Topic Overview

What is shaken baby syndrome?

Shaken baby syndrome is brain injury that occurs when someone shakes a baby or throws a baby against an object. It is a form of child abuse. It may happen to children of all ages, but it is most common in babies younger than 1 year old.

It is never okay to shake or throw a child. It may not leave any obvious sign of injury, but it can cause serious long-term problems or even death.

Shaken baby syndrome often occurs when a parent or someone else looking after a baby gets frustrated with the baby’s crying, temporarily loses control, and violently shakes the baby. Parents can help prevent this problem by learning healthy ways to relieve stress and anger. It's also important to choose child care providers carefully.

Shaken baby syndrome may also be called "shaken-impact syndrome." Many doctors use the term "abusive head trauma" to describe the injury. 

What causes the brain injury?

When a baby is shaken or thrown, the head twists or whips back and forth. This can cause tears in brain tissue, blood vessels, and nerves. The child's brain slams against the skull. This can cause bleeding and swelling in the brain.

Young children are at high risk for brain injury when they are shaken or thrown. That's because they have:

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

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

What are the symptoms?

Symptoms vary among children based on how old they are, 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. For example, a child may:

    • Be fussy, grouchy, or sluggish.
    • Vomit.
    • Not be hungry.
    • No longer smile, make eye contact or babble.

A child with more severe injuries may have symptoms such as:

    • Seizures.
    • Difficulty breathing or a change in breathing pattern.
    • A limp body.
    • A slow heartbeat.
    • Trouble hearing.
    • Bleeding inside one or both eyes.

A child who has been shaken or thrown may also have other signs of abuse, such as broken bones, bruises, or burns.

Symptoms can start quickly, especially in a badly injured child. Other times, it may take a few days for brain swelling to cause symptoms.

Sometimes caregivers who harm a child will put the child to bed. They may hope that symptoms will get better with rest. By the time the child gets to a doctor, the child may need urgent care. In some cases, the child may be in a coma before a caregiver seeks help.

How is shaken baby syndrome diagnosed?

Shaken baby syndrome can be hard to detect because often there aren't clear signs of abuse. Instead, a baby may have vague symptoms, such as vomiting or a poor appetite. At first these symptoms may seem related to an infection, such as influenza (flu) or a kidney infection. Sadly, shaken baby syndrome may not be discovered until repeated abuse or more severe harm occurs.

To confirm a diagnosis of shaken baby syndrome, a doctor will:

  • Ask about the child's medical history, including when changes in behaviour began.
  • Do a physical examination to look for signs of injury and increased blood pressure.
  • Do imaging tests such as a CT scan or an MRI to look for bleeding or other injury in the brain.
  • Take X-rays to check for broken bones.

A doctor may also do tests to rule out other possible causes of the child's symptoms. For example, a lumbar puncture checks the spinal fluid for signs of meningitis. Blood tests may be done to check for internal injuries or to rule out other conditions, such as rare blood disorders.

A doctor who suspects shaken baby syndrome must report it to the local child welfare office and police.

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.

Depending on the symptoms, doctors may try seizure medicine, physiotherapy, or other treatments. A child who has severe bleeding in the brain may need surgery.

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

A child may have brain damage that causes one or more serious problems, such as:

  • Seizures. A baby may have uncontrolled muscle movement and be unable to speak, see, or interact normally.
  • Blindness or trouble seeing or hearing.
  • Cerebral palsy, with muscle stiffness (spasticity) that results in awkward movements.
  • Intellectual disabilities that can affect every area of a child's life. For example, a child may have trouble learning to talk or may not be able to care for himself or herself in the future.
  • Learning disabilities that may not appear until the child starts school.
  • Emotional or behaviour problems.

Some children die from their injuries.

What should you do if you suspect shaken baby syndrome?

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.

Call 911 or other emergency services immediately if a child:

Young children can't defend themselves, so it is up to adults who care to protect them. If you suspect abuse and the child is not in immediate danger:

  • Call local child protective services or the police.
  • Do not confront the person who may have abused the child. This may cause more harm to the child.

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Other Places To Get Help

Organizations

Canadian Paediatric Society
www.cps.ca
Provincial and Territorial Helplines and Websites (Canada)

If you want to save this information but don't think it is safe to take it home, see if a trusted friend can keep it for you. Plan ahead. Know who you can call for help, and memorize the phone number.

Be careful online too. Your online activity may be seen by others. Do not use your personal computer or device to read about this topic. Use a safe computer such as one at work, a friend's house, or a library.

Many of the resources below have toll-free phone numbers and provide help 24 hours a day, 7 days a week in multiple languages. In an emergency, call 911.

Canada-wide resources

  • To find a suicide prevention crisis centre phone number or website in your province, visit the Canadian Association for Suicide Prevention's webpage at http://suicideprevention.ca/need-help.
  • To find a rape crisis or women's centre phone number or website in your province, visit the Canadian Association of Sexual Assault Centres' webpage at www.casac.ca/content/anti-violence-centres.
  • Kids and teens can call Kids Help Phone at 1-800-668-6868 or visit http://org.kidshelpphone.ca.

Alberta

  • Provincial Health Information Line. Health Link. Call 8-1-1 or visit www.albertahealthservices.ca/assets/healthinfo/link/index.html.
  • Alberta Human Services: Connect to Support and Services. Call one of the numbers below or visit http://humanservices.alberta.ca/abuse-bullying/14839.html.
    • Family Violence Info Line. Call 310-1818.
    • Child Abuse Hotline. Call 1-800-387-5437.
    • Bullying Helpline. Call 1-888-456-2323.
  • Sexual Assault Centre of Edmonton (SACE). Call (780) 423-4121 or visit www.sace.ab.ca.
  • Mental Health Helpline. Call 1-877-303-2642.
  • Addiction Services Helpline. Call 1-866-332-2322.

British Columbia

  • Provincial Health Information Line. HealthLinkBC. Call 8-1-1 or visit www.healthlinkbc.ca.
  • VictimLinkBC. Call 1-800-563-0808 or visit http://www2.gov.bc.ca/gov/content/justice/criminal-justice/victims-of-crime/victimlinkbc.
  • Keeping Kids Safe. Call 1-800-663-9122 or visit http://www2.gov.bc.ca/gov/content/safety/public-safety/protecting-children/keeping-kids-safe.
  • Helpline for Children. Children and youth can call 310-1234.
  • BC Mental Health and Substance Use Services. Call 310-6789 or visit www.bcmhsus.ca.
  • Crisis Centre. Call 1-800-784-2433 or visit http://crisiscentre.bc.ca.

New Brunswick

  • Provincial Health Information Line. Tele-Care: Call 8-1-1 or visit www2.gnb.ca/content/gnb/en/departments/health/Tele-Care.html.
  • Emergency Social Services. Visit http://www2.gnb.ca/content/gnb/en/departments/social_development/about_us/emergency_socialservices.html to find the number for the office nearest you or call 1-800-442-9799.
  • Fredericton Sexual Assault Crisis Centre. Call (506) 454-0437 or visit www.fsacc.ca.
  • Suicide Prevention CHIMO Helpline. Call 1-800-667-5005 or visit www2.gnb.ca/content/gnb/en/departments/health/Suicide_Prevention.html.

Ontario

  • Provincial Health Information Line. Telehealth Ontario: Call 1-866-797-0000 or visit www.ontario.ca/page/get-medical-advice-telehealth-ontario.
  • Assaulted Women's Helpline. Call 1-866-863-0511 or visit www.awhl.org.
  • Distress and Crisis Ontario. Visit www.dcontario.org centres.html to find the phone number for a crisis line in your calling area.
  • Drug and Alcohol Helpline. Call 1-800-565-8603 or visit www.drugandalcoholhelpline.ca.
  • Mental Health Helpline. Call 1-866-531-2600 or visit www.mentalhealthhelpline.ca.

Quebec

  • Provincial Health Information Line. Info-Sante. Call 8-1-1 or visit www.santemonteregie.qc.ca/portail/services/info-sante.en.html.
  • Domestic Violence. Go to http://domesticviolence.gouv.qc.ca.
  • Batshaw Youth and Family Centres Foundation. Call Youth Protection Services at (514) 935-6196 or visit www.batshaw.qc.ca/en/need-help/report.
  • Drugs: Help and Referral. Call 1-800-265-2626 or visit www.drogue-aidereference.qc.ca/www/index.php.
  • Preventing Suicide. Call 1-866-277-3553 or visit http://sante.gouv.qc.ca/en/conseils-et-prevention/prevenir-le-suicide.
  • Mental Health. Visit http://sante.gouv.qc.ca/en/problemes-de-sante/sante-mentale.

Saskatchewan

  • Provincial Health Information Line. HealthLine. Call 8-1-1 or visit www.saskatchewan.ca/residents/health/accessing-health-care-services/healthline.
  • Victims of Crime and Abuse. Go to www.saskatchewan.ca/residents/justice-crime-and-the-law/victims-of-crime-and-abuse for a list of community-based organizations and their contact information.
  • Child Abuse and Neglect. Go to www.saskatchewan.ca/residents/justice-crime-and-the-law/child-protection/child-abuse-and-neglect for a list of local child protection offices and their contact information.
  • Mental Health and Addiction Services. Go to www.saskatchewan.ca/residents/health/accessing-health-care-services/mental-health-and-addictions-support-services for a list of local mental health and addictions services.

Yukon

  • Territorial Health Information Line. HealthLine: Call 8-1-1 or visit www.hss.gov.yk.ca/811.php. If you are calling from a satellite phone, you can dial (604) 215-4700 to reach the Health Services Representative at HealthLink BC.
  • Family and Children's Services. Call 1-800-661-0408, ext. 3002, or visit www.hss.gov.yk.ca/family_children.php.
  • VictimLink. Call 1-800-563-0808 or visit the Department of Justice "Need Help? Phone Directory" at www.justice.gov.yk.ca/prog/cor/vs/phonedir.html.
  • Alcohol and Drug Services. Call 1-855-667-5777 or visit http://hss.gov.yk.ca/ads.php.

Other provinces and territories

Check your local phone book or provincial or territorial website.

The Period of Purple Crying (U.S.)
www.purplecrying.info

References

Other Works Consulted

  • Saunders BE, et al., eds. (2004). Child Physical and Sexual Abuse: Guidelines for Treatment (Revised). Charleston, SC: National Crime Victims Research and Treatment Center. Also available online: http://academicdepartments.musc.edu/ncvc/resources_prof/ovc_guidelines04-26-04.pdf.
  • American Academy of Pediatrics (2007, reaffirmed 2012). Evaluation of suspected child physical abuse. Pediatrics, 119(6): 1232-1241. Also available online: http://pediatrics.aappublications.org/content/119/6/1232.full.
  • American Academy of Pediatrics (2008). Promoting mental health. In Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd ed., pp. 77-107. Elk Grove Village, IL: American Academy of Pediatrics.
  • Braverman R (2014). Eye. In WW Hay Jr et al., eds., Current Diagnosis and Treatment: Pediatrics, 22nd ed., pp. 447-489. New York: McGraw Hill.
  • The Arc (accessed October 2012). Shaken Baby Syndrome. Silver Spring, MD: The Arc. Available online: http://www.thearc.org/page.aspx?pid=2549.

Credits

Adaptation Date: 12/3/2017

Adapted By: HealthLink BC

Adaptation Reviewed By: HealthLink BC

Adaptation Date: 12/3/2017

Adapted By: HealthLink BC

Adaptation Reviewed By: HealthLink BC