Shaken Baby Syndrome consists of the violent shaking of the child, with possible brain trauma and subsequent neurological complications

Shaken Baby Syndrome is one of the most serious forms of physical abuse of newborns and infants, representing the first cause of death from abuse

Most cases occur in the first year of life, with a greater frequency in the first six months.

This form of maltreatment consists of the violent shaking of the child with possible brain trauma and subsequent neurological complications.

This occurs when the child held by the trunk is vigorously shaken; in this case the head undergoes rapid rotational movements and, due to its large size and a still inadequate neck musculature, the contents of the skull cavity or encephalon (brain, cerebellum and medulla oblongata) undergoes rapid acceleration and deceleration with blunt trauma to the cranial box, nerve injury and rupture of blood vessels with haemorrhage.

This form of maltreatment is often a consequence of inconsolable crying, ‘not tolerated’ by the parents or, more rarely, by other figures caring for the child; very often the parents arrive at these extreme gestures because they are already severely exhausted and feel inadequate to resolve the causes of the crying.

In most cases, such sudden movements are made without a clear awareness of the serious damage that can be done and result from parents’ ignorance of the delicacy of an infant’s encephalon and the consequences that can result.

Shaken baby syndrome, sometimes risk factors are present:

• Young age of the mother;
• Depressive state;
• Socio-economic distress;
• Use of substances of abuse;
• Low cultural level;
• Previous history of abuse in the family.

The injuries that can be caused by shaking are related to the age of the child (the younger the child, the more severe they are) and the violence with which he or she was shaken.

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The three symptoms that allow for diagnosis but are not always present are:

• Subdural haematoma, effusion of blood in the meninges that can cause simple nausea, dizziness, up to more serious symptoms such as altered state of consciousness and coma;
• Cerebral oedema, accumulation of fluid in the brain that swells (oedema) and compresses the blood capillaries, thus blocking the flow of blood and the arrival of oxygen to the brain; it manifests itself with symptoms that can range from simple headaches to seizures and loss of consciousness;
• Retinal haemorrhage with the appearance of tiny blood spots on the retina that can be observed with an instrument called an ophthalmoscope.

More frequently, the symptoms may be non-specific and the diagnosis not suspected for a long time: irritability or drowsiness, vomiting and lack of appetite, difficulty in sucking or swallowing, motor or speech delay, behavioural disorders, excessive increase in head circumference.

In the most severe cases: altered consciousness, blindness, convulsions, cerebral palsy, coma, death.

In some cases, signs of maltreatment may be suspected even after years, in connection with behavioural or learning disorders.

Of course, it will be much more difficult to relate these disorders to shaking that occurred so long ago.

Normal play activities such as bouncing an infant on one’s knee or lifting it into the air may not cause injuries; it is important, however, that parents and carers know how dangerous a more vigorous shaking of the head can be.

Advice should be given to parents by paediatricians on what to do in the event of inconsolable crying and how to manage their stress.

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Source

Bambino Gesù