Shaken baby syndrome

Overview

Shaken baby syndrome (SBS), also known as abusive head trauma (AHT), is a serious and potentially fatal form of child abuse that occurs when an infant or young child is violently shaken. The syndrome results in traumatic brain injury, which can lead to severe neurological damage, long-term disability, or death. SBS typically affects children under the age of two, as their neck muscles are not strong enough to support their disproportionately large heads. The rapid back-and-forth motion causes the brain to move within the skull, leading to bleeding, swelling, and damage to brain tissues.

Causes

Shaken baby syndrome is caused by the forceful shaking of a child, often in response to frustration or anger—typically due to persistent crying or difficulty soothing the infant. The violent motion causes the brain to bounce or twist inside the skull, resulting in:

• Subdural hematoma: Bleeding between the brain and the skull

• Retinal hemorrhages: Bleeding in the eyes

• Cerebral edema: Swelling of the brain

• Axonal injury: Tearing of nerve fibers within the brain

It is important to note that these injuries do not occur from normal play, gentle bouncing, or minor falls. SBS is always the result of violent trauma.

Symptoms

Symptoms of shaken baby syndrome can vary widely in severity, depending on the extent of the injury. They may appear immediately or develop over time. Common signs and symptoms include:

Early or Mild Symptoms:

• Irritability and inconsolable crying

• Lethargy or decreased responsiveness

• Poor feeding or vomiting

• Tremors or seizures

• Difficulties breathing

Severe Symptoms:

• Unconsciousness

• Coma

• Paralysis

• Severe seizures

• Cardiopulmonary arrest

In some cases, caregivers may not report any trauma, making clinical suspicion and diagnostic evaluation crucial.

Diagnosis

Diagnosing shaken baby syndrome involves a combination of clinical evaluation, imaging studies, and a detailed history. Because symptoms can mimic other medical conditions, careful investigation is necessary. Diagnostic steps include:

• Clinical examination: Assessing neurological status and signs of trauma

• Imaging:

  • CT or MRI scans of the head to detect subdural hematomas, cerebral edema, or skull fractures

  • Skeletal survey to identify other injuries such as rib or long bone fractures

• Ophthalmologic exam: Detection of retinal hemorrhages, which are highly indicative of SBS

• Laboratory tests: To rule out bleeding disorders or infections

Pediatricians, neurologists, radiologists, and child abuse specialists often collaborate to confirm the diagnosis.

Treatment

Treatment for shaken baby syndrome focuses on stabilizing the child and minimizing further brain damage. Care is typically provided in an intensive care setting and may include:

• Emergency care: Managing airway, breathing, and circulation

• Medications: To control seizures, reduce brain swelling, and manage pain

• Neurosurgical intervention: In cases of severe brain swelling or bleeding, surgery may be necessary to relieve pressure

• Supportive care: Nutrition, hydration, and temperature regulation

• Rehabilitation: Long-term care often involves physical therapy, occupational therapy, and speech therapy

In cases of confirmed abuse, child protective services and law enforcement are involved to ensure the child’s safety and pursue legal action against the perpetrator.

Prognosis

The prognosis for infants and children with shaken baby syndrome varies widely based on the severity of the injury and how quickly treatment is initiated. Outcomes include:

• Full recovery: Possible in mild cases with prompt intervention

• Long-term disabilities: Many survivors suffer from permanent impairments such as cerebral palsy, epilepsy, developmental delays, vision or hearing loss, or learning disabilities

• Mortality: Approximately 15–25% of affected children die from their injuries

Early recognition and medical intervention improve the chances of survival and reduce the severity of long-term complications. However, prevention remains the most effective strategy. Public awareness campaigns, parental education, and caregiver support are essential to preventing shaken baby syndrome and protecting vulnerable infants.