Topic Overview

What is shaken baby syndrome?

Shaken baby syndrome (SBS) is a form of child abuse. It refers to brain injury that happens to the child. It occurs when someone shakes a baby or slams or throws a baby against an object. A child could be shaken by the arms, legs, chest, or shoulders.

Some experts use the term shaken-impact syndrome, because injury from throwing a child against a surface can equal that of shaking. Many doctors use the term "abusive head trauma" or "intentional head injury."

Shaken baby syndrome often occurs when a baby won't stop crying and a caregiver who is frustrated shakes the baby. To help prevent this problem, learn healthy ways to relieve stress and anger. And carefully choose your child care providers.

Normal play, such as bouncing a child on a knee or gently tossing a child in the air, does not cause shaken baby syndrome.

Shaken baby syndrome occurs mostly in children younger than 3. It is most common in babies younger than 1 year of age. But it also can affect children up to age 5. Shaken baby syndrome can cause serious long-term problems.

What causes the brain injury?

Shaking or throwing a child, or slamming a child against an object, causes uncontrollable forward, backward, and twisting head movement. Brain tissue, blood vessels, and nerves tear. The child’s skull can hit the brain with force, causing brain tissue to bleed and swell.

Young children are most likely to have brain injury when they are shaken or thrown because they have:

• Heavy, large heads for their body size.
• Weak neck muscles that do not hold up the head well.
• Delicate blood vessels in their brains.

What are the symptoms?

Symptoms vary among kids based on their age, how often they've been abused, how long they were abused each time, and how much force was used.

Mild injuries may cause subtle symptoms. A child may vomit or be fussy or grouchy, sluggish, or not very hungry. More severe injuries may cause seizures, a slow heartbeat, trouble hearing, or bleeding inside one or both eyes.

It is important to get help if something doesn't seem right with your baby. Shaken baby syndrome may cause only mild symptoms at first, but any head injury in a young child can be dangerous. A child who has trouble breathing, is unconscious, or has seizures needs hospital care right away.

Symptoms can start quickly, especially in a badly injured child. Other times, it may take a few days for brain swelling to show symptoms. Often the caregiver who shook the child puts the child to bed in the hope that symptoms will get better with rest. By the time the child gets to a doctor, the child needs urgent care. In some cases, the child may be in a coma before a caregiver seeks help.

Shaken children may also have other signs of abuse, such as broken bones, bruises, or burns.

How is shaken baby syndrome diagnosed?

Doctors may first suspect shaken baby syndrome when caregivers give vague or changing information about what has happened to the sick child. For example, the caregiver may tell a doctor that the child fell out of bed and then later say that a sibling or a pet caused the injury.

Shaken baby syndrome can be hard to detect, because often there aren't clear signs of abuse. A baby may vomit, have a poor appetite, or be fussy or sluggish. These symptoms may at first seem related to an infection, such as the flu or meningitis. Sadly, you may not find out that shaken baby syndrome caused your child’s injury until repeated abuse or more severe harm occurs.

Doctors check for shaken baby syndrome in several ways. They ask for a child’s medical history. They may also do a physical examination and blood tests. Imaging tests such as X-rays, a CT scan, or an MRI can look for bleeding problems or other injury.

A doctor may also do tests to rule out other conditions. For example, a lumbar puncture checks a baby's spinal fluid for signs of meningitis. Blood found in this sample could point to a shaking injury.

Although each province has its own reporting procedure, a health professional who suspects shaken baby syndrome is required to notify local child welfare officials, social services, or the police.

If you suspect child abuse and the child is not in immediate danger, call your local child protection agency or the police. Do not confront the person who may have abused the child. This may cause more harm to the child.

How is it treated?

A child with shaken baby syndrome needs to be in the hospital, sometimes in an intensive care unit (ICU). Oxygen therapy may be used to help the child breathe. Doctors may give the child medicine to help ease brain swelling. Sometimes a cooling mattress will help lower the child's body temperature and reduce brain swelling too. A child who has severe bleeding in the brain may need surgery.

Depending on the symptoms, doctors may try seizure medicine, physiotherapy, or other treatments.

What are the long-term problems from shaken baby syndrome?

Children can die from their injuries. Those who survive may have brain and vision problems that can last forever. These problems can include:

• Seizures, which are sudden bursts of abnormal electrical activity in the brain. A baby may have uncontrolled muscle movement and be unable to speak, see, or interact normally.
• Muscle stiffness (spasticity) that results in stiff, awkward movements.
• Intellectual disability that can affect every area of a child's life, such as learning to talk or being able to care for himself or herself in the future.
• Blindness or trouble seeing.
• Physical or emotional growth delays.
• Learning or behaviour problems that may not appear until the child starts school.

Frequently Asked Questions

Learning about shaken baby syndrome:	What is shaken baby syndrome? What are the symptoms?
Being diagnosed:	How is shaken baby syndrome diagnosed? What questions are asked during a medical history? What will the doctor look for during a physical examination?
Getting treatment:	How is shaken baby syndrome treated?
Ongoing concerns:	What can I do if I suspect shaken baby syndrome? Who is most likely to shake or throw a child? What can caregivers do to help avoid shaking or throwing a child? What is my stress level? Where can I get help to control anger? Am I depressed?