Shaken baby syndrome

Shaken baby syndrome
Other namesAbusive head trauma, non-accidental head injury, non-accidental trauma
An intraparenchymal bleed with overlying skull fracture from shaken baby syndrome
SpecialtyPediatrics
SymptomsVariable[1]
ComplicationsSeizures, visual impairment, cerebral palsy, cognitive impairment[2][1]
Usual onsetLess than 5 years old[3]
CausesBlunt trauma, vigorous shaking[1]
Diagnostic methodCT scan[1]
PreventionEducating new parents[1]
PrognosisLong term health problems common[3]
Frequency3 per 10,000 babies per year (US)[1]
Deaths≈25% risk of death[3]

Shaken baby syndrome (SBS), also known as abusive head trauma (AHT), is a medical condition in children younger than five years old,[3] generally caused by blunt trauma, vigorous shaking, or a combination of both.[1] The concept is controversial and remains scientifically disputed.[4]

According to literature, the condition is caused by violent shaking with or without blunt impact that can lead to long-term health consequences for infants or children.[3] Diagnosis can be difficult as symptoms may be nonspecific.[1] A CT scan of the head is typically recommended if a concern is present.[1] If there are concerning findings on the CT scan, a full work-up for child abuse should occur, including an eye exam and skeletal survey. Retinal hemorrhage is highly associated with AHT, occurring in 78% of cases of AHT versus 5% of cases of non-abusive head trauma.[5][6] Diagnosis is generally characterized by a triad of findings: retinal hemorrhage, encephalopathy, and subdural hematoma.[7]

The concept is controversial in child abuse pediatrics, with critics arguing it is an unproven hypothesis that has little diagnostic accuracy.[4][8] Diagnosing the syndrome has proven to be both challenging and contentious for medical professionals because objective witnesses to the initial trauma are generally unavailable.[9] This is said to be particularly problematic when the trauma is deemed 'non-accidental'.[9] Some medical professionals propose that SBS is the result of respiratory abnormalities leading to hypoxia and swelling of the brain.[10] The courtroom has become a forum for conflicting theories with which generally accepted medical literature has not been reconciled.[11] There are often no outwardly visible signs of trauma, despite the presence of severe internal brain and eye injury.[1] Complications include seizures, visual impairment, hearing loss, epilepsy, cerebral palsy, cognitive impairment, cardiac arrest, coma, and death.[2][1][12][13]

SBS is the leading cause of fatal head injuries in children under two,[11] with a risk of death of about 25%.[3] The most common symptoms include retinal bleeds, multiple fractures of the long bones, and subdural hematomas (bleeding in the brain).[14] Educating new parents appears to be beneficial in decreasing rates of the condition.[1] SBS is estimated to occur in three to four per 10,000 babies per year.[1] These signs have evolved through the years as accepted and recognized signs of child abuse. Medical professionals strongly suspect shaking as the cause of injuries when a young child presents with retinal bleed, fractures, soft tissue injuries, or subdural hematoma that cannot be explained by accidental trauma or other medical conditions.[15]

Retinal hemorrhage (bleeding) occurs in around 85%[contradictory] of SBS cases and the severity of retinal hemorrhage correlates with severity of head injury.[5] The type of retinal bleeds are often believed to be particularly characteristic of this condition, making the finding useful in establishing the diagnosis.[16]

Fractures of the vertebrae, long bones, and ribs may also be associated with SBS.[17] Infants may display irritability, failure to thrive, alterations in eating patterns, lethargy, vomiting, seizures, bulging or tense fontanelles (the soft spots on a baby's head), increased size of the head, altered breathing, and dilated pupils.

  1. ^ a b c d e f g h i j k l m Shaahinfar A, Whitelaw KD, Mansour KM (June 2015). "Update on abusive head trauma". Current Opinion in Pediatrics. 27 (3): 308–314. doi:10.1097/mop.0000000000000207. PMID 25768258. S2CID 38035821.
  2. ^ a b Advanced Pediatric Assessment, Second Edition (2 ed.). Springer Publishing Company. 2014. p. 484. ISBN 978-0-8261-6176-5. Archived from the original on 5 November 2017.
  3. ^ a b c d e f "Preventing Abusive Head Trauma in Children". www.cdc.gov. 4 April 2017. Archived from the original on 11 June 2017. Retrieved 9 June 2017.
  4. ^ a b Gabaeff SC (1 January 2016). "Exploring the controversy in child abuse pediatrics and false accusations of abuse". Legal Medicine. 18: 90–97. doi:10.1016/j.legalmed.2015.12.004. ISSN 1344-6223. PMID 26832385.
  5. ^ a b Maguire SA, Watts PO, Shaw AD, Holden S, Taylor RH, Watkins WJ, et al. (January 2013). "Retinal haemorrhages and related findings in abusive and non-abusive head trauma: a systematic review". Eye. 27 (1): 28–36. doi:10.1038/eye.2012.213. PMC 3545381. PMID 23079748.
  6. ^ Christian CW, Block R (May 2009). "Abusive head trauma in infants and children". Pediatrics. 123 (5): 1409–1411. doi:10.1542/peds.2009-0408. PMID 19403508. S2CID 23001705.
  7. ^ Cite error: The named reference :4 was invoked but never defined (see the help page).
  8. ^ Lynøe N, Elinder G, Hallberg B, Rosén M, Sundgren P, Eriksson A (2017). "Insufficient evidence for 'shaken baby syndrome' – a systematic review". Acta Paediatrica. 106 (7): 1021–1027. doi:10.1111/apa.13760. ISSN 0803-5253. PMID 28130787.
  9. ^ a b Vinchon M (October 2017). "Shaken baby syndrome: what certainty do we have?". Child's Nervous System. 33 (10): 1727–1733. doi:10.1007/s00381-017-3517-8. PMID 29149395. S2CID 22053709.
  10. ^ Geddes JF, Tasker RC, Hackshaw AK, Nickols CD, Adams GG, Whitwell HL, et al. (February 2003). "Dural haemorrhage in non-traumatic infant deaths: does it explain the bleeding in 'shaken baby syndrome'?". Neuropathology and Applied Neurobiology. 29 (1): 14–22. doi:10.1046/j.1365-2990.2003.00434.x. PMID 12581336.
  11. ^ a b "Consensus Statement: Abusive Head Trauma in Infants and Young Children". Pediatrics. 142 (2). August 2018. doi:10.1542/peds.2018-1504. PMID 30061300. S2CID 51878771.
  12. ^ Nadarasa J, Deck C, Meyer F, Willinger R, Raul JS (December 2014). "Update on injury mechanisms in abusive head trauma--shaken baby syndrome". Pediatric Radiology. 44 (S4): S565–S570. doi:10.1007/s00247-014-3168-9. PMID 25501728.
  13. ^ Reith W, Yilmaz U, Kraus C (May 2016). "[Shaken baby syndrome]". Der Radiologe (in German). 56 (5): 424–431. doi:10.1007/s00117-016-0106-x. PMID 27118366.
  14. ^ "NINDS Shaken Baby Syndrome information page". National Institute of Neurological Disorders and Stroke. 14 February 2014. Archived from the original on 29 May 2014. Retrieved 23 June 2008.
  15. ^ Brogdon BG, Shwayder T, Elifritz J (31 March 2021). Child Abuse and its Mimics in Skin and Bone. Taylor & Francis. ISBN 978-0-367-77818-7.
  16. ^ Levin AV (November 2010). "Retinal hemorrhage in abusive head trauma". Pediatrics. 126 (5): 961–970. doi:10.1542/peds.2010-1220. PMID 20921069. S2CID 11456829. Archived from the original on 20 October 2014.
  17. ^ Kempe CH, Silverman FN, Steele BF, Droegemueller W, Silver HK (July 1962). "The battered-child syndrome". JAMA. 181: 17–24. CiteSeerX 10.1.1.589.5168. doi:10.1001/jama.1962.03050270019004. PMID 14455086.