Shaken Baby Syndrome

By : Erica Montelo & Tania Tulian

 What is Shaken Baby Syndrome ?
❖ Preventable and severe form of child abuse
❖ Valid subset of Abusive Head Trauma (AHT)
❖ "The mechanism of abusive head trauma is shaking injuries that occur from repetitive
rapid flexion, extension, and rotation of the head and neck. The rapid movement of
the brain striking the skull can tear vessels resulting in bleeding around the brain and a
hematoma."
❖ An estimated 600-1400 cases each year in the U.S
 Pathophysiology
❖ Shaken baby syndrome destroys
a child's brain cells and prevents
his or her brain from getting
enough oxygen.
❖ Sheering forces across the brain
injure nerve axons resulting in
diffuse axonal injury. Babies have
very weak neck muscles that
cannot fully support their
proportionately large heads
❖ Cerebral contusions
Encephalopathy
subdural hematoma
retinal hemorrhages
Tx
 Causes
❖ Number one cause is frustration due to inconsolable baby
❖ Stress due to environmental, social, biologic or financial situations
❖ Those Involved with domestic violence and/or substance abuse
❖ Low education Level
Mandated Reporting
❖ Illinois law requires all mandated reporters to call the DCFS hotline
when a child known to them may be an abused or neglected child
• 1-800-25-ABUSE

❖ Criteria needed for child abuse or neglect investigation

• Alleged victim is a child under the age of 18
• Alleged perpetrator is anyone responsible for the child's welfare
• Incident of harm or a set circumstances that would lead a
reasonable person to suspect that child was abused or
neglected

❖ Information the reporter should have ready

• Names, birth dates (or approximate ages), races, genders, etc.
for all adult and child subjects.
• Addresses for all victims and perpetrators, including current
location
• Information about the siblings or other family members, if
available.
• Specific information about the abusive incident or the
circumstances contributing to risk of harm—for example, when
the incident occurred, the extent of the injuries, how the child
says it happened, and any other pertinent information
 How can it be diagnosed ?

Ophthalmoscopy CT SCAN MRI

Diagnosis
❖ Patterns of Injuries that suggest abusive head trauma or child abuse

❖ This syndrome is primarily seen in children younger than age 2, with the majority of cases
occurring before the baby’s 1st birthday. The average victim is between 3 and 8 months
old. However, children up to age 4 have been victims of this abuse

❖ Shaken baby syndrome is difficult to diagnose as the incidence is uncertain.

❖ Shaken baby syndrome can be hard to detect because often there aren't clear signs of
abuse.
Symptoms & physical findings
of Shaken Baby Syndrome
❖ Vomiting ❖ Soft tissue swelling
❖ Decreased Appetite ❖ Contusions
❖ Dilated pupils that don't respond to ❖ Concussions
light
❖ Lacerations
❖ Drowsiness accompanied by ❖ Bruises on the face, scalp, arms,
Irritability
abdomen or back
❖ Abnormally slow and shallow
respiration ❖ Abdominal Injuries
❖ Breathing problems and ❖ Chest Injuries
irregularities ❖ Closed Head Injuries
❖ Coma ❖ Retinal hemorrhages
Infantile spasm and the link
between Shaken Baby Syndrome
❖ In the study a 3month old presented to the emergency room with intermittent cluster of
head nods, irritable crying, arching, writhing, stiffening, and jerk of both arms.

❖ Electroencephalography findings were attributed as the diagnosis of infantile spasms (IS).

❖ Furthe tests, an MRI, was conducted and revealed the presence of chronic subdural
hematoma mixed with acute ischemic injurie.

❖ Examination of the eye fundus confirmed the presence of retinal hemorrhage. Therefore,
all evidence pointed to a diagnosis of shaken baby syndrome (SBS).

❖ The child made a full recovery after 10 days in the hospital

Prognosis
Many cases are fatal or lead to severe neurological deficits. Death is usually caused by
uncontrollable increased intracranial pressure from cerebral edema, bleeding within the
brain or tears in the brain tissue

Typically, surviving babies with SBS may develop any of the following disabilities:

❖ Cerebral palsy
❖ Developmental delays
❖ Motor disfunction
❖ Sensory deficits
❖ Paralysis
❖ Vision loss or blindness
❖ Epilepsy
❖ Seizures
Impairments
Permanent brain damage, hydrocephalus, developmental delay, blindness,
deafness, paralysis and mental retardation have been noted

❖ Sever motor disfunction

❖ muscle weakness

❖ Spasticity

❖ Hearing loss

❖ problems with speech and learning

Pediatric Glasgow coma scale

❖ mild brain injury —

a score of 13 to 15
❖ moderate brain
injury—a score of 9
to 12 (this usually
suggests that
there was a loss of
consciousness
greater than 30
minutes.)
❖ severe brain injury
is a score of 3 to 8
Medical interventions
❖ Anticonvulsant medicine ❖ Pediatrician

❖ Brain diuretics ❖ Rehab medicine

❖ Supplemental O2 ❖ Speech-language therapy

❖ Ventilator ❖ Physical therapy (PT)

❖ Surgery may be required to treat bleeding in the ❖ Occupational therapy (OT)

brain

❖ Shunt
A shunt
❖ Shunt is a flexible tube placed into a space in the child's
brain. The tube helps drain fluid out of the brain and into
the abdomen and or chest

❖ A head trauma can damage the brain’s tissues, nerves or

blood vessels. Blood from these ruptured vessels may
enter the SF pathways. Because this blood causes
inflammation, there may be scarring of the meninges, or
blood cells may block the CSF absorptive sites. When this
occurs, the CSF flow becomes restricted and
hydrocephalus develops

❖ Headaches and vomiting are signs of increased

intracranial pressure, which can result from
hydrocephalus

❖ shunts are placed in the lateral brain ventricle and drain

to the abdomen; known as the ventriculoperitoneal (VP)
shunt

❖ Detecting enlarged ventricles commonly include

magnetic resonance imaging (MRI) and computerized
tomography (CT).
Signs of shunt malformation
❖ Ventriculoperitoneal (VP) shunts are generally safe, but there are some risks
during and after the surgery. There can be bleeding, or an infection can
develop on either the ventricular or distal catheter. A shunt can also become
obstructed by blood cells or tissue, causing a blockage of flow. Malformation
can also occur

Some signs of malformation are :

▪ If the infant has swelling, redness, or fluid leaking from where the shunt went in

▪ Swelling along the shunt tract or if the infant and has a bulging soft spot

▪ Enlargement of the baby’s head

▪ Infant shows Irritability

▪ Prominent scalp veins

▪ seizures
Potential Interventions
After an injury, PTA's will work with patient to decrease pain, improve
movement, and help kids return to daily activities.
Exercises are designed to help them regain strength, ROM , and patient
education for families on how to prevent future injuries

❖ Developmental activities
❖ Balance and coordination
❖ Adaptive play
❖ Safety and prevention programs
Treatment

Crawligator
 https://www.dontshake.org/purple-crying
 REFERENCES
1. Shaken Baby Syndrome. (n.d.). Retrieved from https://www.aans.org/en/Patients/Neurosurgical-Conditions-
and-Treatments/Shaken-Baby-Syndrome#:~:text=This syndrome is primarily seen, been victims of this abuse

2. Joyce, T. (2020, November 12). Pediatric Abusive Head Trauma. Retrieved from
https://www.ncbi.nlm.nih.gov/books/NBK499836/#:~:text=The mechanism of abusive head, the brain and a
hematoma.

3. Preventing Abusive Head Trauma in Children|Child Abuse and Neglect|Violence Prevention|Injury

Center|CDC. (2020, March 05). Retrieved from
https://www.cdc.gov/violenceprevention/childabuseandneglect/Abusive-Head-Trauma.html

4. C;, S. S. (n.d.). Abusive head trauma: The relationship of perpetrators to their victims. Retrieved from
https://pubmed.ncbi.nlm.nih.gov/7838645/#:~:text=Male perpetrators outnumbered females 2.2,previously
unrecognized group of perpetrators.

5. Preventing Shaken Baby Syndrome. (n.d.). Retrieved from

https://www2.illinois.gov/dcfs/safekids/safety/Pages/Preventing-Shaken-Baby-Syndrome.aspx

6. Child Protection. (n.d.). Retrieved from https://www2.illinois.gov/dcfs/safekids/reporting/Pages/index.aspx

7. Shaken Baby Syndrome. (n.d.). Retrieved from https://www.mottchildren.org/health-library/hw169815