Traumatic head injury due to child maltreatment (Shaken baby syndrome)

The most common trigger for shaking a baby is its crying. Serious injuries can occur when a parent or caregiver gets frustrated, angry or upset because they are unable to console their crying baby and they temporarily lose control and violently shake the baby.

A baby’s crying can be very stressful and it is common for parents and caregivers to experience negative emotions. You will find useful resources and strategies below to support and help you if you feel frustrated, angry or overwhelmed.

What is shaken baby syndrome?

Traumatic Head Injury due to Child Maltreatment (THI-CM) is also known as shaken baby syndrome (SBS) or Abusive Head Trauma (AHT). A variety of serious injuries to the skull, brain, head, neck, eye and spine, can result from violently shaking an infant, with or without impact to the head. These injuries are entirely preventable.

Why is shaking a baby so dangerous?

Shaking a baby is dangerous because they have a soft, fragile brain that is still developing. Their heads are heavy and large compared to the rest of the body and their neck muscles are not strong enough to support the weight of their head. During shaking, an infant’s head moves back and forth in a figure-eight motion. This rapid acceleration-deceleration causes the brain and skull to move at different speeds in different locations causing damage to nerves, veins and swelling of the brain.

It is never okay to shake a baby or child. Approximately 25 percent of babies who are shaken die and as many as 80 percent have permanent brain damage.

Shaking injuries do not occur during regular interactions. For example, gently bouncing an infant on your knee, sudden stops in a car or going over bumps in a stroller does not cause THI-CM.

What damage can shaking a baby cause?

Shaking a baby can cause:

• Seizures
• Permanent brain damage
• Speech and learning difficulties
• Blindness and deafness
• Paralysis
• Behaviour problems
• Death

How can I protect my baby from THI-CM?

Never shake a baby.

If your baby continues crying after you have tried soothing and you feel overwhelmed, stressed or angry, take a break. Gently place your baby in a safe place, such as the crib, and leave the room. Take 10 to 15 minutes to give yourself a chance to calm down before you try again. When you feel more in control, it will be easier to calm your baby. If you feel unable to cope, call someone for help once you have put your baby in a safe place or call HealthLinkBC at 8-1-1. Never pick up a baby when you are angry or overwhelmed.

Talk to others who care for your baby such as babysitters, relatives and friends. Make sure they understand that it is more important to be calm than to stop your baby from crying. Let caregivers know that you are happy to come get the baby if the crying is too stressful for them. Do not leave your baby in the care of someone who has problems controlling their anger. Remind inexperienced or impatient caregivers to take breaks.

Why do babies cry?

All babies cry. Sometimes it is easy to tell why a baby is crying, sometimes it is not. It is normal for babies to cry more and for longer periods of time starting at about 2 weeks of age and continuing until about 3 to 4 months. This period of crying is referred to as the Period of PURPLE Crying®. Some babies are more resistant to soothing and can cry for hours but are still healthy. For more information visit www.dontshake.ca.

Not being able to soothe your baby or stop their crying does not mean you are a bad parent. Crying is an annoying sound; it is supposed to be. If it were a pleasant sound, crying would be easy to ignore and the baby’s needs would not be met. Listening to your baby cry can be heart-wrenching. Remember that a period of more intense crying in the early months is a normal developmental stage that most babies go through.

If your baby’s crying is constant or louder than usual, your baby is feeding poorly, has difficulty breathing, a fever, is vomiting, or you have concerns that something is wrong, call your doctor. You can also call 8-1-1 or take your baby to the hospital or health clinic.

What can you do when your baby won’t stop crying?

There is no all-purpose solution to stop every baby from crying. You may find that what works today will not work tomorrow. Sometimes nothing you do will stop your baby from crying. That does not mean you’re doing something wrong as a parent.

Here are some suggestions that may help comfort your baby:

• Snuggle your baby close to your chest. Your heartbeat may comfort your baby, skin-to-skin contact is preferable
• Follow your baby’s cues for hunger such as bringing their hands to their mouth, rooting or moving their head, opening their mouth, licking their lips and sucking their hands. For the first few months of life, babies usually feed at least every 2 to 3 hours. Your baby may want to feed more frequently during growth spurts. Burp your baby after feeding
• Check your baby’s diaper. Keep your baby clean and dry
• Wrap your baby in a soft blanket:
  • Keep your baby warm and comfortable but not too hot
  • Do not put your baby in a crib or bassinette when wrapped in a blanket. For more information on safe sleep visit Safer sleep for my baby
• Provide soft music or other relaxing sounds:
  • Try humming or singing a lullaby
  • Sometimes white noise such as the sound of the vacuum cleaner, clothes dryer, fish tank filter or dishwasher helps calm a baby. White noise apps can also be found on a smart phone
• Offer a favourite blanket or soft toy while cuddling the baby
• Provide gentle motion or change your baby’s position:
  • Walk with or rock your baby. You may want to put your baby in an infant carrier and walk around the house
  • Try an age-appropriate baby swing, rocker or bouncer
  • Take your baby for a walk outside in an infant carrier or stroller
  • Some babies like to go for a car ride. Be sure your baby is safely secured in an infant car seat

Sometimes these suggestions work and sometimes they don’t. It is worth trying these suggestions but try not to blame yourself or get frustrated with your baby if they do not work. Remember that the Period of PURPLE Crying® is a normal stage that will come to an end.

Plan ahead for the Period of PURPLE Crying®

Plan ahead and know that you are not alone in feeling difficult emotions when your baby cries. Try establishing a routine that includes going outside even for a bit. Building a scheduled activity into your routine that helps you feel connected is important. This could be joining a parent group in person or virtually. If you find you are struggling, it is ok to ask for help. Reach out to:

• Family and friends
• Parent groups
• Your child’s health care provider
• Your public health nurse

You can also call 8-1-1 to speak with a registered nurse 24 hours a day, 7 days a week or you can call your local hospital or health clinic for other contacts in your community.

Remember – NEVER shake a baby!

Put your baby in a safe place and take a break.

Signs to look for

Red flag signs: Seek immediate medical help if you suspect your child has been violently shaken. Call 9-1-1 or take your child to the emergency department if your baby shows any of the following signs:

• Seizures
• Loss of consciousness
• Difficulty breathing or turning blue
• Unable to make sounds or follow movement
• Unable to suck or swallow

 Non-specific signs: On their own, non-specific signs are not an indicator of THI-CM. However, if there are multiple signs, it is best to follow-up with your health care provider. Signs include:

• Bruising on face, neck or torso
• Trouble sucking or swallowing or decreased appetite
• Loss of smiling or vocalizing
• Low level of consciousness/lethargy
• Poor muscle tone
• Dilated or different sized pupils
• Vomiting
• Extreme fussiness or irritability

For more information

For more information on ways to comfort your baby, review the Period of PURPLE Crying® program materials that you received at the hospital. For mothers that did not give birth at a hospital in British Columbia, you can receive the mobile app/booklet package from your public health centre or nurse. To find your local public health authority unit use www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/partners/health-authorities/regional-health-authorities.

For more tips and resources online, visit www.dontshake.ca.