Shaken Baby Syndrome: Facts and Controversies

Few topics are as controversial as Shaken Baby Syndrome (SBS). Whereas some medical experts defend that there is enough evidence to support it, others question the diagnosis. Keep reading to discover what shaken baby syndrome is, how to prevent it, and what the controversy is all about. 

What Is Shaken Baby Syndrome?

Shaken Baby Syndrome ⁽¹⁾ is a serious brain injury that occurs when a parent or a caregiver violently shakes a baby. As the baby’s brain, neck, and skull are still immature, violent shaking can cause swelling, bruising, and bleeding in the brain. As a result, the brain can be permanently damaged, impairing the baby’s future development or even killing them. 

SBS is also known as whiplash shaken infant syndrome, inflicted head injury, shaken impact syndrome, or abusive head trauma. 

The National Center on Shaken Baby Syndrome (NCSBS) in the US estimates that there are between 600 and 1400 cases of shaken baby syndrome a year. It is the leading cause of death from physical child abuse in the U.S. 

Shaken Baby Syndrome Symptoms  

Symptoms ⁽²⁾ vary a lot and are caused by generalized brain swelling. They may appear immediately after the shaking and tend to reach a peak within 4 to 6 hours. Often, there is no obvious physical sign of violence or injury, therefore parents and caregivers may not be aware of what has happened to the baby. As a result, they may think that the baby is fussy because they have a virus or a cold. 

These signs and symptoms may indicate shaken baby syndrome:

• Brain swelling, bleeding in the eyes, and blood in a protective layer that sits between the brain and the skull, called the dura. These three symptoms are typically referred to as the triad. 

• Vomiting.

• Poor feeding.

• Dilated pupils that do not respond to light.

• Breathing problems and irregularities.

• Cardiac arrest.  

• Seizures or convulsions. 

• Decrease/increase in tone. 

• Lethargy.

• Irritability.

• Coma.

• Fractures in the femur, humerus, or ribs, depending on how the infant was held. 

• Death.

How Is Shaken Baby Syndrome Diagnosed?

• Baby’s medical history ⁽³⁾.

• Exam for retinal haemorrhages.

• X-rays.

• Magnetic resonance imaging (MRI) scans.

• Computed tomography (CT) scans.

• Skeletal survey.

• Drug screening. 

• Blood sample.

• A thorough medical, forensic, and social investigation that excludes alternative diagnoses, underlying disease, and accidental trauma. 

How Is Shaken Baby Syndrome Treated?

It is treated ⁽⁴⁾ in the same way as any cranial haemorrhage. Typically, the brain is drained using a surgical procedure. 

It is important that parents disclose the incident as soon as possible to prevent further damage to the baby’s physical and mental health. 

Prognosis of Shaken Baby Syndrome

Although each case of SBS is different, the prognosis is poor ⁽⁵⁾ in most cases. It is a common cause of severe traumatic lesions and mortality in infants. 

Common disabilities include: 

• Speech delays.

• Developmental delays.

• Learning disabilities.

• Paralysis.

• Seizures.

• Epilepsy.

• Cerebral palsy. 

• Permanent hearing loss.

• Vision loss. 

• Blindness.

Mortality rate is approximately 15-25%. For those who survive, 80% suffer long term disabilities. Around 5-10% are left in a vegetative state, 30-40% suffer visual impairment, 30-50% experience paralysis or developmental retardation, and 30% suffer epileptic episodes. 

Until What Age Can Shaken Baby Syndrome Happen?

It can be seen in children up to 5 years old, but it is more likely during the first year of life ⁽⁶⁾. It occurs most often in babies younger than six months old. 

Who Is More Likely to Do This To A Baby?

• Ethnicity, race, or socio-economic status do not play a significant role in SBS ⁽⁷⁾.

• A factor that plays a role is the psychological state of the parent or caregiver.

• Men are more likely to violently shake their babies. 

Are Some Babies at Higher Risk than Others?

Yes, babies ⁽¹⁾ who are:

• Premature at birth (they tend to be more restless and more prone to crying)

• Male.

• Younger than 4 months

• Have pathologies (they require more complex parental care)

How Can Parents and Caregivers Prevent Shaken Baby Syndrome?

The number one trigger for SBS is frustration when a baby won’t stop crying. All babies cry, however, some cry more than others, may it more difficult for parents and caregivers to keep their cool. Typically, babies cry for 4 or 5 hours a day, peaking at 6-8 weeks of life. From around 3 months of age, most babies start crying a bit less. 

This means that SBS is totally preventable and that efforts must be made to educate parents about normal infant crying and how to prevent SBS. There is a program called the “Period of Purple Crying” that has been developed by the National Center of Shaken Baby Syndrome, that is being quite successful. 

‘Purple’ is an acronym of:

Peak of crying: Your baby may cry more each week, the most in month 2, then less in months 3-5.

Unexpected: Crying can come and go, and you don’t know why.

Resists soothing: Your baby may not stop crying no matter what you try.

Pain like face: A crying baby may look like they are in pain, even when they are not. 

Long lasting: Crying can last as much as 5 hours a day, or more.

Evening: Your baby may cry more in the late afternoon and evening.

Can Tossing a Baby in the Air or Rough Play Cause Shaken Baby Syndrome?

No. The force required to cause shaken baby syndrome makes it very unlikely to happen by accident. 

SBS injuries are not caused by:

• Tossing a baby in the air.

• Bouncing a baby on your knee. 

• Falls off a couch or other furniture.

• Sudden stops in a car or driving over bumps.

• Jogging or cycling with your baby.

Controversy Among Medical Experts 

The view of most medical experts, police forces, and prosecutors is that when the triad of symptoms (brain swelling, bleeding in the eyes, and blood in the dura) is found, it is very likely that violent shaking has taken place. Even when there are no other physical signs of abuse, such as bruising, fractures, or neck injuries. They argue that although the presence of the triad is not absolutely diagnostic of child abuse, it is highly suggestive of the diagnosis, particularly if there are no other impact injuries. The absence of an alternative obvious explanation warrants an investigation to determine if the child ⁽⁸⁾ has been subject to abuse. 

On the other hand, during the past few decades a growing number of sceptics have questioned if there is ever enough evidence to link the triad with a shaken baby. They claim that SBS can never be diagnosed with absolute certainty. 

The implications of this debate are incredibly important. Sometimes, abused babies are left at the mercy of their abusers when their parents are not found guilty. On the other hand, parents may be wrongly accused of abusing their children, they may be wrongly convicted, and their children may be unfairly removed from the home. 

The term ‘Shaken Baby Syndrome’ was first quoted in 1972 by British paediatrician neurosurgeon Norman Guthkelch. Based on a few cases, he introduced the hypothesis that shaking a baby backwards and forwards in whiplash-like manner might cause the triad of symptoms. However, Guthkelch became worried ⁽⁹⁾ that injustices were taking place and later in his life became a campaigner against the ‘dogmatic thinking’ of triad believers. 

Finally…

Much remains to be understood about SBS. What is clear is that our main priority should always be to protect our children. Therefore, educating parents to know how to deal with a crying baby and the dangers of shaking, is of paramount importance. 

At REC Parenting, our aim is to give you the tools to manage those moments when the baby won’t stop crying. If you have any questions on this topic, or you would like 1-2-1 support, please do get in touch with me. We are here to help! 

Love,

Ana

Dr Ana Aznar

References

⁽¹⁾ Latino, A. L., Miglioranzi, P., Coppo, E., & Giannotta, F. (2024). Knowing, recognizing, and preventing shaken baby syndrome: The role of primary care pediatrician. Global Pediatrics, 9, 100206.https://doi.org/10.1016/j.gpeds.2024.100206

⁽²⁾ Ludwig, S., & Warman, M. (1984). Shaken baby syndrome: a review of 20 cases. Annals of emergency medicine, 13(2), 104-107. https://doi.org/10.1016/S0196-0644(84)80571-5

⁽³⁾ Saunders D, Raissaki M, Servaes S et al (2017) Throwing the baby out with the bath water — response to the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) report on traumatic shaking. Pediatr Radiol 47: 1386–1389

⁽⁴⁾ Mian, M., Shah, J., Dalpiaz, A., Schwamb, R., Miao, Y., Warren, K., & Khan, S. (2015). Shaken baby syndrome: a review. Fetal and pediatric pathology, 34(3), 169-175. DOI: 10.3109/15513815.2014.999394 

⁽⁵⁾ Antonietti, J., Resseguier, N., Dubus, J. C., Scavarda, D., Girard, N., Chabrol, B., & Bosdure, E. (2019). The medical and social outcome in 2016 of infants who were victims of shaken baby syndrome between 2005 and 2013. Archives de Pédiatrie, 26(1), 21-29. https://doi.org/10.1016/j.arcped.2018.10.002

⁽⁶⁾ Lee, C., Barr, R. G., Catherine, N., & Wicks, A. (2007). Age-related incidence of publicly reported shaken baby syndrome cases: is crying a trigger for shaking?. Journal of Developmental & Behavioral Pediatrics, 28(4), 288-293.10.1097/DBP.0b013e3180327b55

⁽⁷⁾ Sinal, S. H., Petree, A. R., Herman-Giddens, M., Rogers, M. K., Enand, C., & DuRant, R. H. (2000). Is race or ethnicity a predictive factor in shaken baby syndrome?. Child abuse & neglect, 24(9), 1241-1246.https://doi.org/10.1016/S0145-2134(00)00177-0

⁽⁸⁾ Vinchon M (2017) Shaken baby syndrome: what certainty do we have? Childs Nerv Syst 33:1721–1733. https://doi.org/10.1007/s00381-017-3517-8

⁽⁹⁾ Guthkelch AN. Problems of infant retino-dural hemorrhage with minimal external injury. Houston J Health Law Policy 2012; 201–8, ISSN 1534-7907, http://bit.ly/29b5qqn.