
  • Ask someone else (a friend, a coworker, a neighbor or a family member) to take over for you for a period of time so you can have a break. It is very reasonable to ask for help. (Be sure to check references if you plan to place your child in daycare.)
  • If no one else is available to take over for you, put the baby safely in the crib and leave the room for a few minutes while you calm down. Remember, crying won’t hurt babies, but shaking will.

Last reviewed by a Cleveland Clinic medical professional on 07/01/2019.

References

  • National Center on Shaken Baby Syndrome. Accessed 9/13/2021.What is Shaken Baby Syndrome/Abusive Head Trauma (SBS/AHT)? (https://www.dontshake.org/learn-more#what-is-shaken-baby-syndrome-abusive-head-trauma-sbs-aht)
  • American Association of Neurological Surgeons. . Accessed 9/13/2021.Shaken Baby Syndrome (https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Shaken-Baby-Syndrome)
  • National Institute of Neurological Disorders and Stroke. . Accessed 9/13/2021.Shaken Baby Syndrome Information Page (https://www.ninds.nih.gov/Disorders/All-Disorders/Shaken-Baby-Syndrome-Information-Page)

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