shaken baby syndrome
Variant: shaken impact syndrome
A syndrome seen in abused infants and children, sometimes referred to as “infant whiplash syndrome” because of its presentation with impact injuries to the head and other body parts.
Incidence: About 50,000 cases are reported each year in the U.S. This number probably represents underreporting.
Causes: Shaken baby syndrome results from physical abuse of the child, usually by a caregiver, older sibling, or parent.
Symptoms and Signs: The presence of injuries to the brain, retinal hemorrhaging, fractures of ribs and long bones, extensive bruising of the skin and apnea in combination, strongly suggests the diagnosis of child abuse in the absence of other explanations for the trauma. Injuries to the genitals, mouth, or abdominal organs should also raise concerns for the syndrome, as should a prior history of reported child abuse.
Diagnosis: The diagnosis may be first suspected by nursing staff who care for the injured infant. Nursing concerns should be discussed with social workers and physicians sharing the care of the patient. Radiological imaging is used to identify specific sites of injury.
Other conditions that should be considered as explanations for the infant's injuries include automotive crashes, falls, hemophilia and other bleeding disorders, scurvy, rickets and osteogenesis imperfecta, meningitis and sepsis, and rare inherited metabolic disorders.
Treatment: Treatment is directed at both the specific injuries received by the abused child and at arranging for the recovering child to be placed in a safe environment.
Impact on Health: The prognosis for affected infants and children is extremely guarded. Only about 15% to 20% of them recover without sequelae, such as vision and hearing impairments, seizure disorders, cerebral palsy, and developmental disorders requiring ongoing medical, educational, and behavioral management. Between 10% and 20% of shaken babies die of their injuries.
SEE: battered child syndrome; child abuse .
In domestic situations in which a child is abused, it is important to examine other children and infants living in the same home because about 20% of these children will have signs of physical abuse as well. That examination should be done without delay, to prevent further abuse.Patient Care: Health care providers are obligated to report concerns about possible child abuse to child protective service agencies. The abuse of children may be prevented with new parent education programs (undertaken during pregnancy). Preventing child abuse and , in particular, repeated episodes of shaken baby syndrome after it has already occurred has proven to be more challenging. At present most authorities favor foster care placement of the injured child.