Shaken Baby Syndrome

  |   ABSTRACT |
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Shaken baby syndrome is a serious and clearly definable form of child abuse. It results from extreme rotational cranial acceleration induced by violent shaking or shaking/impact, which would be easily recognizable by others as dangerous. More resources should be devoted to prevention of this and other forms of child abuse.

  |   INTRODUCTION |
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Physical abuse isthe leading cause of serious head injury in infants.1,2 Although physical abuse in the past has been a diagnosis of exclusion, data regarding the nature and frequency of head trauma consistently support the need for a presumption of child abuse when a child younger than 1 year has suffered an intracranial injury.1,2
Shaken baby syndrome is a serious form of child maltreatment most often involvingchildren younger than 2 years but may be seen in children up to 5 years old.2-5 It occurs commonly, yet may be misdiagnosed in its most subtle form and underdiagnosed in its most serious form.6 Caretakers may misrepresent or claim to have no knowledge of the cause of the brain injury. Caretakers who are not responsible for the injuries may not know how they occurred. Externally visible injuriesare often absent. Given possible difficulties in initially identifying an infant as having been abusively shaken and the variability of the syndrome itself, physicians must be extremely vigilant when dealing with any brain trauma in infants and be familiar with radiologic and clinical findings that support the diagnosis of shaken baby syndrome.
  |   HISTORY |
In 1972, pediatric radiologist JohnCaffey7 popularized the term "whiplash shaken baby syndrome" to describe a constellation of clinical findings in infants, which included retinal hemorrhages, subdural and/or subarachnoid hemorrhages, and little or no evidence of external cranial trauma. One year earlier, Guthkelch8 had postulated that whiplash forces caused subdural hematomas by tearing cortical bridging veins. In the mid-1970s,computedtomography (CT) began to be used to help with diagnosis. The advent of magnetic resonance imaging (MRI) in the mid-1980s has furthered the diagnostic capabilities.9
  |   ETIOLOGY |
The act of shaking leading to shaken baby syndrome is so violent that individuals observing it would recognize it as dangerous and likely to kill the child. Shaken baby syndrome injuries are the result ofviolent trauma. The constellation of these injuries does not occur with short falls, seizures, or as a consequence of vaccination. Shaking by itself may cause serious or fatal injuries.10,11 In many instances, there may be other forms of head trauma, including impact injuries.10-12 Thus, the term shaken/slam syndrome (or shaken-impact syndrome) may more accurately reflect the age range of the victims(who are not always babies) and the mechanisms of injury seen. Such shaking often results from tension and frustration generated by a baby's crying or irritability, yet crying is not a legal justification for such violence.13 Caretakers at risk for abusive behavior generally have unrealistic expectations of their children and may exhibit a role reversal whereby caretakers expect their needs to bemet by the child.14
Additionally, parents who are experiencing stress as a result of environmental, social, biological, or financial situationsmay also be more prone to impulsive and aggressive behavior. Those involved with domestic violence and/or substance abuse may also be at higher risk of inflicting shaken baby syndrome. Small children are particularly vulnerable to such abuse because of thelarge disparity in size between them and an adult-sized perpetrator.
  |   EPIDEMIOLOGY |
Head injuries are the leading cause of traumatic death and the leading cause of child abuse fatalities. Homicide is the leading cause of injury-related deaths in infants younger than 4 years.2 Serious injuries in infants, particularly those that result in death, are rarely accidental unless there is...