Symptoms vary and are caused by generalized brain swelling secondary to trauma. They may appear immediately after the shaking and usually reach a peak within 4-6 hours. The following signs and symptoms may indicate shaken baby syndrome:

The prognosis for victims of shaken baby syndrome varies with the severity of injury but generally is poor. 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. However, even babies with injuries that appear to be mild may show developmental difficulties. Typically, surviving babies with this syndrome may develop any of the following disabilities:


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Shaken baby syndrome is a serious brain injury resulting from forcefully shaking an infant or toddler. It's also known as abusive head trauma, shaken impact syndrome, inflicted head injury or whiplash shaken infant syndrome.

While sometimes there's bruising on the face, you may not see signs of physical injury to the child's outer body. Injuries that might not be immediately seen include bleeding in the brain and eyes, spinal cord damage, and fractures of the ribs, skull, legs and other bones. Many children with shaken baby syndrome show signs and symptoms of prior child abuse.

Babies have weak neck muscles and can't support the weight of their heads. If a baby is forcefully shaken, their fragile brain moves back and forth inside the skull. This causes bruising, swelling and bleeding.

Most cases of abusive head trauma (also called shaken baby syndrome) happen to babies and toddlers younger than 2 years old. Rarely, it can happen in children up to 5 years old. It can happen to boys or girls in any family.

Parents or caregivers often won't say that the child was shaken or hit, so doctors may not know to check for head injury. Many signs of abusive head trauma, like fussiness and throwing up, are common in routine childhood illnesses. So it can be hard for doctors to figure out that a baby was harmed.

Shaken baby syndrome is a severe form of head injury caused by the baby's brain rebounding inside of the baby's skull when shaken. In this injury there is bruising of the brain, swelling, pressure, and bleeding (intracerebral hemorrhage). This can easily lead to permanent, severe brain damage or death. If a child has this injury there are usually no outward physical signs of trauma, but there may be a change in the child's behavior such as irritability, lethargy, pale or bluish skin, vomiting, and convulsions.

When an infant or toddler is shaken, the brain bounces back and forth against the skull. This can cause bruising of the brain (cerebral contusion), swelling, pressure, and bleeding in the brain. The large veins along the outside of the brain may tear, leading to further bleeding, swelling, and increased pressure. This can easily cause permanent brain damage or death.

Injuries are most likely to happen when the baby is shaken and then the baby's head hits something. Even hitting a soft object, such as a mattress or pillow, may be enough to injure newborns and small infants. Children's brains are softer, their neck muscles and ligaments are weak, and their heads are large and heavy in proportion to their bodies. The result is a type of whiplash, similar to what occurs in some auto accidents.

An eye doctor may find bleeding behind the baby's eye or retinal detachment. There are, however, other causes of bleeding behind the eye and they should be ruled out before diagnosing shaken baby syndrome. Other factors must be considered.

The National Center on Shaken Baby Syndrome commits to prevent shaken baby syndrome / abusive head trauma and promote the well-being of infants through supporting and educating families, caregivers and professionals.

Although this study highlights the devastating effects of SBS, there are several limitations that should be noted. First, the SBS cases are a highly selected sample from admissions to tertiary care pediatric hospitals. These results may not reflect the number of shaken children in the community. Therefore, we are not able to estimate the incidence of SBS. Second, the data collection was retrospective and lacked a comparison group, making it difficult to identify factors that may be associated with SBS. Third, SBS was defined and classified at each participating hospital, and we did not perform an independent assessment to confirm the diagnosis. Fourth, the information obtained was limited to the quality of the documentation in the medical record. Many of the children described here were extremely ill when admitted, and certain elements of the admitting history may not have been reviewed in detail or documented, including sociodemographic and perinatal information. Fifth, the data collection occurred during a time period when the recognition and diagnosis of SBS was evolving and it is possible, especially early in the study, that SBS cases were not identified. Finally, while we have probably accounted for most of the more serious injuries, as these were children admitted to hospital in tertiary care pediatric centres, cases that resulted in death before hospital admission may not have been included.

One study has questioned the validity of shaking as a mechanism of head injury in children. A prospective, postmortem study investigated 80 deaths from head trauma to identify the roles of shaking and direct impacts. Evidence of shaking was defined as two or more of the following criteria: 1) finger marks and/or rib fractures, 2) subdural and/or subarachnoid hemorrhage, or 3) a history of vigorous shaking. Shaking to the exclusion of other head trauma was defined as the presence of two or more of the above criteria together with the complete absence of scalp or skull injuries. Nine (11.3%) of the 80 study deaths qualified as exclusively shaking injuries by this definition. Thirty (37.5%) of the deaths had direct injuries as well as two of the criteria of shaking; these deaths were classified as combined shaking and blunt trauma. Forty-one (51.3%) of the deaths had impact injuries without having two of the criteria of shaking. We reviewed the extent of ocular injuries in all the cases. We found ocular hemorrhages with increased frequency in cases with two or more of the criteria of shaking compared to cases with only impact mechanism of injury. Retinal hemorrhages continue to show themselves to be a good marker of infants injured by vigorous, intentional shaking. This study likewise confirms the observations of others that most, but not all, shaken babies have impact injuries as well.

Shaken Baby Syndrome (SBS), a form of abusive head trauma, occurs when an adult or older child violently shakes a young child, sometimes hitting the baby's head on a surface such as a bed or floor. Nearly all victims of SBS have serious health consequences, such as brain injury, cerebral palsy, seizures and paralysis, and at least one of every four babies who are violently shaken dies. Most adults who admit to shaking a baby say that they became frustrated and upset when the baby would not stop crying. Evidence based research suggests that programs that teach parents and caregivers about the dangers of shaking a baby, as well as ways to cope with the stresses of caring for a child, are very effective in reducing the incidence of SBS. In New York State, all hospitals are required to offer new parents the option of viewing a video on Shaken Baby Syndrome, including ways to cope with a crying child. It is important to reach as many current or future caregivers as possible to share this important message with them:

Purpose:  To examine the comprehensive ophthalmologic experience with the shaken baby syndrome at one medical center, including clinical findings, autopsy findings, and the outcome of survivors.

Conclusions:  Shaken baby syndrome causes devastating injury to the brain and thus to vision. Retinal hemorrhages are extremely common, but vision loss is most often the result of brain injury. The patient's visual reaction and pupillary response on presentation showed a high correlation with survival. Good initial visual reaction was highly correlated with good final vision and neurologic outcome. According to the literature, when retinal hemorrhages are found in young children, the likelihood that abuse occurred is very high. Nonophthalmologists' difficulty in detecting retinal hemorrhages may be an important limiting factor in identifying shaken babies so they can be protected from further abuse.

Shaken baby syndrome is a type of brain injury that happens when a baby or young child is shaken violently. When this happens, the brain can bounce back and forth against the skull which can cause bleeding, bruising, and swelling.

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 a 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.[11]

A biomechanical analysis by F. A. Bandak published in 2005 reported that "forceful shaking can severely injure or kill an infant, this is because the cervical spine would be severely injured and not because subdural hematomas would be caused by high head rotational accelerations... an infant head subjected to the levels of rotational velocity and acceleration called for in the SBS literature, would experience forces on the infant neck far exceeding the limits for structural failure of the cervical spine. Furthermore, shaking cervical spine injury can occur at much lower levels of head velocity and acceleration than those reported for SBS."[21] Other authors were critical of the mathematical analysis by Bandak, citing concerns about the calculations the author used concluding "In light of the numerical errors in Bandak's neck force estimations, we question the resolute tenor of Bandak's conclusions that neck injuries would occur in all shaking events."[22] Other authors critical of the model proposed by Bandak concluding "the mechanical analogue proposed in the paper may not be entirely appropriate when used to model the motion of the head and neck of infants when a baby is shaken."[23] Bandak responded to the criticism in a letter to the editor published in Forensic Science International in February 2006.[24] 2351a5e196

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