Child Abuse Injuries: Shaken Baby Syndrome 2/3

April is Child Abuse Prevention month and this week I’m posting about the most devastating child abuse injury—Shaken Baby Syndrome or SBS.
Last post I discussed the leading cause of death is a brain injury called Diffuse Axonal Injury (DAI) which leads to massive swelling in the brain, which if not controlled will push the brainstem into the spinal cord, and this leads to brain death.
There are other classic injuries associated with SBS. In Part I I described how DAI occurs—by the violent shaking and the brain hitting the inner surface of the skull repeatedly.
What also occurs is the small bridging veins that cover the brain and are attached to the underside of the skull are torn as well. This leads to bleeding on the brain and is referred to as a Subdural Hematoma (SH) or subdural bleed. This can be picked up radiologically and although forensically a specific time and date cannot be given as to when the bleeding occurred—a radiologist can tell if there are old and new bleeds which correlates to different episodes of shaking.
People who have committed this type of child abuse injury have confessed to shaking multiple times. It’s as if they see shaking work one time to quiet an infant’s crying—it’s an easy solution the next time.
As stated in the earlier post—the bleeding is generally not what kills the child—it is the insidious brain swelling and subsequent herniation.
How do these children present to medical personnel?
Mild Presentation:

Large head.
Can’t lift their head.
Eyes can’t focus or track.
Decreased Responsiveness.
Decreased muscle tone.
Poor appetite.
Not smiling.
Not vocalizing.

Severe Presentation:
Decreased respiratory rate.
Not breathing.
Rigid posture.
Bulging soft spot.
The medical team is generally clued in to the possibility of child abuse when a caregiver gives an implausible account of why the child is so sick. Typical responses are—“Well, my one-month-old baby just rolled off the couch.”
Hmmm… if only he could roll.
Next post we’ll talk about another classic injury associated with SBS.

And please– never, ever shake an infant. 

For help in dealing with a crying baby– click here

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