Shaken baby syndrome: the problem and a model for prevention

Children Today, March-April, 1992 by Jacy Showers

The term "Shaken Baby Syndrome" (SBS) describes the consequences which occur when a young child's head is whiplashed back and forth during shaking.

Babies can be easily injured when shaken. Their neck muscles aren't strong enough to control head movements, and rapid movement of the head can result in the brain being bruised from banging against the skull wall.(1-4) Bleeding behind the eyes and in and around the brain occurs and can cause serious injury. Depending upon the vulnerability of the child and the severity of the shaking, consequences may include seizures, partial or total blindness, paralysis, mental retardation, or death.(1,4-10) In cases of less violent and sometimes chronic shaking of a young child, long-term outcomes can include attention deficits and learning disabilities.

With recent introduction of a technological instrument called a Magnetic Resonance Imager (MRI), more and more cases of SBS are being identified. In the past, these cases may have gone undetected or been misdiagnosed as Sudden Infant Death Syndrome (SIDS). As more cases of SBS have been identified medically, criminal investigation of, and prosecution for, possible child abuse have increase. A concomitant rise in media attention to the problem is in part responsible for a greater emphasis on prevention efforts.

Need For Education

Problems associated with shaking and the need for a national campaign to educate the public that shaking a baby is dangerous were clearly described as early as 1972.(1) Unfortunately it has only been in the past few years that the need has been taken seriously. The delay in acceptance of the need for education about SBS and its prevention can be attributed to several factors. First, there was inadequate medical documentation that SBS was a serious problem. Thanks to the MRI scan, medical identification of SBS has improved. Second, there was no evidence indicating whether or not the American public knew that shaking a baby was dangerous.

In addition, there was the assumption by many professionals that people surely knew shaking a baby is harmful. Five studies conducted between 1982 and 1990 revealed that 25-50% of teenagers and adults did not know that shaking a baby is dangerous.(11-14) These data clearly dispute the assumption that knowing about the dangers of shaking is just common sense. The need for education has never been more clear.

Case Examples

The following recent case examples illustrate the nature of the problem: * In November, 1991, an 18-year-old man shook a 7-week-old infant for whom he was baby-sitting because he wanted him to stop crying. The infant died the next day. * In July, 1991, a 29-year-old man shook his girlfriend's 9-month-old boy on two different occasions. The baby had recurring vomiting and seizures, but survived. The boyfriend admitted shaking the baby but said he didn't mean to harm him. * In January, 1991, a 32-year-old mother shook her one-month-old son to death. She blamed her 2-year-old daughter for injuring the baby. * In October, 1990, a 32-year-old man shook his 4-month-old daughter violently. She died three days later. * In June, 1990, a 29-year-old man shook his girlfriend's 13-month-old to stop her from crying. She suffered partial paralysis, visual impairment, and speech delay. * In April, 1990, a 22-year-old father said he "lost his cool" before shaking his 5-week-old son, causing severe neurological damage. He admitted shaking the child to stop him from crying, but said he didn't mean to harm him. *In September, 1989, a 22-year-old man admitted shaking his 7-month-old daughter but said it wasn't hard enough to hurt her. The baby died. * In July, 1989, a 29-year-old mother killed one of her 8-month-old twins by violently shaking her. The mother said she was under stress when the incident happened. * In September, 1988, a 30-year-old man was baby-sitting for a 3-month-old baby and shook him hard. The baby died six months later.

In many cases of SBS, there are common threads. The precipitating event is consistently reported as infant crying. The perpetrator often says he or she didn't mean to hurt the baby but just wanted to stop the crying. Many report high levels of stress. Although case examples exist in which child day care providers are perpetrators, most often those who shake babies are family members or parent's boyfriend/girlfriend left to baby-sit an infant. Although not enough data have been gathered to develop a case "profile," the available information suggests that perpetrators are more likely to be men than women, and victims are more likely to be boy babies than girl babies. Case examples defy characterization by race or socioeconomic class. The problem, it seems, is everywhere.

Combatting SBS

There is increasing recognition nationwide that Shaken Baby Syndrome is not a rare phenomenon and that a public education campaign is needed. More and more, agencies have begun to distribute printed material describing the problem. The number of public service announcements (PSAs) and billboard ads has also risen. The most comprehensive campaign to date has been a "Don't Shake The Baby" program begun in Ohio.[15] What follows is a description of program components and what has been learned.