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What is Shaken Baby Syndrome?

WHAT IS SHAKEN BABY SYNDROME (ABUSIVE HEAD TRAUMA)

Head injuries are the leading cause of death and disability in young children.  Shaken Baby Syndrome (SBS) is a subset of Abusive Head Trauma (AHT), the leading cause of fatal head injuries in children younger than two years. It is responsible for 53% of serious or fatal traumatic brain injury cases in the United States.1 At least 1 of 4 infants who are violently shaken die from this form of child maltreatment.2  Babies less than one-year-old are at greatest risk of injury from SBS.3   SBS is unlikely to be an isolated event.  Evidence of previous abuse, cranial injuries (e.g., old intracranial hemorrhages) from shaking is found in 33% - 40% of all cases.”4   In addition to head injuries, other forms of child abuse including skin injuries, fractures, abdominal injuries, and burns result in pain, permanent injury and disfigurement of children. Neglect is often unrecognized and when reported can be challenging to investigate and prosecute. Our youngest most vulnerable victims, including our children with disabilities, often cannot tell us what has happened to them.

THE IMPACT OF SHAKEN BABY SYNDROME

1.  Approximately 25% of SBS/AHT victims die.  Of the remaining survivors, 1/3 of the victims will have profound disabilities, 1/3 will have moderate disabilities, and 1/3 will have mild disabilities.  These conditions range from vegetative to varying degrees of intellectual and developmental disabilities including cognitive, visual, and physical disabilities, seizure disorders, visual impairments, and increased risk of additional physical and sexual abuse.5

2. All victims of SBS/AHT have medical conditions and diagnoses that result in additional medical costs.  AHT is associated with significantly greater medical service use and higher inpatient, outpatient, drug, and total costs for multiple years after the diagnosis.6

3. Because the most common perpetrator of this abuse is the biological father (37%) followed by the mother’s boyfriend (21%), female child care provider (17%), mother (13%) male child care provider (4%), stepfather (3%) and other (5%), families are often broken.7   The child victim is often raised by a single parent, grandparent, another family member, or in a foster/adoptive home.  These children require intensive, weekly therapy and are often ill because of the weakened immune system. This may cause days of lost wages for the remaining parent and resulting financial difficulties.  While SBA addresses the root issues with each family, SBS families have complex needs.  Each family is different.

4. Without proper support and education for the MDT (multidisciplinary team) professionals involved in these complex cases, victim families can be destroyed, investigations can be stalled, and court cases are lost, resulting in repeated abuse of children.  Scarce resources besides SBA exist for the advanced forensic training necessary to facilitate successful case outcomes. SBA distinctively targets comprehensive training to First Responders, law enforcement, child protection, medical providers,

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1. Pediatric Radiology https://doi.org/10.1007/s00247-018-4149- Received: 16 November 2017 / Revised: 22 March 2018 / Accepted: 25 April 2018.  # Springer-Verlag GmbH Germany, part of Springer Nature 2018. Arabinan Kumar Choudhary & Sabah Servais & Thomas       L. Solves & Vincent J. Pelosi & Gary L. Hedlund &Sandeep K. Narang & Joelle Anne Moreno & Mark S. Dias8 & Cindy W. Christian & Marvin D. Nelson Jr & V. Michelle Silver & Susan Palais & Maria Arisaka & Andrea Ross & Akaka C. Offish

2. Charbagh S. Understanding shaken baby syndrome. Adv Neonatal Care. 2004;4(2):105-116.

3. Keenan HT, Runyan DK, Marshall SW, Nocera MA, Marten DF, Signal SH. A population-based study of inflicted traumatic brain injury in young children.  JAMA. 2003; 290:621-626.

4. Pediatrics Vol 108 No.1 July 2001

5. Starling S, et al, Pediatrics. Feb 1995; 95:259-262.

6. Peterson, et al. Pediatrics. July 2014; 134:91-99.

7. Starling S, et al, Pediatrics. Feb 1995; 95:259-262.

prevention specialists, and legal personnel utilizing a multidisciplinary faculty to address the unique needs of each profession involved. SBA is one of the few providers nationwide with training programs to address child physical abuse, specifically, SBS. As such, we may be involved in a case from the date of the abuse, when we meet the victim family, to the training of First Responders and law enforcement who investigate the case, to the legal professional who calls for help in development of the legal case.

SIDS (Sudden Infant Death Syndrome)  VS SUID (Sudden Unexplained Infant Death)
1. Sudden Infant Death Syndrome (SIDS)

The American Academy of Pediatrics defines Sudden Infant Death Syndrome as the sudden and unexplained death of an apparently healthy infant, under one year of age, which remains unexplained after a review of the complete medical history, thorough death scene investigation, and autopsy. SIDS is a diagnosis of exclusion.8

2. Sudden Unexpected Infant Death (SUID)

The American Academy of Pediatrics defines Sudden Unexpected Infant Death (SUID) as a sudden and unexpected death, whether explained or unexplained (including SIDS), occurring during infancy.

CDC (Centers for Disease Control defines SUID (Sudden Unexpected Infant Death) to be used as a broad term that encompasses all sudden infant deaths. This include SIDS (Sudden Infant Death Syndrome) as a subset, accidental deaths (such as suffocation and strangulation), sudden natural deaths (such as those caused from infections, cardiac or metabolic disorders, and neurological conditions), and homicides.9

3. Difference betweenSIDS and other SUID subsets

The Office of the Chief Medical Examiner of Virginia (2007) explains the major difference between SIDS and other SUID subsets is the presence or absence of an external risk factor such as an unsafe sleeping environment or a medical disease.  All SIDS cases are classified as natural deaths with regard to manner of death.   In some rare case, SUID cases are classified as natural deaths.

In the last several years, the terms connoting sudden infant death have become confusing, not only to parents, but also to professionals and researchers.

CDC (Centers for Disease Control), in an attempt to clarify the issue, suggested that SUID (Sudden Unexpected Infant Death) be used as a broad term that encompasses all sudden infant deaths. This would include SIDS (Sudden Infant Death Syndrome), accidental deaths (such as suffocation and strangulation), sudden natural deaths (such as those caused from infections, cardiac or metabolic disorders, and neurological conditions), and homicides.10

Definitions vary from state to state.  There are stark differences in how various states, and even separate jurisdictions within the same state, handle death-scene investigations and classifications. Some

use SUID to mean Sudden Unexplained Infant Death.  For example, when a medical examiner, even after a thorough scene investigation, cannot tell the difference between SIDS and suffocation, they will often use this term to mean it is unexplained. Other medical examiners might call these “undetermined” and others would still call them SIDS. Since there is usually no way to tell the difference between suffocation and SIDS at the autopsy, the scene investigation is of utmost importance. Increasingly, investigators are using doll reenactments at the home to help parents clarify the situation surrounding their infant’s death.11

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 8. PEDIATRICS Volume 138 , number 5 , November 2016 :e 20162938

 9. http://www.cdc.gov/SIDS/suid/

10. http://www.cdc.gov/SIDS/suid/

11. http://sids.org/what-is-sidssuid

 

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