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What Does The Recent Literature Tell Us About Shaken Baby Syndrome? |
 Robert M. Reece, M.D.
Clinical Professor of Pediatrics
Tufts University School of Medicine
Editor, The Quarterly Update
Background:
The term Shaken Baby Syndrome (SBS) refers to the various signs, symptoms, clinical, radiographic and, in fatal cases, autopsy findings resulting from violent shaking and/or impacting the head of an infant or young child. Some have suggested the alternative term “Shaken Impact Syndrome (SIS)” since in many cases impact is demonstrable and is thought to be responsible for some of the traumatic lesions seen. During such assaults, the bridging veins running from the surface of the brain to the superior sagittal sinus, rupture and bleed into the subdural and/or subarachnoid spaces. Direct traumatic damage occurs to the brain; hypoxia during and after the assault causes further irreversible damage to brain tissue; and the cascade of injury continues as there is breakdown of dying brain cells that release intra-cellular enzymes, injuring adjacent neurons. The combined effect is destruction of brain tissue, leading to cerebral edema, raised intra-cranial pressure within the closed skull of the infant, decreased blood flow to the brain and a vicious circle of anoxia, cerebral edema, and death of brain tissue. These insults to the brain cause the signs, symptoms, radiologic and laboratory findings that characterize the course of this form of inflicted brain injury. The signs and symptoms seen are mild to severe, on a continuum from a “low-dose” of shaking/impact to a “high-dose” of shaking/impact and severe craniocerebral injury and may run the gamut from decreased responsiveness, poor feeding, irritability, lethargy and hypotonia to convulsions, vomiting, tachypnea, hypothermia, bradycardia, coma, fixed dilated pupils to death.
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What Does Science Tell Us About Abusive Head Injuries in Infants and Young Children? |
 Mary E. Case, MD
What Is The Shaken Baby Syndrome? Abusive head injury refers to the traumatic brain injury inflicted on an infant or young child and is used in this discussion to encompass all mechanisms of inflicted traumatic brain injury. Because the investigation into whether an injury is intentional or unintentional is often complicated by caretakers providing a false history or no history at all to explain a child’s injury, understanding mechanisms of head injury as revealed by the pathological findings may assist in determination of how the injury was caused. Abusive head injuries are the most common cause of death in child abuse. These injuries are most common in infants under one year old but the same injuries can be seen in children as old as age 4 or 5 years. Shaken Baby Syndrome is one form of abusive head injury in which a child is submitted to severe repetitive acceleration-deceleration forces with or without blunt impact to the head that result in a characteristic pattern of injuries which may include retinal hemorrhages, certain fractures (in particular ribs and the ends of long bones) and recognizable patterns of brain injury.
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The Evidence Base for Shaken Baby Syndrome: Response to Editorial from 106 Doctors |
This letter to the editor orginally appeared in the May 29, 2004 issue of the British Medical Journal. The full text as it appeared in the journal is reprinted below, with permission from BMJ.
EDITOR—In challenging the diagnosis of shaken baby syndrome in their recent editorial Geddes and Plunkett make a number of serious errors in interpreting the research on this issue, and they display a worrisome and persistent bias against the diagnosis of child abuse in general.1
In their opening sentence Geddes and Plunkett describe shaking a child to "produce whiplash forces that result in subdural and retinal bleeding," omitting the most important element in this condition: brain injury itself. They elaborate that the "theory" of shaken baby syndrome rests on some core assumptions, including that "the injury an infant receives from shaking is invariably severe."
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Preventing head trauma from abuse in infants |
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Carole Jenny, MD, is director of the Child Protection Program at Hasbro Children's Hospital and an internationally known expert in child abuse prevention and treatment. Since joining the hospital in 1996, Jenny has developed a comprehensive child protection program. ChildSafe includes examinations, consultation, referrals for inpatient care and round-the-clock on-call services for children with suspected physical abuse, sexual abuse, failure to thrive, psychological abuse, neglect, medical neglect or factitious illness.
Jenny is nationally known for her work in child protection and lectures around the globe. She was the recipient of the 2002 Ray Helfer Award, an annual award presented to a pediatrician who has made a significant contribution to the prevention of child abuse and neglect.
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Clinical Assessment of the Crying Infant Should Guide Decision Making
Laurie Barclay, MD
Medscape Medical News 2009. © 2009 Medscape
March 25, 2009 - History and physical examination is the key to evaluate the crying infant and to determine testing, which should include urine evaluation for afebrile infants in the first few months of life, according to the results of a retrospective review reported in the March issue of Pediatrics.
"Although the differential diagnosis of crying is extensive, the frequency of severe underlying disease is unclear," write Stephen B. Freedman, MDCM, MSc, FRCPC, from Hospital for Sick Children, University of Toronto in Toronto, Ontario, Canada. "On the basis of very limited data, it has been recommended that corneal fluorescein staining, eyelid eversion, and rectal examination be performed on crying infants."
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SBS RESEARCH
Shaken Baby Syndrome