Shaken Baby Syndrome Shirley Ezell Dottie Hollingsworth
HISTORY OF Shaken Baby Syndrome • 1945-Battered babies-Dr. John Caffey • 1972-Whiplash shaken infant syndrome- Dr. John Caffey, Dr. A.N. Guthkelch • Today, Shaken Baby Syndrome
What is Shaken Baby Syndrome? • Violent Whiplash Injury • Inflicted, not accidental • Result of violently shaking a baby or child • Causes severe disabilities or death due to brain injury
What is Shaken Baby Syndrome? Shaken Baby Syndrome is a severe form of head injury that occurs when a baby is shaken forcibly enough to cause the baby’s brain to rebound (bounce) against his or her skull. This rebounding may cause bruising, swelling, and bleeding (intracerebral hemorrhage) of the brain, which may lead to permanent, severe, brain damage or death.
How Shaken Baby Syndrome Happens When someone forcefully shakes a baby, the head rotates about uncontrollably because infants’ neck muscles are not well developed and provide little support for the head. The violent movement pitches the infant’s brain back and forth within the skull, rupturing blood vessels, and nerves throughout the brain and tearing the brain tissue. The brain strikes the inside of the skull, causing bruising and bleeding to the brain. The damage is even greater when the shaking ends with an impact (hitting a wall or crib mattress etc.)
Shaken Baby Syndrome Symptoms • Head turned to one side • Unable to lift or turn head • Pinpointed, dilated, or unequal size pupils • Blood pooling in the eyes • Pupils unresponsive to light • Bulging or spongy forehead • No smiling or vocalization • Poor sucking or swallowing
Shaken Baby Syndrome Symptoms Continued • Rigidity and or posturing • Semi-consciousness, lethargy, or decreased muscle tone • Difficulty breathing • Seizures or spasms • Swollen head, which may appear later • Extreme irritability
Immediate Consequences • Poor feeding/eating • Vomiting • Failure to Thrive • Inability to suck or swallow • Limp arms and legs • Rigidity or posturing (seizures) • Extreme irritability • Pale or blush skin • Cardiac or Respiratory arrest • Coma and or death
Long Term Consequences • Learning disabilities • Physical disabilities • Visual disabilities or blindness • Hearing impairment • Speech disabilities • Cerebral Palsy • Seizures • Behavior disorders • Cognitive impairment • Death
Clinical Signs of Shaken Baby Syndrome • Subdural Hematoma • Retinal Hemorrhage • Cerebral Edema • Skull Fracture • Diffuse Axonal Injuries • Subarachnoid Hemorrhage • Black Brain – Wasting away of the brain due to the lack of blood supply (Seen on MRI and CT scan)
Shaken Baby SyndromeTriad of Injuries • Retinal Hemorrhage • Subdural Hematoma • Cerebral Edema The presence of this combination is characteristic of Shaken Baby Syndrome. Other causes for this particular combination are remote
Medical Terms Associated WithShaken Baby Syndrome • Cerebral edema • Fluid collecting in the brain, causing tissue to swell. • Hematoma • A localized accumulation of blood in tissues as a result of hemorrhaging. • Hemorrhage • A condition of bleeding, usually severe. • Retinal hemorrhage • Bleeding of the retina, a key structure in vision located at the back of the eye. • Subdural hematoma • A localized accumulation of blood, sometimes mixed with spinal fluid, in the space of the brain beneath the membrane covering called the dura mater.
Acute Subdural Hematoma Blood appears Bright Red if the Subdural Hematoma is Acute. For whatever reason, 78% of the children with subdural hematomas resulting from Shaken Baby Syndrome are bilateral.
Chronic Subdural Hematoma Chronic or old Subdural Hematomas will be darker in color and may leave iron stain on the Dura. The color of port wine, brown, or yellow.
Acute Subdural Hematoma Non-enhanced computed tomogram of a 9 month old infant showing an acute subdural hemorrhage on the right. The child arrived in the casualty department unconscious and having fits. Note the convex shadow and brain swelling on the right with midline shift.
Subdural Hematoma Axial view of MRI T1 weighted image of a 6 month old infant who "fell off a settee". A subdural hemorrhage is apparent on the right. Note the detailed resolution of brain anatomy.
MEDICAL DETECTION OF SBS • Differentiating symptoms, mild vs. severe • Take a thorough history of illness • Perform a thorough physical assessment • Who is consistent caregiver at home? • Others? Unrealistic expectations • Involve Pediatric Radiologist
Understanding Crying • Infant’s crying is normal • They cry more and more each day • It is normal for it to come and go • It is normal for them to cry even when you are comforting them • It is normal for them to look like they are in pain even when they are not • It is also normal for the crying to last for a long time • The crying becomes more frequent in the evening hours
Questions to be addressed when the baby continues to cry • Is the baby sick? • Is the baby hot? • Is the baby cold? • Is the baby hungry? • Does the baby need to be burped? • Does the baby need to be changed? • If the answer is NO to all the above THEN try to soothe the baby
Ways To Soothe The Baby • Rock the baby • Walk with the baby • Swaddle the baby • Play some soft music • Rub the baby’s back, give a gentle massage • Offer the baby a pacifier • Leave a soft light on in the baby’s room • Go for a ride in the car with the baby • Record the sounds of a hair dryer or vacuum cleaner • Sing or talk to the baby in a soothing voice
Dr Harvey Karp’s“5 S’s” • Shushing (using "white noise," or rhythmic sounds that mimic the constant whir of noise in the womb, with things like vacuum cleaners, hair dryers, clothes dryers, a running tub, or a white noise CD) • Side/stomach positioning (placing the baby on the left side - to help digestion - or on the belly while holdinghim or her, then putting the sleeping baby in the crib or bassinet on his or her back) • Sucking (letting the baby breastfeed or bottle-feed, or giving the baby a pacifier or finger to suck on) • Swaddling (wrapping the baby up snugly in a blanket to help him or her feel more secure) • Swinging gently (rocking in a chair, using an infant swing, or taking a car ride to help duplicate the constant motion the baby felt in the womb)
When You Can’t Soothe the Baby It is : Better That The Baby CRIES Than The Baby DIES
Shaken Baby Statistics • 1 Shaken Baby in 4 dies • 15% of children’s deaths are due to battering • An additional 15% are possible cases of Shaken Baby Syndrome • The average age ranges from a few days to several months but the average is 6 months • 60% of the babies abused are male • Almost 80% of the perpetrators are male and the average age is 22 • Children of families below poverty level are at an increased risk for SBS (and any other type of abuse)
What Causes Parental Frustration? • Your baby crying more than you anticipated • You worry people will feel you have a bad baby • Fear of being a bad parent • Feelings of anger toward your baby • Feeling that your life will never be normal again
What Coping Mechanisms Should Parents Learn? • Put the baby in a safe place • Take care of yourself • Take a break from the sound of the crying • Call a good friend • Listen to soothing music • Exercise • Remember the CRYING will come to an end • No matter how mad you get, NEVER SHAKE YOUR BABY
SBS Can Be Prevented WithPATIENCE • P Put the baby down • A Ask someone to watch the baby • T Try gently rocking the baby, or give them a pacifier or a bottle. • I If you heat UP then put the baby DOWN • E Eventually, you will calm down • N Not all situations are simple so go step by step to figure them out • C Control your anger • E Exit the house, take baby for a ride
WHEN BABY KEEPS CRYING, YOU CAN TRY COPING TIPS Remember you are the adult… Take a deep breath…just breathe B - Be calm, put the baby down R - Relax and step away E - Exit the room A - Ask for help, or T - Take a “time out” H - Help yourself first, then try to comfort the baby
If You Shake Your Baby Or Suspect They Have Been ShakenImmediately Report It You Could Save the Baby from Brain Damage or Even Death All forms of brain injury produce swelling/edema of the brain which can lead to its own secondary damage of the brain locally or as a whole.
Statistics • Nationally, Shaken Baby Syndrome affects between 1,200 and 1,600 children every year • In 2003 53 child homicides reported in Alabama ……………..Of those 6 were in Mobile County. Three of those were less than 1 year old • In 2005 we have already had three infant deaths. One in Mobile County, one in Baldwin County and one in Escambia County
Florence Nightingalefamous pledge, “I devoted myself to the welfare of those committed to my care.” Guess this nurse misunderstood that concept for 9 years 1948-1956 Dozens of babies were shaken by a nurse over a nine year period. This happened to very affluent, well educated parents. Since there were no outward signs it wasn’t until a baby died that the investigation began. The nurse finally admitted to her horrific deed.
Jury Sentence for David Allen Austin “David Allen Austin, 23, receives life in prison for the beating death of his 6 week old daughter Ashley Austin” He pled guilty to escape the death penalty
Lakedra Hill June 21, 2007 • LaKedra Hill was arrested on a grand jury indictment and was being held as of this afternoon at Mobile County Metro Jail in lieu of $10,000 bail • Hill is accused of causing injuries to her 1-year-old daughter consistent with shaken baby syndrome, according to Assistant District Attorney Steve Giardini, who prosecutes child abuse cases. Giardini said the baby suffered hemorrhaging, broken ribs and head injuries but survived. • Giardini said he did not know how much time passed between when the injuries were inflicted and when the mother sought medical attention. The alleged abuse took place several months ago, Giardini said. • Under Alabama law, aggravated child abuse is a Class B felony that carries a punishment of up to 20 years in prison.
Brian Deshon Miller 11 month old Fairhope girl who lapsed into a coma on Christmas Eve appears to have been a victim of Shaken Baby Syndrome.
Ralph Herbert Rammage 3 month old suffers broken leg, bleeding in her brain behind her eyes resulting in almost total loss of vision, loss of hearing, loss of reflexes……..unable to suck and swallow on admission to hospital. Dad confessed. He became agitated when she wouldn’t stop crying
Financial Impact of Shaken Baby Syndrome • The first initial visit for a baby admitted with Shaken Baby Syndrome cost between $75,000 and $95,000 • Direct cost for (judicial, law enforcement and health system is estimated at $24 billion • Indirect cost (long term consequences) exceed an estimated $69 billion a year
Legislation • 5 States who have passed legislation addressing Shaken Baby Syndrome • Florida, Texas, Utah, New York, and Pennsylvania • 3 States who have bills pending • Maryland, Missouri, and Ohio WHERE DOES ALABAMA STAND ?
Skipper 11 Months old SKIPPER INITIATIVE • S Shaking • K Kills; • I Instead • P Parents • P Please • E Educate • R Remember: If today is an average day in the United States, 4 children under the age of 5 will die or be permanently disabled when they are shaken by a caregiver.
Why Daddy Why Why, Daddy, Why You took the sight from My eyes, Why, Daddy, Why They were just little Baby cries. Why Daddy, Why You shook me so violently Why Daddy Why You gave me cerebral palsy and epilepsy Why, Daddy, Why Did you need to show You’re strong Why, Daddy, Why You fractured my little bones. Why, Daddy, Why You tore my ribs from their cage, Why, Daddy, Why Were you so full of rage. Why, Daddy, Why Will I never walk Why, Daddy, Why Will I never talk. Why, Daddy, Why Thirty-three medications A day Why, Daddy, Why You changed my life this way. Why, Daddy, Why I smell but cannot eat, Why, Daddy, Why Lots of seizures and lots of sleep Why, Daddy, Why Will I never run, Why, Daddy, Why Will I never have fun. Why, Daddy, Why Won’t my hands hold the toys Why, Daddy, Why Can’t I play like other boys Why, Daddy, Why You destroyed my brain Why, Daddy, Why Mommy’s tears fall like rain. Why, Daddy, Why Can’t I even lift my head Why, Daddy, Why Do you wish I were dead. Why, Daddy, Why Am I always in pain Why, Daddy, Why Do you feel any shame. Why, Daddy, Why, Does my temperature rise and fall Why, Daddy, Why Can’t they regulate it at all Why, Daddy, Why You hurt me so bad Why, Daddy, Why You’re supposed to be my Loving Dad