Shaken baby syndrome

Definition

Shaken baby syndrome is a severe form of head injury caused by the forcible shaking of a child. The force is sufficient to cause the brain to bounce against the baby's skull, causing injury or damage to the brain.

Description

Shaking an infant forcibly transfers a great deal of energy to the infant. When the shaking occurs as the infant is being held, much of the force is transferred to the neck and the head. The force can be so great that the brain can move within the skull, rebounding back and forth from one side of the skull to the other. The bashing can be very destructive to the brain, causing bruising, swelling, or bleeding. Bleeding of the brain is also called intracerebral hemorrhage. The force of shaking can also damage the neck.

As its name implies, shaken baby syndrome can often be a result of deliberate abuse. The brain damage can also be the result of an accident. The force and length of the force necessary to cause shaken baby syndrome is debatable. What is clear is that not much time is needed, since most shaking events likely tend to last only 20 seconds or less. It is the explosive violence of the shaking that exacts the damage.

Demographics

Reliable statistics on the prevalence of shaken baby syndrome do not exist. Estimates in the United States approach 50,000 cases each year. Nearly 25% of infants with shaken baby syndrome die from the brain injuries sustained. The victims of this syndrome range in age from just a few days to five years, with an average age of six to eight months. Statistics point to men as the usual perpetrators, typically young men (i.e., early 20s). Females who shake babies tend to be caregivers. As reliable statistics emerge, it would not be unexpected to find the actual number of cases greatly exceeds these crude estimates. Abuse of children is a hidden event, so many cases of abuse, including shaken baby syndrome, are not reported or are presented in some other form (such as a fall or an accident).

Causes and symptoms

The cause of the brain, neck, and spine damage that can result from shaken baby syndrome is brute force. The violent shaking of a baby by a much stronger adult conveys a tremendous amount of energy to the infant. Part of the reason for the damage is because an infant's head is much larger than the rest of the body, in relation to an older child or an adult. This, combined with neck muscles that are still developing and are incapable of adequately supporting the head, can make shaking an explosively destructive event. The amount of brain damage depends on how hard the shaking is and how long an infant is shaken. If accidental, the force and length of the head trauma similarly determines the extent of injury.

The normal tossing and light "horse play" that can occur between an adult and an infant is not sufficient to cause shaken baby syndrome.

The damage to the brain can have dire consequences that include permanent and severe brain damage or death. Other symptoms that can develop include behavioral changes, lack of energy or motivation, irritable behavior, loss of consciousness, paling of the skin color or development of a bluish tinge to the skin, vomiting, and convulsions. These symptoms are the result of the destruction of brain cells that occurs directly due to the trauma of the blow against the skull, and secondarily as a result of oxygen deprivation and swelling of the brain. The banging of the brain against the sides of the skull causes the inflammation and swelling as well as internal bleeding. Increased intracranial pressure can be damaging to the structure and function of the brain.

Additionally, because the neck and head can absorb a tremendous amount of energy due to the shaking force of the adult, bones in the neck and spine can be broken and muscles can be torn or pulled. The eyes can also be damaged by the explosive energy of shaking. Retinal damage occur in 50–80% of cases. The damage can be so severe as to permanently blind an infant.

Shaken baby syndrome is also known as abusive head trauma, shaken brain trauma, pediatric traumatic brain injury , whiplash shaken infant syndrome, and shaken impact syndrome.

Diagnosis

Diagnosis depends on the detection of a blood clot below the inner layer of the dura (a membrane that surrounds the brain), but external to the brain. The clot is also known as a subdural hematoma . Two other critical features of shaken baby syndrome that are used in diagnosis are brain swelling and hemorrhaging in the eyes.

An infant may also have external bruising on parts of the body that were used to grip him or her during shaking. Bone or rib fractures can also be apparent. However, these external features may not always be present. Diagnosis can also involve the nondestructive imaging of the brain using the techniques of computed tomography (CT ), skull x ray, or magnetic resonance imaging (MRI) . Typically, these procedures are done after an infant has been stabilized and survival is assured.

Treatment team

Treatment in an emergency setting typically involves nurses and emergency room physicians. A neurosurgeon is usually consulted when shaken baby syndrome is suspected. Depending on the extent of injury, neurosurgeons can become involved if surgery for brain repair is needed.

Police officers and social workers also become involved in cases of shaken baby syndrome, who work to ensure that the child is placed in a safe environment.

Treatment

Initially, treatment is provided on an emergency basis. Life-saving measures can include stopping internal bleeding in the brain and relieving pressure that can build up in the brain because of bleeding and swelling of the brain.

Recovery and rehabilitation

If the infant survives the initial injury from shaken baby syndrome, rehabilitation focuses on recovering as much function as possible. Physical and occupational therapies can offer exercises for caregivers to provide the child, as well as any supportive or positional devices required. The full effects of the brain injury sustained in infants who survive shaken baby syndrome may not become apparent until delays in developmental milestones such as sitting alone, walking, or acquiring speech are noticed.

Clinical trials

As of May 2004, there are no clinical trials on shaken baby syndrome underway or recruiting participants in the United States. However, agencies such as the National Institute of Neurological Disorders and Stroke fund studies that seek to better understand the basis of the damage. Other agencies attempt to lessen the occurrence of the syndrome through counseling, anger management, and interventions in abusive situations.

Prognosis

The prognosis for children with shaken baby syndrome is usually poor. Twenty percent of cases result in death within the first few days. If an infant survives, he or she will most often be left with intellectual and developmental disabilities such as mental retardation or cerebral palsy . Damage to the eyes can cause partial or total loss of vision. A survivor will likely require specialized care for the remainder of his or her life.

Resources

BOOKS

Lazoritz, Stephen, and Vincent J. Palusci, eds. Shaken Baby Syndrome: A Multidisciplinary Approach. Binghamton, NY: Haworth Press, 2002.

PERIODICALS

Geddes, J. F., and J. Plunkett. "The Evidence Base for Shaken Baby Syndrome." British Medical Journal (March 2004): 719–720.

Harding, B., R. A. Risdon, and H. F. Krous. "Shaken Baby Syndrome." British Medical Journal (March 2004): 720–721.

OTHER

"NINDS Shaken Baby Syndrome Information Page." National Institute of Neurological Disorders and Stroke. May 13, 2004 (May 27, 2004). http://www.ninds.nih.gov/health_and_medical/disorders/shakenbaby.htm>.

ORGANIZATIONS

National Institute for Neurological Diseases and Stroke. P.O. Box 5801, Bethesda, MD 20824. (301) 496-5751 or (800) 352-9424. <http://www.ninds/nih.gov>.

The National Center on Shaken Baby Syndrome. 2955 Harrison Blvd., #102, Ogden, UT 84403. (801) 627-3399 or (888) 273-0071; Fax: (801) 627-3321. [email protected]. <http://www.dontshake.com>.

National Institute of Child Health and Human Development. 31 Center Drive, Rm. 2A32 MSC 2425, Bethesda, MD 20892-2425. (301) 496-5133; Fax: (301) 496-7101. <http://www.nichd.nih.gov>.

The Arc of the United States. 1010 Wayne Avenue, Suite 650, Silver Spring, MD 20910. (301) 565-3842; Fax: (301) 565-3843. [email protected]. <http://www.thearc.org>.

Think First Foundation [National Injury Prevention Program]. 5550 Meadowbrook Drive, Suite 110, Rolling Meadows, IL 60008. (847) 290-8600 or (800) 844-6556; Fax: (847) 290-9005. [email protected]. <http://www.thinkfirst.org>.

Brian Douglas Hoyle, PhD

Shaken baby syndrome

Definition

Shaken baby syndrome (SBS) is a collective term for the internal head injuries a baby or young child sustains from being violently shaken.

Description

Shaken baby syndrome was first described in medical literature in 1972. Physicians earlier labeled these injuries as accidental, but as more about child abuse became known, more cases of this syndrome were properly diagnosed.

Demographics

Every year, nearly 50,000 children in the United States are forcefully shaken by their caretakers. More than 60 percent of these children are boys. Nearly 2,000 children die every year as a result of being shaken. The victims are on average six to eight months old, but may be as old as five years or as young as a few days.

Men are more likely than women to shake a child; typically, these men are in their early 20s and are the baby's father or the mother's boyfriend. Women who inflict SBS are more likely to be babysitters or child care providers than the baby's mother. The shaking may occur as a response of frustration to the baby's inconsolable crying or as an action of routine abuse.

Causes and symptoms

Infants and small children are especially vulnerable to SBS because their neck muscles are still too weak to adequately support their disproportionately large heads, and their young brain tissue and blood vessels are extremely fragile. When an infant is vigorously shaken by the arms, legs, shoulders, or chest, the whiplash motion repeatedly jars the baby's brain with tremendous force, causing internal damage and bleeding. While there may be no obvious external signs of injury following shaking, the child may suffer internally from brain bleeding and bruising (called subdural hemorrhage and hematoma); brain swelling and damage (called cerebral edema); mental retardation ; blindness, hearing loss, paralysis, speech impairment, and learning disabilities; and death.

Physicians may have difficulty initially diagnosing SBS because there are usually few witnesses to give a reliable account of the events leading to the trauma, few if any external injuries, and, upon close examination, the physical findings may not agree with the account given. A shaken baby may present one or more signs, including vomiting ; difficulty breathing, sucking, swallowing, or making sounds; seizures; and altered consciousness.

When to call the doctor

A physician should be called when a baby exhibits one or more of the following: vomiting; difficulty breathing, sucking, swallowing, or making sounds; seizures; and altered consciousness. An unresponsive child should never be put to bed, but must be taken to a hospital for immediate care.

Diagnosis

To diagnose SBS, physicians look for at least one of three classic conditions: bleeding at the back of one or both eyes (retinal hemorrhage), subdural hematoma , or cerebral edema. The diagnosis is confirmed by the results of either a computed tomography scan (CT scan) or magnetic resonance imaging (MRI).

Treatment

Appropriate treatment is determined by the type and severity of the trauma. Physicians may medically manage both internal and external injuries. Behavioral and educational impairments as a result of the injuries require the attention of additional specialists. Children with SBS may need physical therapy, speech therapy, vision therapy, and special education services.

Prognosis

Unfortunately, children who receive violent shaking have a poor prognosis for complete recovery. Those who do not die may experience permanent blindness, mental retardation, seizure disorders, or loss of motor control.

Prevention

Shaken baby syndrome is preventable with public education. Adults must be actively taught that shaking a child is never acceptable and can cause severe injury or death.

Parental concerns

When the frustration from an incessantly crying baby becomes too much, caregivers should have a strategy for coping that does not harm the baby. The first step is to place the baby in a crib or playpen and leave the room in order to calm down. Counting to 10 and taking deep breaths may help. A friend or relative may be called to come over and assist. A calm adult may then resume trying to comfort the baby. A warm bottle, a dry diaper, soft music, a bath, or a ride in a swing, stroller, or car may be offered to soothe a crying child. Crying may also indicate pain or illness, such as from abdominal cramps or an earache. If the crying persists, the child should be seen by a physician.

KEY TERMS

Cerebral edema —The collection of fluid in the brain, causing tissue to swell.

Hematoma —A localized collection of blood, often clotted, in body tissue or an organ, usually due to a break or tear in the wall of blood vessel.

Hemorrhage —Severe, massive bleeding that is difficult to control. The bleeding may be internal or external.

Retinal hemorrhage —Bleeding of the retina, a key structure in vision located at the back of the eye.

Subdural hematoma —A localized accumulation of blood, sometimes mixed with spinal fluid, in the space between the middle (arachnoid) and outer (dura mater) membranes covering the brain. It is caused by an injury to the head that tears blood vessels.

Resources

BOOKS

Antoon, Alia Y. and Donovan, Mary. "Brain injuries." In Nelson Textbook of Pediatrics. 17th ed. Ed. by Richard E. Behrman, et al., Philadelphia: Saunders, 2003, 330-7.

Augustyn, Marilyn, and Zuckerman, Barry. "Impact of viokence on children." In Nelson Textbook of Pediatrics. 17th ed. Ed. by Richard E. Behrman, et al., Philadelphia: Saunders, 2003, 120-1.

Lazoritz, Stephen, and Palusci, Vincent J. Shaken Baby Syndrome: A Multidisciplinary. Binghamton, NY: Haworth Press, Incorporated, 2002.

Minns, Robert, and Brown, Keith. Shaken Baby Syndrome and Other Non-Accidental Head Injuries in Children. London: MacKeith Press, 2003.

PERIODICALS

Carbaugh, S.F. "Family teaching toolbox. Preventing shaken baby syndrome." Advances in Neonatal Care 4, no. 2 (2004): 118-9.

Carbaugh, S.F. "Understanding shaken baby syndrome." Advances in Neonatal Care 4, no. 2 (2004): 105-14.

Evans, H.H. "The medical discovery of shaken baby syndrome and child physical abuse." Pediatric Rehabilitation 7, no. 3 (2004): 161-3.

Lin, C.L., et al. "External subdural drainage in the treatment of infantile chronic subdural hematoma." Journal of Trauma 57, no. 1 (2004): 104-7.

Sugarman, N. "Shaken Baby Syndrome: compensating the victims." Pediatric Rehabilitation 7, no. 3 (2004): 215-20.

ORGANIZATIONS

Brain Injury Association. 105 North Alfred Street, Alexandria, VA 22314. (800) 444-6443 or (703) 236-6000. Web site: <http://www.biausa.org/Sportsfs.htm>.

International Brain Injury Association. 1150 South Washington Street, Suite 210, Alexandria, VA 22314. (703) 683-8400. Web site: <www.internationalbrain.org>.

WEB SITES

"Please Don't Shake Me." National Center on Shaken Baby Sybdrome. Available online at <http://www.dontshake.com>.

"Shaken Baby Information Page." National Institute of Neurological Disorders and Stroke. Available online at <http://www.ninds.nih.gov/health_and_medical/disorders/shakenbaby.htm>.

"Shaken Baby Syndrome." Shaken Baby Alliance. Available online at <http://www.shakenbaby.com>.

"Shaken Baby Syndrome." The Arc. Available online at <http://www.thearc.org/faqs/Shaken.html.asp>.

L. Fleming Fallon, Jr., MD, DrPH

Shaken Baby Syndrome

Definition

Shaken baby syndrome (SBS) is a collective term for the internal head injuries a baby or young child sustains from being violently shaken.

Description

Shaken baby syndrome was first described in medical literature in 1972. Physicians earlier labeled these injuries as accidental, but as more about child abuse became known, more cases of this syndrome were properly diagnosed.

Every year, nearly 50,000 children in the United States are forcefully shaken by their caretakers. More than 60% of these children are boys. The victims are on average six to eight months old, but may be as old as five years or as young as a few days.

Men are more likely than women to shake a child; typically, these men are in their early 20s and are the baby's father or the mother's boyfriend. Women who inflict SBS are more likely to be babysitters or child care providers than the baby's mother. The shaking may occur as a response of frustration to the baby's inconsolable crying or as an action of routine abuse.

Causes and symptoms

Infants and small children are especially vulnerable to SBS because their neck muscles are still too weak to adequately support their disproportionately large heads, and their young brain tissue and blood vessels are extremely fragile. When an infant is vigorously shaken by the arms, legs, shoulders, or chest, the whiplash motion repeatedly jars the baby's brain with tremendous force, causing internal damage and bleeding. While there may be no obvious external signs of injury following shaking, the child may suffer internally from brain bleeding and bruising (called subdural hemorrhage and hematoma); brain swelling and damage (called cerebral edema ); mental retardation; blindness, hearing loss, paralysis, speech impairment, and learning disabilities; and death. Nearly 2,000 children die every year as a result of being shaken.

Physicians may have difficulty initially diagnosing SBS because there are usually few witnesses to give a reliable account of the events leading to the trauma, few if any external injuries, and, upon close examination, the physical findings may not agree with the account given. A shaken baby may present one or more signs, including vomiting; difficulty breathing, sucking, swallowing, or making sounds; seizures; and altered consciousness.

Diagnosis

To diagnose SBS, physicians look for at least one of three classic conditions: bleeding at the back of one or both eyes (retinal hemorrhage ), subdural hematoma, and cerebral edema. The diagnosis is confirmed by the results of either a computed tomography scan (CT scan) or magnetic resonance imaging (MRI).

Treatment

Appropriate treatment is determined by the type and severity of the trauma. Physicians may medically manage both internal and external injuries. Behavioral and educational impairments as a result of the injuries require the attention of additional specialists. Children with SBS may need physical therapy, speech therapy, vision therapy, and special education services.

Alternative treatment

There is no alternative to prompt medical treatment. An unresponsive child should never be put to bed, but must be taken to a hospital for immediate care.

KEY TERMS

Cerebral edema— Fluid collecting in the brain, causing tissue to swell.

Hematoma— A localized accumulation of blood in tissues as a result of hemorrhaging.

Hemorrhage— A condition of bleeding, usually severe.

Retinal hemorrhage— Bleeding of the retina, a key structure in vision located at the back of the eye.

Subdural hematoma— A localized accumulation of blood, sometimes mixed with spinal fluid, in the space of the brain beneath the membrane covering called the dura mater.

Prognosis

Sadly, children who receive violent shaking have a poor prognosis for complete recovery. Those who do not die may experience permanent blindness, mental retardation, seizure disorders, or loss of motor control.

Prevention

Shaken baby syndrome is preventable with public education. Adults must be actively taught that shaking a child is never acceptable and can cause severe injury or death.

When the frustration from an incessantly crying baby becomes too much, caregivers should have a strategy for coping that does not harm the baby. The first step is to place the baby in a crib or playpen and leave the room in order to calm down. Counting to 10 and taking deep breaths may help. A friend or relative may be called to come over and assist. A calm adult may then resume trying to comfort the baby. A warm bottle, a dry diaper, soft music, a bath, or a ride in a swing, stroller, or car may be offered to soothe a crying child. Crying may also indicate pain or illness, such as from abdominal cramps or an earache. If the crying persists, the child should be seen by a physician.

Resources

ORGANIZATIONS

American Humane Association, Children's Division. 63 Inverness Drive East, Englewood, CO 80112-5117. (800) 227-4645. 〈www.americanhumane.org〉.

Child Abuse Prevention Center of Utah. 2955 Harrison Boulevard, #102, Ogden, UT 84403. (888) 273-0071.

National Center on Shaken Baby Syndrome. 2955 Harrison Blvd., #102, Ogden, UT 84403. (801) 627-3399. 〈http://www.dontshake.com〉.

SHAKEN BABY SYNDROME

DEFINITION

Shaken baby syndrome (SBS) refers to a combination of injuries that occurs when a baby or young child is violently shaken.

DESCRIPTION

Medical writers first described shaken baby syndrome in 1972. At first, doctors thought that shaken baby syndrome was caused by accidents. Later, they became more aware of patterns of child abuse and more cases of SBS were properly diagnosed.

Every year, about fifty thousand cases of SBS are reported. Boys make up more than 60 percent of those injured. The average SBS victim is six to eight months old, but children as old as five years or as young as a few days can be affected.

Some cases of SBS occur when a very angry or frustrated adult shakes an infant. In other cases, the injury is a result of ongoing abuse. Statistically, men inflict injury more often than women. These men tend to be in their early twenties. Men responsible for causing SBS are often either the baby's father or the mother's boyfriend. Data shows that women who injure babies are more likely to be babysitters or child care providers than the victim's mother.

CAUSES

Shaking is more likely to injure a baby than an older child or adult for three reasons. First, a baby's neck muscles are still weak. Second, its head is still relatively large and heavy, compared to its body size. Third, the baby's brain tissue and blood vessels are still quite fragile.

When a child is shaken violently, its head snaps back and forth. The brain is pushed first against one side of the skull, then against the other side. The bumping action can cause brain tissue to tear and blood vessels to break.

SYMPTOMS

Shaking may produce no visible symptoms in the baby even when extensive damage has occurred within the brain. Internal (inside) bleeding within the skull may cause the brain to swell. If the swollen brain pushes against the skull, damage to nerves and other parts of the brain may occur. Such damage can cause serious problems including blindness, hearing loss, paralysis, speech impairment, mental retardation, learning disabilities, and death. Nearly two thousand children die every year as a result of being shaken.

DIAGNOSIS

Shaken baby syndrome is often difficult to diagnose. There are usually no witnesses to the shaking. The baby may seem to be normal for a period of time after shaking. Babies who act abnormally may be diagnosed with some other medical disorder. Some changes in behavior that may suggest SBS include vomiting, seizures, or loss of consciousness. A baby may also have difficulty breathing, sucking, swallowing, or making sounds.

Additional clues about SBS sometimes come from interviews with the baby's parents. The parents may offer other reasons for the baby's unusual behavior. The explanations offered may not seem reasonable to a doctor.

A doctor who suspects SBS may look for several characteristic conditions that accompany the disorder. The first condition is bleeding at the back of both eyes. Shaking easily breaks blood vessels at the back of the eye. The bleeding is easy to see when the eyes are examined carefully.

Two other conditions often found with SBS are cerebral edema (pronounced suh-REE-bruhl ih-DEE-muh) and subdural hematoma (pronounced sub-DYOOR-uhl hee-muh-TOE-muh). These two terms refer to masses of blood in the brain caused when tissues swell and blood vessels break. The two conditions can be detected by using some form of imaging technique, such as a computed tomography (CT) scan (often also called a computerized axial tomography (CAT) scan), and magnetic resonance imaging (MRI). These techniques use X-ray photographs or electromagnetic fields to provide pictures of the interior of the brain without actually doing surgery.

Shaken Baby Syndrome: Words to Know

Cerebral edema:

Swelling of the brain caused by an accumulation of fluid.

Child abuse:

Intentional harm done to infants and children, usually by parents or care givers.

Computed tomography (CT) scan:

A technique in which X-ray photographs of a particular part of the body are taken from different angles. The pictures are then fed into a computer that creates a single composite image of the internal (inside) part of the body. CT scans provide an important tool in the diagnosis of brain and spinal disorders, cancer and other conditions.

Computerized axial tomography (CAT) scan:

Another name for a CT scan.

Magnetic resonance imaging (MRI):

A procedure that uses electromagnets and radio waves to produce images of a patient's internal tissue and organs. These images are not blocked by bones, and can be useful in diagnosing brain and spinal disorders and other diseases.

Subdural hematoma:

An accumulation of blood in the outer part of the brain.

TREATMENT

The type of treatment provided to an injured baby depends on the kind and extent of injuries. In mild cases, the injury may simply heal over time. In more serious cases, treatment may be needed to deal with a specific symptom or injury, such as hearing loss or speech impairment.

Steps are often taken to protect the baby from further injury. The child may have to be placed in a foster home and/or the adult responsible for causing the injuries may be provided with counseling. Adults who cause SBS may also face criminal charges in the courts.

Alternative Treatment

There are no alternative treatments for SBS. A child who is not behaving normally should be taken to a hospital immediately.

PROGNOSIS

The prognosis for shaken baby syndrome is usually not good. A significant number of babies who are mistreated die.

Many others suffer serious, long-term damage that will stay with them throughout their lives. Injuries that cause blindness, mental retardation, or loss of motor (muscular) control, for example, are permanent. They can not be repaired. Rehabilitation, however, can help a child learn to live and cope with their new disability.

PREVENTION

Because this medical problem is caused by adults who intentionally and physically abuse a child, the only way to prevent shaken baby syndrome is by educating adults.

A common reason given by adults for this type of abuse is frustration with a crying baby. Parents and caregivers can be taught how to deal with this frustration. One general rule is to leave a crying baby alone until the adult has calmed down. Possible reasons for the baby's discomfort should then be considered. A warm bottle, dry diaper, soft music, a bath, or a ride in a swing may calm the child, which in turn may calm the adult.

Adults should also be aware that a baby who cries excessively may have a medical disorder and should be examined by a doctor.

FOR MORE INFORMATION

Books

Morey, Ann-Janine. What Happened to Christopher: An American Family's Story of Shaken Baby Syndrome. Carbondale, IL: Southern Illinois University Press, 1998.

Organizations

American Humane Association. Children's Division. 63 Inverness Drive East, Englewood, CO 80112. (303) 792–9900.

Shaken Baby Syndrome Prevention Plus. 649 Main Street, Suite B, Groveport, OH 43125. (800) 858–5222; (614) 836–8360. http://members.aol.com/sbspp/sbspp.html.

Web sites

"Ask NOAH About: Neurological Problems." NOAH: New York Online Access to Health. [Online] http://www.noah.cuny.edu/neuro/neuropg.html#Shaken (accessed on October 31, 1999).

Shaken Baby Syndrome

Shaken baby syndrome (SBS) is a collection of findings used to describe the aggressive shaking, jolting, and jerking of an infant or young child primarily about the arms, chest, legs, or shoulders, and the strong impact trauma, or blows, on and about the head and skull of a baby. (Other names for shaken baby syndrome include shaken/impact syndrome, abusive head trauma, pediatric traumatic brain injury, shaken brain trauma, shaken impact syndrome, and whiplash shaken infant syndrome.) SBS is most often inflicted by biological fathers, step-fathers, male partners of biological mothers, and caregivers, but can also be inflicted by biological mothers.

Shaken baby syndrome is diagnosed by physicians (in cases of live children) and forensic scientists (those of dead children) when finding such problem areas as retinal hemorrhages (bleeding within the retina of eyes), intracranial hemorrhage (bleeding in and around the brain), increased head size (as a result of too much fluid in brain tissues), spinal cord damage, and broken and fractured ribs and bones. When brain damage is suspected, various diagnostic methods are used including computed tomography (CT) and magnetic resonance imaging (MRI) in order to show injuries to the brain. When such problems occur, more subtle symptoms are usually also present such as viral illnesses (such as influenza), infant colic (stomach aches and cramps), swallowing and feeding dysfunction, vomiting, lethargy (sluggishness), and irritability. Enough traumatic force used when shaking a baby can lead to brain damage, hearing loss, blindness, learning disorders, mental retardation, paralysis, seizures, and eventual death of the child.

Shaken baby syndrome, a type of child abuse, is investigated by law enforcement officials as a criminal assault in the United States and in many countries around the world. Such investigations are mostly performed by an expert who can distinguish between common childhood illness and injuries, and symptoms associated with SBS. It could also be investigated by professionals from local or state child welfare, social services, and public health care agencies due to the need to protect the child. Forensic experts must be called in when death has occurred in order to verify that the cause of death was shaken baby syndrome.

see also Skull.