General
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Medical Consensus
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General Consensus
In May 2018, The Society for Pediatric Radiology (SPR), European Society of Paediatric Radiology (ESPR), American Society of Pediatric Neuroradiology (ASPNR), American Academy of Pediatrics (AAP), European Society of Neuroradiology (ESNR), American Professional Society on the Abuse of Children (APSAC), Swedish Paediatric Society, Norwegian Pediatric Association and Japanese Pediatric Society published a joint consensus statement on abusive head trauma/shaken baby syndrome. This is the most comprehensive and complete consensus statement published to date. The statement is published in Pediatric Radiology.
American Academy of Pediatrics
The AAP continues to affirm the dangers and harms of shaking infants, continues to embrace the “shaken baby syndrome” diagnosis as a valid subset of the AHT diagnosis, and encourages pediatric practitioners to educate community stakeholders when necessary.The World Health Organization
… the baby will be considered a possible victim of ‘shaken baby syndrome’, a form of child abuse that involves the violent shaking of an infant…According to Dr Kieran Moran, forensic paediatrician at Sydney Children’s Hospital, babies are victims of violent shaking mainly in their first year of life, as that is often when they cry inconsolably and when parents and carers become most frustrated.The American Association of Neurological Surgeons
Shaken Baby Syndrome (also known as Shaken Impact Syndrome) is a serious form of abuse inflicted upon a child. It usually occurs when a parent or other caregiver shakes a baby out of anger or frustration, often because the baby will not stop crying.Canadian Joint Statement on Shaken Baby Syndrome/Abusive Head Trauma
Shaken Baby Syndrome is a collection of findings, all of which may not be present in any individual child with the condition. Injuries that characterize Shaken Baby Syndrome are intracranial hemorrhage (bleeding in and around the brain); retinal hemorrhage (bleeding in the retina of the eye); and fractures of the ribs and at the ends of the long bones.The American Academy of Ophthalmology
Shaken Baby Syndrome is a subset of Abusive Head Trauma characterized by repetitive acceleration-deceleration forces with or without blunt head impact resulting in a unique complex of ocular, intracranial, and sometimes other injuries, usually in infants…it has become widely recognized as one of the most serious manifestations of physical child abuse.The American Academy of Neurology
Shaken baby syndrome is a type of inflicted traumatic brain injury that happens when a baby is violently shaken. A baby has weak neck muscles and a large, heavy head. Shaking makes the fragile brain bounce back and forth inside the skull and causes bruising, swelling, and bleeding, which can lead to permanent, severe brain damage or death.Centers for Disease Control and Prevention
Abusive head trauma (AHT), which includes shaken baby syndrome, is a preventable and severe form of physical child abuse that results in an injury to the brain of an infant or child. AHT is most common in children under age five, with children under one year of age at most risk. It is caused by violent shaking or blunt impact.The Royal College of Ophthalmologists and The Royal College of Paediatrics and Child Health
A child suspected of abusive head injury is referred by paediatricians to an ophthalmologist for evaluation. The incidence of abusive head injury in children is highest in infancy and less frequently seen in children over 3 years of age. Retinal haemorrhages have a high positive predictive rate for abusive head injury.French Society of Physical Medicine and Rehabilitation
SBS is a type of inflicted, non-accidental or abusive head injury caused by shaking (either alone or combined with an impact). It mainly occurs in babies under the age of one. It is thought that 180 to 200 children per year are victims of this type of abuse in France, although this value is certainly an underestimate. Failure to diagnose SBS increases the likelihood of recurrence.
Research
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Articles Everyone Should Know
These are some of the most relevant research articles about Shaken Baby Syndrome/Abusive Head Trauma that will aid a lay person wanting to learn more about this form of child abuse.
Recent Research
The list below contains the most recent research relevant to SBS/AHT published during the past few years. The list cites the article’s title, author(s), title of the periodical or book, publication date and a link to the abstract or full article (if available).
FAQ
Guest Commentary
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In the Midst of Child Abuse, the Face of an Angel
Lawrence R. Ricci, MD
Angel was then, and is even now, one of the most beautiful babies I have ever seen and I have seen many in my thirty years as a child abuse pediatrician. Yet, to look at her today, asleep against her foster mother’s shoulder, one could never guess at the devastation wrought upon her.
I first met Angel, then only a few months old, in the pediatric intensive care unit just before Christmas. She had been admitted unresponsive the night before. Her father had told the hospital staff that he had picked her up from her crib tochange her soaked diaper and as he did so she slipped from his grasp and fell back into her crib. He said she went limp and stopped breathing. He rushed her into his car and drove wildly to the local hospital. Eventually, Angel ended up in my hospital.
I was called in to see her after a CT scan showed subdural hematomas. Later, an MRI found evidence of parenchymal injury. An ophthalmology exam found such severe hemorrhages retinal hemorrhages that they were visible on the MRI.
Angel’s mother was at work when the injury occurred and only found out about it after Angel was rushed to the hospital. She told me what her boyfriend had told her, that Angel had fallen from his grasp into the crib. She said she had no reason to believe otherwise.
I finished the interview with Angel’s mother then spoke with her father. He was anxious and somewhat furtive. He told me that Angel had “peed everywhere,” on her clothes, in her bed. When he went to pick her up, she slipped from his grasp and fell onto the mattress. She immediately lost consciousness.
I ended the interview after a few more questions about the fall, and we both went back into the ICU, he to his baby’s side, me to the computer workstation to type my note. As I typed, Angel’s mother came up to me and said that she now knew what had happened. Her boyfriend had just then confessed to her that he had shaken Angel and that he wanted to talk to me.
I went into Angel’s hospital room. Her father was sitting on the cot with his head in his hands, Angel’s mother by his side consoling him. He didn’t look like a bad person; perpetrators rarely do.
Before I could speak he offered, “I’m sorry Doc. I lied. I shook her.”
I asked him why he had shaken her. “I picked her up from the crib. She was screaming and kicking and scratching at me, and I just lost it. I shook her.”
“Did the fall happen?”
“No, Doc. She didn’t fall. I shook her.”
And finally “What happened after you shook her?
“She went limp and stopped breathing. She looked dead. I know what I did was wrong. I’m sorry Doc.”
So there it was. I thanked him for telling me the truth. I told him it was the right thing to do and left to notify the police.
Months later, Angel’s father pled guilty to assault. He said at his sentencing that he had shaken Angel and that he was sorry. He is serving several years in prison.
All of that was yet to pass. Here was Angel in the ICU, profoundly brain damaged, never to awake, a victim of devastating violence, and for all the world she looked like a healthy, beautiful, three-month-old girl about to experience her first Christmas. Having seen too many shaken babies, it always astounds me how normal many of these babies look, few if any bruises, no obvious fractures, nothing to suggest the violence that had been perpetrated on them. To look at her in her hospital bed, surrounded by beeping instruments and tubes, intubated, not breathing, to look at her face and body, she looked fine, not a scratch, cherubic.
I saw her one last time several months later accompanied by her foster parents. Her functioning at a year was that of a one month old. Her existence, like that of a light switch without nuance, flipped between screaming/arching and deep sedation. She was quadriplegic, blind, and deaf. Her foster parents attend to her every day and every night, ceaselessly, religiously. I am myself not religious and have never said to anyone “God bless you.” I did to them. My eyes filling, I told them they were saints who deserved a special place in heaven.
There is something of a “debate” within the legal community and on the fringes of the scientific community about the existence of shaken baby syndrome. One argument offered is that confessions are always coerced. Another is that shaking cannot cause these injuries. Those who would say such things should talk to Angel’s father.
Yet, for Angel, none of this matters. Words and events orbit around her like so many errant planets: shaken baby prevention, child protective custody, termination of parental rights, grand jury, criminal prosecution, plea bargain, prison. Unknown and unknowing, immutably beautiful, she spins silently within her own dying sun.
God bless you Angel and may flights of angels sing thee to thy rest.
Re-posted with permission from Dr. Lawrence Ricci.
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