Abusive head trauma or AHT is a term that is used by doctors when there are other forms of blunt injuries to the head of the baby. This may result from whiplash baby, throwing the baby against a hard surface or banging the head forcefully. The resultant injury is the same as the one that occurs by shaking the baby.
The average prevalence of shaken baby syndrome in the United States is about 3 cases in 10,000 babies. It has been seen that out of these cases, one out of five babies die and about one third are left with a deformity. Studies have shown that the risk factors for such cases of child abuse are poverty, stress and mental stress or illness in one of the parents.
Causes of Brain Injury in Shaken Baby Syndrome
This is one of the reasons of brain damage in newborns. When the baby is shaken vigorously or is subjected to a blunt trauma on the head the brain bears the brunt. Babies have larger and heavier heads and so they are at a greater risk of head injury. When the head is jerked, the brain slams against the skull and causes rupture of the small blood vessels inside as the wall of the blood vessels is very thin. The tissues and nerves also may get damaged. The neck muscles of the baby are not so strong so they cannot withstand the jerk. The injury inside the brain leads to swelling and bleeding which can have effects like serious deformities.
It should be remembered that gently playing with the baby or tossing the baby in the air while playing do not cause shaken baby syndrome. This is most likely to occur when the action is done forcefully and intentionally. The force exerted by the adult is far too much for the baby to handle and thus it leads to an injury.
Symptoms of Shaken Baby Syndrome
The Shaken Baby Syndrome symptoms will vary based on the intensity of the injury. If the injury is mild, then the baby may be fussy, irritable and may refuse to eat.
If the injury is very severe and the baby has been shaken for more than five seconds then the symptoms will be more intense-
- Difficulty in staying awake
- Slow heartbeat
- Difficult hearing
- Discolored skin
- Coma and paralysis may occur if the injury within the brain is very severe.
If the child has been thrown against a hard surface, there may be signs of bruises, cuts, hematoma due to blunt injury and even fracture of limbs.
The symptoms appear almost immediately but if the brain has been injured then the swelling and collection of blood is gradual and so the symptoms will come on within a few days of the injury.
If any such symptoms are noticed in the baby then you must seek immediate medical help as the consequences can be severe and even life threatening. The child is at a risk of going into coma due to the head injury.
Diagnosis of Shaken Baby Syndrome Cases
The diagnosis of shaken baby syndrome is a difficult one and it comes into the picture after a lot of other baby troubles are ruled out. Also the symptoms make their appearance on repeated injuries. The commonest reason why small babies cry is colic. Baby colic makes its appearance after the third month and can lead to uncontrollable crying at night.
When reaching the diagnosis the doctor will ask for any other symptoms like colic or an illness due to which the child was crying a lot. The change in the behavior like drowsiness or redness of the eyes will be noted with details like number of days. A physical examination will reveal the presence of any cuts, bruises or signs of blunt trauma.
The three classic diagnostic findings along with a history of abusive head trauma are-
- Swelling in the brain.
- Subdural hemorrhage – bleeding within the brain
- Retinal hemorrhage- bleeding within the retina of the eye due to rupture of small blood vessels.
If a brain injury is suspected then detailed investigations like CT Scan and MRI will be needed which can detect the presence of blood clots or ruptured vessels in the brain. An X-ray may be done to look for fractures.
In all such cases, it is very important to rule out other serious medical problems like meningitis or rare blood disorders. A lumbar puncture may be required to check the CSF (cerebrospinal fluid) for meningitis.
If the treating doctor suspects or detects a case of shaken baby syndrome, he must report it to the police and child welfare authorities. These authorities get in touch with the parents to help and counsel them about the problem and also safe guard the life of the baby. If the parent is found to be mentally ill or unstable to take care of the baby, then appropriate measures need to be taken.
Treatment of Shaken Baby Syndrome
If you suspect that a baby has shaken baby syndrome, check for the breathing as many baby stop breathing after they are violently shaken. The first thing to do in such cases is to perform CPR and call 911. There is also a risk that the baby may vomit due to a head injury. So keep the baby turned on one side. This will prevent chocking and the aspiration of the vomits. Rolling the baby completely on one side also keep a check on the damage to the spinal cord if any.
The baby may need Intensive Care Treatment. Oxygen therapy may be required to help the child breathe normally again. Medications are given to reduce the swelling in the brain. A cooling mattress may be used to bring down the temperature and ease the pains.
If the baby has seizures, then anti epileptic medication needs to be given. Due to brain damage, the child may be left behind with a disability which needs to be talked with the help of occupational therapy. A severe bleed in the brain due to head injury baby may require a surgery.
Complications of Shaken Baby Syndrome
Shaken Baby syndrome may lead to brain damage in the child and other serious problems such as-
- Blindness or restricted sight
- Hearing difficulties
- Seizures which may be generalized or restricted to a single part of the body due to which the child may have random uncontrolled movements and difficulty in coordination.
- Learning disabilities
- Emotional problems
- Behavioral problems
- Paralysis of one or more limbs of the body.
- Fractures resulting from the injury may lead to permanent disability.
If you ever come across a child who may be subjected to physical abuse or shows signs of shaken baby syndrome, make sure you never confront the parent or caregiver directly. Instead report the matter to the local police authority and also child welfare associations. They will take up the matter and ensure that the child is safe.