It’s been a rough day. The baby has been wailing for hours. The bottle won’t pacify, and the lullaby isn’t lulling. Your blood suddenly comes to a boil because the baby …just …won’t …stop… crying.

This very moment, experts say, is when some parents or caregivers do what they never thought they could. They grab the infant and shake, sometimes with such force that they cause irreversible brain damage.

The collection of signs and symptoms resulting from the violent shaking of an infant or small child is labeled Shaken Baby Syndrome (SBS).

It is tough to detect, but it’s a very serious form of child abuse.

According to the National Center on Shaken Baby Syndrome (NCSBS), in America last year, treatment was sought for approximately 1,200 to 1,400 shaken children and 25 to 30 percent of those victims died as a result of their injuries. The rest will have lifelong complications.

It is likely that many more babies suffered from the effects of SBS and no one knows because SBS victims rarely have any external evidence of trauma.

SBS occurs when an infant is forcefully shaken – usually by the shoulders – causing the child’s head to flop back and forth. Because a baby’s head is about 25 percent 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 the baby’s fragile and immature blood vessels that bridge the brain and skull. As a result of the sheered vessels, blood is released.

Speaking from years of experience on the Mayerson Center for Safe and Healthy Children team at Cincinnati Children’s Hospital, Kathi L. Makoroff, MD, says, “What we see when we image these brains, or in an autopsy if the child dies, is that they have blood in between the layers that protect the brain, also known as subdural hematoma. This happens because different parts of the head move at different velocities. The blood is a small amount and probably doesn’t affect the brain. We think a lot of the brain injury actually happens to the brain itself. We just can’t image it.”

Even though there isn’t a truly effectively way to image the nerve fibers and brain, Makoroff says, it is well known that subdural hematoma is most likely a marker for an even deeper injury.

“It’s a clue that shaking injuries have happened to the brain,” Makoroff adds, “And there has been some sort of trauma.”

The torn nerve fibers not only release blood into the brain’s protective layers, it can also cause a lack of oxygen, which literally kills off the brain. If these children aren’t brought in for care right away, this vital organ is essentially strangled and the child suffers even more brain damage.

“We think a lot of the brain damage occurs because of a lack of oxygen that could have been avoided if the child had been seen more quickly,” Makoroff says. “In some cases, there may be no benefits to bringing in a child immediately, but in other cases the children are operated on to evacuate the bleed.”

When a shaken baby is brought in for care, a correct diagnosis early on is key.

Makoroff says misdiagnosis is a major reason why SBS can be traumatic to a child. In fact, she says, recent research shows that SBS is missed at least 30 percent of the time. Misdiagnosing a SBS patient can be especially detrimental because it’s a brain injury, and early detection can save lives in some cases.

“Obviously, [the head is] an important part of your body,” says Makoroff. “And anything that injures the brain can either have devastating effects right away or may cause problems further on down the road – especially as they get into school.”

A correct diagnosis is important for monetary reasons as well. Spotting SBS symptoms can avoid costly diagnostic errors and save hospitals a significant amount of money.

Makoroff says more money is spent on the care of children with inflicted injuries, such as SBS, than children with heart transplants, liver transplants or other serious surgeries in the intensive care unit.

Why? SBS wreaks not only medical trauma, but also legal complications.

“We may have the diagnosis, but we have to prove it in court,” says Makoroff. “It would be a lot easier, less expensive and safer if the perpetrator would just raise their hand and say, ‘I did it’ or even better, if it didn’t happen at all.”

But it’s not that easy. It still happens. And when it does, law enforcement steps in.

Moira Weir, assistant director of the Hamilton County, Ohio Department of Job and Family Services, says she doesn’t come onto the scene until the hospitals call with a likely SBS case.

“Our department is involved after the incident occurs. Our goal at that point is to get all the information we need and make sure that child and any other children in the home are safe,” says Weir. “It’s a team approach. The hospital, police, detectives and the child abuse team work closely together to gather information. Once we get the proof, the perpetrator spends time locked away after being sentenced. It’s a serious offense.”

More often than not, Weir says, SBS occurs to children living in a home with a low-functioning mother.

“We see a lot of cases where the mother is trying to hold a job and has someone else caring for her kids,” Weir says. “These moms often leave their children with new boyfriends or caregivers they barely even know, and that can lead to big problems.”

Karen McCann, senior program director with the Cincinnati-based Council on Child Abuse of Southern Ohio Inc. (COCA), says a major part of preventing SBS involves a process of empowering these mothers.

When McCann does outreach efforts, she tries to talk to parents about trusting their instincts.

“We’ve had women call our helpline and say their husband has a bad temper and wonder if they should be leaving their child with them any longer. Now, I honestly think she knows the answer,” says McCann. “I always tell people to trust their gut with things like this. It’s not really scientific, so I can’t explain it on an EKG or CAT scan, but just trust that voice in your head.”

Talking to parents when they are calm is important, too. McCann suggests getting them to relax and talk realistically about how dealing with kids can be frustrating and strenuous.

“That approach is different than walking into a room, pointing at a person and saying, ‘Don’t shake that baby!’ I think it’s better to walk in and say that you’re going to help them learn how to better manage infant crying. When you start talking to people in a way that lowers their defenses, you can tap into how they react in the moment.”

Parents and caretakers should take the time to analyze their reactions and prepare for the frustrating situations they will encounter with small children. It’s also useful to know that there is someone to call when blood rises to a boil. Many local agencies like COCA offer places to call for help, and national organizations, such as the Shaken Baby Task Force, offer a 24-hour hotline (1-866-243-BABY) for those that need help through the frustrating situations that arise, ultimately avoiding serious SBS injuries.

“It’s tough to admit that you can’t handle a ten-pound baby,” says McCann. “We understand that. We want to help because there is a way out of this. It is preventable.”

SBS awareness and prevention initiatives are in demand. McCann says more hospitals need to team up with child abuse prevention organizations to make sure SBS education comes across to parents right when they’re discharged off the maternity floor.

“I’m just one spoke in the wheel and everyone needs to help. A lot more work and education needs to be done,” says McCann. “I have to believe it’s possible – if not I’d have to go home and pull the covers over my head – that education and working in unison will help us to all come together to decrease this problem. But right now, we have a long way to go.”


Amy Storer is the editor of TherapyTimes.com.