FAQs About Shaken Baby Syndrome

Even with plans and teaching to prevent child abuse, there will be children that end up being victims of child abuse. If you encounter an infant or a child that is injured from child abuse, call 911. Get the local authorities involved. If an infant appears injured, do not pick up the infant and do not attempt to give the baby something by mouth. If the baby is lethargic and vomiting, gently roll the infant to its side while waiting for emergency assistance (Call 911). The head and body should be rolled as a unit to one side and supported with no manipulation of the infant’s body and head in the meantime. This will allow the infant or child to vomit and avoid inhaling the vomit into the lungs. Let the EMS know your suspicions and provide as much information as possible, so the EMS personnel can provide the information to physicians and nurses at the hospital.  

If you suspect child abuse is happening with someone you know or are acquainted with, call the local county Child Protective Service (CPS) hotline and report your suspicions. The CPS social workers will investigate the complaint and your call will remain anonymous. They will not disclose who made the complaint. They have the tools to investigate the child’s environment. You do not need to investigate before you report. Don’t hesitate to call. You may save a life by calling. 

If you have any questions or concerns about what can be done to help babies who have been shaken due to Shaken Baby Syndrome, Child Abuse, or families of babies who have died, please call Christopher Keane and The Keane Law Firm toll-free for free consultation at (888) 592-5437 (KIDS), click on contact us here, or use the web form provided at https://www.keanelaw.com

The first objective of the law is to prevent bad things from happening.  Let me say that again, the first objective of the law is to prevent bad things from happening. This is done first by recognizing the situations where damage could occur. Next, by educating those who might find themselves in that situation on how to avoid it. Last, by creating incentive for those persons to avoid causing the damage. Also, from a philosophical and evidentiary perspective, if shaken baby syndrome could not be prevented, there would be no justification or basis for lawsuits against those who inflict shaken baby syndrome or those who are charged with being able to but failing to prevent it.

Prevention of non-accidental head trauma and shaken baby syndrome is achievable. Some states have mandated that hospital staff provide parental teaching about the hazards of shaking infants prior to discharging newborn babies home with their families. Different educational materials, such as pamphlets, teaching sessions and videos have been developed for this purpose. Different methods have been devised to assist parents with developing a personal plan to manage their own stress and to prevent child abuse when parents find themselves frustrated, tired or angry. Assisting a parent or caregiver with developing a plan for anticipating what they will do if the baby doesn’t stop crying or misbehaves are methods of preventing over-reaction to stressful situations. Plans to prevent child abuse include teaching parents how to assess the baby to determine the reason for crying, such as assessing for hunger, wet diapers, fever or pain; then placing the baby in a safe area, like the crib, and leaving the room for 10 minutes to calm down if the infant continues to cry despite not being ill or uncomfortable. The plan should include determining who to contact in a time of need, the parent may call someone to come and assist by providing respite during a stressful time. Also the parents should agree not to hold their baby during an argument or stressful moment if they feel they are at risk for losing control of their tempers.  

Teaching parents and caregivers how to recognize the signs of possible abuse and to develop a plan for response to abuse and what to do if they suspect it, will help prevent future abuse of a child from continuing. Teaching parents the importance of not ignoring stress and irritability in each other while caring for the children, especially when one parent is primarily providing the child care in the absence of the other. Single parents need help raising their families. Assisting with helping single parents learn to ask for help and develop a plan for who to contact will prevent child abuse. Provision of hotline resources and support service contact information is important to provide families with timely resources to cope and prevent child abuse.        

It is important for caregivers of infants and children to have adequate rest and a supportive environment. Feelings of stress and frustration are normal while caring for infants and children, however acting out in a harmful way towards the infant or child is not acceptable. The caregiver should focus on developing an abuse-prevention plan for dealing with feelings of stress and frustration that may emerge in the presence of the infant or the child. The abuse-prevention plan should include a cooling off period and developing an effective coping behavior that prevents physical abuse from occurring. 

It is best for families to be proactive and make an effort to provide a supportive environment for caregivers with children by assisting with childcare and allowing the caregiver respite. And the caregiver should not hesitate to ask family members and friends to assist with childrearing. It takes more than one person to care for an infant or raise a child. If you or someone you know has difficulty managing anger than utilizing community programs may be necessary if the family is not supportive. Encourage parents not to hesitate to contact an organization in their community to assist them with childcare and respite issues. Encourage parents and caregivers to seek assistance if they feel overwhelmed by stress. If you know someone that has expressed frustration and is feeling overwhelmed, reach out and assist in any way that you can. Communication is essential to preventing child abuse. Seeking assistance before an injury occurs is not a crime.

If you have any questions or concerns about what can be done to help babies who have been shaken due to Shaken Baby Syndrome, Child Abuse, or families of babies who have died, please call Christopher Keane and The Keane Law Firm toll-free for free consultation at (888) 592-5437 (KIDS), click on contact us here, or use the web form provided at https://www.keanelaw.com

 

Untimely or improperly treated SBS/non-accidental brain injury will very likely exert a significant negative impact on the emotional, intellectual, occupational, physical and social well-being of the child along the child’s developmental lifespan. The location and severity of brain injury will determine the type of symptoms and disabilities that the child will experience. 

For example, impact to the top of the child’s skull may result in some form of paralysis and impact to the front and back of the skull (occipital injury) may cause blindness, both from retinal and optical nerve damage. The severity of head injury will determine the clinical presentation and persistence of symptoms. 

Mild blunt trauma may cause mild concussion with the immediate onset of symptoms following injury, with symptoms lasting hours to days. Moderate blunt trauma may cause immediate onset of symptoms and symptoms lasting up to approximately six months or longer. Severe blunt trauma is followed by immediate onset of symptoms, and delayed onset of more symptoms with high risk for permanent residual neurological defects. In severe blunt trauma, epidural, subdural and intracerebral bleeding and hematomas may be present. The child may not interact with his/her surroundings but appear alert or neurologically depressed. Severe brain injury may also result in a persistent vegetative state or death for the child. 

Researchers and healthcare providers are exploring clinical methods to reduce secondary and tertiary brain injuries as the child recovers from non-accidental brain injury and Shaken Baby Syndrome. Because of improved surgical and medical management of head-injured infants and children, higher acuity is seen within this patient population as they are admitted to in-patient rehabilitation institutions and treated on an outpatient basis. 

While this is a post about children who have already been shaken, it is always important to remember that shaken baby syndrome can be prevented. Read more to find out how.

If you have any questions or concerns about what can be done to help babies who have been shaken due to Shaken Baby Syndrome, Child Abuse, or families of babies who have died, please call Christopher Keane and The Keane Law Firm toll-free for free consultation at (888) 592-5437 (KIDS), click on contact us here, or use the web form provided at https://www.keanelaw.com

Absolutely. The key, however, is getting the baby into the hospital as quickly as possible in order to treat the secondary effects of the traumatic brain injury (e.g. limiting the damaging effects of the bleeding and swelling that goes on inside the brain, which we discussed above) If someone waits too long, the window of opportunity to help the baby may pass and the damage may become irreversible or much worse than it needed to be.

Careful management of the injured infant’s cerebral hemodynamic status is important for achieving the best possible clinical outcome. Cerebral hemo-dynamics are a balance between cerebral blood volume, cerebral blood flow, cerebral perfusion pressure and oxygen saturation. While treating a child with traumatic head injury, medical providers will take measures to ensure the child’s brain receives enough oxygenation to heal from the injury. 

Many professionals will be involved in the care and treatment of a child that has sustained a traumatic brain injury. Professional experts such as physical and occupational therapists, speech therapists, psychologists, nurses, social workers, neurologists, neurosurgeons and rehabilitation experts will participate in the care of the brain injured infant or child long after the date of the injury. 

If you have any questions or concerns about what can be done to help babies who have been shaken due to Shaken Baby Syndrome, Child Abuse, or families of babies who have died, please call Christopher Keane and The Keane Law Firm toll-free for free consultation at (888) 592-5437 (KIDS), click on contact us here, or use the web form provided at https://www.keanelaw.com

The healthcare provider will use physical examination, Doppler, echo studies, arteriogram, computerized tomography (CT) scan, magnetic resonance imaging (MRI), ophthalmologic examination, laboratory tests and skeletal x-rays to check for clinical evidence of SBS. A neurologist may order more tests to identify specific neurological deficits. Brain CT scans and/or MRIs will reveal the severity of the brain and neck injuries. Doppler, echo and arteriogram studies reveal the integrity of vascular structures and blood flow to distal sites. The neurosurgeon may need to do brain surgery to repair the damage and reduce the pressure in the skull. During the course of hospitalization other tests will be performed such as electroencephalograms and neurological evaluation by specialists. An ophthalmic examination will reveal the extent of the injury inside the eyes. Hearing tests will be performed, too.

If you have any questions or concerns about what can be done to help babies who have been shaken due to Shaken Baby Syndrome, Child Abuse, or families of babies who have died, please call Christopher Keane and The Keane Law Firm toll-free for free consultation at (888) 592-5437 (KIDS), click on contact us here, or use the web form provided at https://www.keanelaw.com

The healthcare provider will use physical examination, Doppler, echo studies, arteriogram, computerized tomography (CT) scan, magnetic resonance imaging (MRI), ophthalmologic examination, laboratory tests and skeletal x-rays to check for clinical evidence of SBS. A neurologist may order more tests to identify specific neurological deficits. Brain CT scans and/or MRIs will reveal the severity of the brain and neck injuries. Doppler, echo and arteriogram studies reveal the integrity of vascular structures and blood flow to distal sites. The neurosurgeon may need to do brain surgery to repair the damage and reduce the pressure in the skull. During the course of hospitalization other tests will be performed such as electroencephalograms and neurological evaluation by specialists. An ophthalmic examination will reveal the extent of the injury inside the eyes. Hearing tests will be performed, too. 

If you have any questions or concerns about what can be done to help babies who have been shaken due to Shaken Baby Syndrome, Child Abuse, or families of babies who have died, please call Christopher Keane and The Keane Law Firm toll-free for free consultation at (888) 592-5437 (KIDS), click on contact us here, or use the web form provided at https://www.keanelaw.com

Associated injury patterns are generally found in victims with SBS and non-accidental head trauma. If additional injuries are present with SBS, the infant and/or child may have bruising on the scalp, torso, and extremities. Bruising may be red, bluish-purple or brown, depending on the age of the bruises. Lacerations and contusions may be found anywhere on the child’s body where areas of impact occurred against a surface. Sprains, torn ligaments and tendons in the neck, shoulders, wrists, hands, hips, legs, knees and feet may be present where joints were stressed from hyper-extension (bending back), hyper-flexion (bending forward) and stretching from forceful pulling and shaking action. 

The mouth, or oral cavity, is often a focal site for signs of abuse.  That’s because a primary cause of SBS is an overstressed caregiver trying to quiet a baby from crying. In an effort to quiet the baby and stop the crying, the caregiver will often jam a bottle in the baby’s mouth – causing visible damage. Oral trauma such as cuts, swelling and bruising may be present where forceful feeding or forceful insertion of a pacifier, oral infant toy, foreign object or bottle occurred in the child’s mouth. Oral trauma may also occur from slapping the face area and the sudden impact of teeth through lips or cheeks from a variety of abusive acts. Oral trauma may be found on the outside of the cheeks, inside the cheeks, upper and lower gums, under the tongue, roof of the mouth and back of the throat. If the child is older, evidence of loose or absent teeth may be present. An infant’s oral structures at the bottom of the mouth, such as under the tongue and floor of the mouth are very compliant, therefore more relative force is necessary to cause injury to an infant as compared to an adult. The presence of injuries in this area of the mouth is almost always indicative of maltreatment to the infant, whether by intent or neglect and an unsafe environment.  

Neck and spinal injuries are commonly present with SBS. Evidence of neck and spinal injuries may or may not be visualized both with and without imaging studies. Bruising, swelling over the spinal area and around the neck may or may not be evident. Fracture of the bones, new and old fractures, may be present in the skull, ribs, extremities, and in the spinal column. Sometimes, while imaging studies are done for an abuse injury, other healed or partially-healed fractures of the infant’s or child’s skull, ribs or extremities may be discovered that were not previously known. These findings are evidence of prior abusive events that went undiscovered. 

Sometimes the age of an old injury can be estimated, depending on the physical findings or the age of an injury may be undetermined. Often times when this happens, parents and caregivers may recall a time in the infant or child’s recent history where the child was irritable or acted to be in pain and then the behavior resolved without treatment or investigation into the discomfort or irritability. But healthcare providers don’t anticipate that accurate histories are always attainable by parents or caregivers in clinical situations that feature child abuse. So there may be no history on record of prior abuse, when in reality there was a history of child abuse that actually occurred multiple times previous to the last clinical presentation. Approximately seventy-five percent of child abuse victims have no prior history of abuse on record.  

Skull fractures are indicative of blunt force trauma to the head in addition to Shaken Baby Syndrome. Skull fractures are clear evidence of impact to the skull, whether by hitting, throwing or banging the skull. There may be more than one skull fracture. And there may be fractures elsewhere on the infant or child’s body. In infants and children, the presence of previous fractures is easily ascertained.     

If an infant or child has sustained bruising to the torso or chest, underlying injury patterns may be present such as, contusions to the heart, lungs, liver, spleen, stomach, intestines and pelvic structures. Nerve pathway and vascular tears may be present anywhere in the body or head. Emergency exploratory surgery may be indicated to stabilize bleeding from organs or vessels in the head, torso, chest and extremities. Neurosurgical repair may be indicated to repair and approximate nerve tracts if possible.  

In some cases, there may be associated sexual abuse. Indicators of sexual abuse may include trauma to the pelvic organs and/or external genitalia, oral cavity and rectum. In females, sex abuse may not be as readily observable. The presence of blood in the vaginal vault may be discovered by a healthcare provider experienced in child sex abuse assessment. Redness and swelling in the perineum and rectal area is indicative of sex abuse. Presence of infection in these areas is evidence of prior abuse. Oral trauma may be indicative of sex abuse also. Sometimes these findings are discovered after initial assessment for head injury takes place. The infant or child may cry from the sex abuse trauma and then become a victim of violent shaking and blunt trauma. Internal organ trauma may be present with distention of the pelvic and abdominal cavity.           

If you have any questions or concerns about what can be done to help babies who have been shaken due to Shaken Baby Syndrome, Child Abuse, or families of babies who have died, please call Christopher Keane and The Keane Law Firm toll-free for free consultation at (888) 592-5437 (KIDS), click on contact us here, or use the web form provided at https://www.keanelaw.com

Non-accidental brain injury has three injury phases that make each traumatic brain injury unique. It is not always possible to predict how a child will respond to the phases of traumatic brain injury. Each injury phase may cause further insult to the initial injury. These injury phases rapidly occur in sequence with phase two and three happening concurrently. Careful management of non-accidental injury requires identification of these phases of injury pattern, and therefore, it is common to see providers adjust therapies in response to the child’s clinical presentation and symptoms. Prevention and front-loading therapies are used to achieve to the best clinical outcome possible. Secondary injuries may unfold in response to inflammation and evolution of the original injury.    

The first injury phase is the primary injury sustained from the abuser’s assault. This phase involves the actual traumatic event, followed by the initial neural damage, damage to adjacent glial tissue and the initial inflammatory response that immediately follows the event.  

The second injury phase is when the brain swelling may contribute to the deterioration of the child’s neurological status. This phase may increase intracranial pressure and may impair blood flow to key areas of the child’s brain, including the injury site(s) and adjacent structures. This is the phase where infection may arise or complications associated with increased intracranial pressure may unfold for the injured child. Increased intracranial pressure may cause impaired blood flow to the child’s brain; with higher intracranial pressure leading to worsening neurological impairment. Impaired blood flow may create various complications like brain swelling that causes a brain shift and cellular changes due to a lack of oxygen. This phase requires careful medical/surgical management to minimize permanent injury and prevent death. If a brain injury is severe enough death may not be prevented despite the healthcare provider’s best efforts to prevent it.  

If the child survives the initial injury and the second phase of brain injury, the third injury phase of brain injury may arise from the second injury phase because of pressure on the brain stem and inflammatory mediators that are released from injured brain cells and the immune system. This phase has a profound effect on the respiratory center of the child’s brain. It also negatively impacts the vascular motor stability throughout the child’s body. So the child may have problems with breathing, blood pressure and heart rhythm which may result in low perfusion states. Low perfusion states interfere with the delivery of oxygen to cells and will adversely affect recovery from traumatic injuries. 

If you have any questions or concerns about what can be done to help babies who have been shaken due to Shaken Baby Syndrome, Child Abuse, or families of babies who have died, please call Christopher Keane and The Keane Law Firm toll-free for free consultation at (888) 592-5437 (KIDS), click on contact us here, or use the web form provided at https://www.keanelaw.com

Non-accidental traumatic brain injury (Shaken Baby Syndrome) results in bleeding inside the skull. There are different types of tissue that hemorrhage or bleed inside the brain and cranium. Clinical presentation is dependent on and determined by the part of the child’s brain or area(s) of lining that is/are bleeding; such as epidural hematomas or hemorrhage, subdural hematomas and intracerebral hematomas that may be present. The location of bleeding determines the type of symptoms a child may experience. 

If you have any questions or concerns about what can be done to help babies who have been shaken due to Shaken Baby Syndrome, Child Abuse, or families of babies who have died, please call Christopher Keane and The Keane Law Firm toll-free for free consultation at (888) 592-5437 (KIDS), click on contact us here, or use the web form provided at https://www.keanelaw.com

Many factors may be present that cause adults to injure their infants and children with SBS. First, not all caregivers are ethical or emotionally well-adjusted. Second, not all caregivers care for infants and children in an appropriate manner. Therefore, in any child care setting – be it at a home or in a daycare center - there may be a spectrum of intentional, or non-intentional, abusive activity taking place which results in a shaken baby or abusive head trauma incident. (http://www.cdc.gov/ncipc/dvp/CMP/CMP-risk-p-factors.htm)

Adults with the following risk factors are more likely to abuse their infants and children and cause SBS: 

• poor coping skills

• unrealistic expectations

• substance abuse

• former victims of child abuse

• mental health problems

• social isolation 

• socio-economically depressed, impoverished

• families that suffer with domestic violence issues. 

• prior instances of abuse or neglect have been committed by them or the household in which they live

• Infants or children with the following risk factors are most likely to be victims of SBS:

• less than one year of age

• infants who cry consistently or for long periods of time, or who cannot be soothed very easily

• infants with health problems and disabilities, including behavioral disorders

• twins, or babies of multiple births

However, SBS may occur in any setting and it is important to know the signs and symptoms that may be present in an infant or child that is a victim of SBS. Once an infant has been victimized by non-accidental head trauma and Shaken Baby Syndrome and becomes disabled, the risk of reoccurrence for abuse to this child increases. 

Children from families that do not have extended family in close proximity are at increased risk for abuse. The absence of extended family may be intentional on the part of the abuser. Abusers isolate their victims so the abuse may not be discovered by family and friends. Or, the abuser may come from a dysfunctional family background where support from extended family is not forthcoming due to a weak and fragmented family network.  

Communities where violence is more readily observable do place infants and children at risk for abuse. These are dysfunctional social networks that overlook and ignore child abuse. Unfortunately, fragmented social relationships in these environments are perpetuated.  

Parents and caregivers with histories of alcohol and substance abuse, criminal history, domestic violence, sexual promiscuity, poverty and mental health disturbances are prominent features in many child abuse cases. Approximately thirty-three percent (33%) of abused children become abusive adults. Prevention of child abuse, and effective treatment of children who have been abused, prevents future abuse.

If you have any questions or concerns about what can be done to help babies who have been shaken due to Shaken Baby Syndrome, Child Abuse, or families of babies who have died, please call Christopher Keane and The Keane Law Firm toll-free for free consultation at (888) 592-5437 (KIDS), click on contact us here, or use the web form provided at https://www.keanelaw.com