Shaken Baby Syndrome
Shaken Baby Syndrome (SBS)
Introduction
Shaken Baby Syndrome (SBS), also known as Abusive Head Trauma (AHT), is a severe form of physical child abuse caused by violent shaking of an infant or small child. The shaking may be done in isolation or combined with impact trauma.
Key Points
- Most common in infants younger than 1 year
- Peak incidence: 2-4 months of age
- Male infants are at higher risk
- Mortality rate: 20-25%
- Survivors often have permanent neurological damage
Pathophysiology
The mechanism involves:
- Rotational acceleration-deceleration forces
- Shearing of bridging veins leading to subdural hemorrhage
- Diffuse axonal injury
- Retinal hemorrhages from vitreoretinal traction
- Brain swelling and increased intracranial pressure
Epidemiology
Risk Factors
- Caregiver factors:
- Young or single parents
- Lower socioeconomic status
- History of domestic violence
- Substance abuse
- Mental health issues
- Unrealistic expectations of child behavior
- Child factors:
- Prematurity
- Multiple births
- Developmental delays
- Chronic illness
- Inconsolable crying
Statistics
- Incidence: 14-40 cases per 100,000 children under 1 year
- 25-30% result in fatality
- 80% of survivors have significant permanent brain damage
Clinical Features
Classic Triad
- Subdural hemorrhage
- Retinal hemorrhages
- Encephalopathy
Presenting Symptoms
- Neurological:
- Altered consciousness
- Lethargy or irritability
- Seizures
- Vomiting
- Poor feeding
- Apnea
- Bradycardia
- Physical findings:
- Bulging fontanelle
- Head circumference increase
- Retinal hemorrhages
- Bruising (may be absent)
- Rib or long bone fractures
Diagnosis
Initial Evaluation
- Complete history and physical examination
- Detailed neurological examination
- Ophthalmologic examination
- Documentation of all findings
Imaging Studies
- Head CT (initial emergency imaging):
- Subdural hemorrhages
- Subarachnoid hemorrhages
- Cerebral edema
- Skull fractures
- MRI (follow-up imaging):
- Extent of parenchymal injury
- Timing of injuries
- Diffuse axonal injury
- Skeletal survey:
- Rib fractures
- Metaphyseal lesions
- Long bone fractures
Laboratory Studies
- Complete blood count
- Coagulation profile
- Liver function tests
- Electrolytes
- Blood glucose
- Toxicology screen
Management
Immediate Interventions
- Stabilization:
- Airway management
- Breathing support
- Circulation maintenance
- Seizure control
- ICP management:
- Head elevation
- Osmotic therapy
- Temperature control
- Sedation if needed
Long-term Care
- Rehabilitation services:
- Physical therapy
- Occupational therapy
- Speech therapy
- Cognitive rehabilitation
- Prevention of complications
- Regular developmental assessment
- Family support and counseling
Legal and Social Aspects
- Mandatory reporting to child protective services
- Documentation for legal proceedings
- Social services involvement
- Safety planning for the child
