Child Abuse Injuries: Shaken Baby Syndrome 3/3


April is Child Abuse Prevention month and as a pediatric ER nurse, I thought I’d spend some time talking about the most devastating child abuse injury, in my opinion, and that is Shaken Baby Syndrome or SBS.
In Part I and Part II I talked about the brain injuries associated with SBS: Diffuse Axonal Injury and Subdural Hematomas.
Now—we’ll discuss another classic injury associated with this abusive injury—retinal hemorrhages.
Just what is this bird? Anyone know? Well, it is a woodpecker. Now you may be wondering exactly what do woodpeckers have to do with shaken baby injuries.
Interestingly, Alex Levin, an ophthalmologist from Canada, wondered why woodpeckers did not suffer retinal hemorrhages when they were pounding their beaks against trees. After all, the whiplash type movement is similar to the injury infants suffer when shaken.
So he got a grant and if you found a deceased woodpecker, you could send it in for money and he sent these birds through the CT scanner.
What he found was that anatomically, woodpeckers had certain mechanisms built in that protected their eyes from sustaining injury.
We know that when an infant is shaken—the brain is tossed around within the skull causing injury. Essentially, the same thing happens to the eyes—they are tossed around as well and hit their bony protective area—the orbits. Imagine a tethered ball hit and tossed around. This mimics the eye anchored by the optic nerve and how it is injured during shaking.
The retina has several layers and bleeding happens in between these layers. Retinal hemorrhages associated with SBS are extensive, in both eyes, and cannot be mimicked by any other type of injury—including a violent car accident. 
What people who perpetrate child abuse don’t understand is that the injuries associated with SBS are VERY distinctive. Multiple studies (particularly of falls) have been done and we know that no other injury pattern (major car accident, falls less than four feet and CPR) gives us this cascade of injures.
What’s distressing is getting the public to believe that parents perpetrate these crimes. Surely, no loving parent could cause this type of injury that led to their child’s death.
Sadly, yes they do. Every day.
Please—if you think a child is being injured. It may be you—and only you—who ever stands in the gap to save their life. Please notify someone if you think a child is being abused. 

And please– never, ever shake an infant. 

For help in dealing with a crying baby– click here

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