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Friday, 5 February, 1999, 08:49 GMT
Shaken baby syndrome
Shaken baby graphic
Shaking a baby causes blood vessels to burst
Shaken baby syndrome is a potentially fatal form of child abuse. It occurs when a baby is forcefully shaken leading to damage within the child's skull. The syndrome rose to prominence during the trial of Louise Woodward, the au pair who was found guilty of shaking baby Matthew Eappen to death. A UK study published in December 1998 found that 75% of babies who suffer brain injuries from shaking will die or suffer permanent disability.

What is it?

It occurs when an infant is forcefully shaken, usually by the shoulders, causing the child's head to flop back and forth.

It is not an injury that occurs from casually playing with a child.

A baby's head is large and heavy. It makes up about 25% of the infant's total body weight. Its neck muscles are too weak to support such a disproportionately large head.

The force of the head movement can tear blood vessels that bridge the brain and skull, because these are fragile and immature.

What happens when a baby is shaken?

When shaking occurs, the brain bounces within the skull cavity, bruising the brain tissue.

The brain swells, creating pressure and leading to bleeding at the back of the eye. This can cause blindness.

Some blood vessels that feed the brain are torn, which leads to additional brain damage or abnormalities.

Blood collects inside the skull, creating more pressure.

Immediate effects include seizures, lethargy, vomiting, and irritability, or in extreme cases, coma or even death.

Infants can also sustain eye injuries, such as detached retinas or retinal bleeding, from the violent shaking.

Long-term effects include learning disabilities, physical disabilities, seizures and, in extreme cases, death.

Who is responsible for shaken baby syndrome?

The injuries are usually caused by parents or carers who have become frustrated by their inability to stop a baby who is crying constantly.

Adults who were victims of abuse themselves and have low frustration levels may be more likely to shake a baby to hush its crying.

Typical victims of this abuse are infants with colic who will not stop crying.

Almost 80% of the perpetrators of the syndrome are male and more than 60% of the victims are male.

Shaken baby syndrome has been referred to as a hidden form of child abuse because doctors evaluating the baby often do not see outward signs of injury on the head or old fractures or burns that are common to abused children.

What are the signs that a baby has been shaken?

The most common complaints presented to a doctor in shaken baby cases are:

  • Lethargy;
  • Seizures;
  • Decreased muscle tone;
  • Reduced appetite;
  • Breathing problems;
  • Vomiting;
  • Irritability;
  • A large head at four months.

Doctors should also look out for bruises to the shoulder and neck, bruises in children who have not yet started to crawl, bone injuries and signs that the body's vital systems are failing, such as the onset of hypothermia.

How can it be avoided?

Stress management is the key. Parents and carers must control their frustration and seek help if appropriate.

The US Child Abuse Prevention Center says: "If nothing works, put the baby on his or her back in bed, close the door and turn up the TV or radio. Check on the baby every 10-15 minutes."

It also advises checking a constantly crying baby for signs of illness and asking a friend or relative to take over caring for a while if the pressure becomes too much.

Is help available?

The NSPCC has produced a leaflet advising parents on now to cope with the frustration of a crying baby. It says that a crying baby will only respond to gentle behaviour.

The association is calling on the government to back a campaign on the dangers of shaking babies.

The leaflet is available by post from: The Publications Office, NSPCC, 42 Curtain Road, London EC2A 3NH.

A spokeswoman said: "But if you're concerned that a baby is being shaken, don't wait. You can phone our Child Protection Helpline."

The line is a freephone number and is staffed 24 hours a day by trained counsellors. The number is 0800 800500.

This page contains basic information. If you are concerned about your or your child's health, you should consult a doctor.

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