What is Shaken Baby Syndrome?


What is Shaken Baby Syndrome? 
Shaken Baby Syndrome (SBS) is a form of Abusive Head Trauma (AHT) that occurs when a frustrated caregiver “shakes” or “slams” a child, usually to stop him/her from crying.  Thousands of children each year are victims of this form of abusive head trauma.  It is considered a serious crime and a severe form of child abuse.

How does SBS occur?
SBS typically occurs when a young child is shaken back and forth, and/or slammed into either a soft or hard surface causing blunt force injury to the brain.  During this abuse, veins over the brain often tear and bleed causing a subdural hematoma (bleeding over the brain).  In addition to this bleeding, brain tissue is sheared, or torn, during the blunt force trauma. This mechanism results in injury to the brain that causes cerebral edema (brain swelling).  As the damaged brain begins to swell, the resulting pressure causes a lack of oxygen to the brain and symptoms appear.
What are the symptoms of SBS?
The symptoms of SBS can range from mild forms of irritability, poor feeding, vomiting and lethargy to the more serious symptoms of breathing difficulties, seizures, coma, and death.  Children that have any of these symptoms should receive immediate medical attention.  Other findings common in SBS/AHT include retinal hemorrhages (bleeding in the back of the eye) and fractures.  Retinal hemorrhage occurs when blood vessels in the retina (lining in the back of the eye) are torn and begin to bleed.  Fractures occur from forces applied to the bones of the body cause the bones to break.

OLIVIA, PICTURED,  IS A SURVIVOR OF SHAKEN BABY SYNDROME.                                                                                                 


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.
1] Pediatric Radiology 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

INFORMATION ABOUT 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

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



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