Shaken Baby Syndrome What is it? “Shaken Baby Syndrome is a form of Abusive Head Trauma that occurs when a frustrated caregiver “shakes” or “slams” a child, usually to stop him/her from crying.” --The Shaken Baby Alliance

Forever Shaken https://www.youtube.com/watch?v=_t9vH6tqwxg

Trigger Head Size Developmental State Crying Frustrated Caregiver Head Size Larger in proportion to body size Developmental State Less muscle control Communication ability

1995 study Starling SP, Holden JR, Jenny C. Abusive head trauma: the relationship of perpetrators to their victims. Pediatrics. 1995;95(2):259-262

2011 Study Esernio-Jenssen, D., Tai, J., & Kodsi, S. (2011). Abusive Head Trauma in Children: A comparison of Male and Female Perpetrators. Pediatrics, 127(4), 649-657. doi:10.1542/peds.2010-1770

Who are the Victims? Usually younger than 2 but can be up to 5 years old 2-4 months olds are at the highest risk http://www.cdc.gov/Concussion/pdf/Preventing_SBS_508-a.pdf

Child’s brain has a higher water content than adults making their brains softer and easier to injure.

What Happens When a Baby is Shaken? Body bruises Cerebral edema (brain swelling) Cerebral contusions (brain bruises) Skull fractures Rib fractures Neck and spinal cord damage Tearing of small blood vessels to the brain Damage to the retina of the eyes What is the retina of the eye? In the simplest terms, the retina is the lining of the inside of the eyes The force that causes the brain to move back and forth in a child’s skull also causes a child’s eyeball to move in the eye socket. This movement stretches the lining of the eyes—the retina– to the point of breaking, resulting in hemorrhaging. This type of injury is not often found in other types of head injury. National Center on Shaken Baby Syndrome https://www.dontshake.org/learn-more#what-is-shaken-baby-syndrome-abusive-head-trauma-sbs-aht

Symptoms Less Talking, Smiling Seizures Unequal Pupils Lethargic Rigid Bleeding or blood spots in the eyes Difficulty Breathing Poor Feeding Irritability Unable to wake Unable to focus eyes

When are people most likely to shake a baby?

Practical and Sometimes Funny Ideas for Crying National Center on Shaken Baby Syndrome "I put my baby in the back seat of the car in her car seat and drive around with the radio on. She is crying most the time but once in awhile she actually does stop.” "I bought a calendar with big squares to write on each day. I put smiley faces on the good days and sad faces on the hard days. Then I realized my baby wasn’t good all day or hard all day, so I started putting three faces in each square to represent my day. When I counted up the faces at the end of the week I was surprised to realize that I actually had many more smiley faces than sad faces. Maybe, my baby really doesn’t cry all the time even if it seems like it some days.” “Sometimes at night when my baby would cry for hours at a time I would turn on the PURPLE Crying DVD and watch it…again. I had seen it several times, but it really helped to remind me that what I was going through was normal and would come to an end.” “When my baby began going through the Period of PURPLE Crying at about two weeks, I drew a picture of a crying baby on a calendar. Each day that passed I put an X on the calendar to remind me how much longer until this crying period was over. Just like the program said, my baby’s crying did eventually come to end around his four month birthday. It is so much easier to get through something if there is an end in sight.” “One night when my wife had been up with the baby for hours she brought her into me and announced, Here, she yours! I am going for a walk. I was glad that she did that because she really looked frazzled.” Please Remember The most important part about all these stories is that all people, of all backgrounds, educational levels, financial status, race and culture go through these things with their baby. Even pediatricians have shared that they got frustrated with their own baby’s crying. The most important thing to remember when you get angry is take a deep breath, put your baby in a safe place and walk away. But never have a baby in your arms when you feel angry or resentful. It is OK. It will get better.

What is the outcome? permanent damage from mild learning disabilities to life long coma including seizures, blindness, severe learning disability

Why is this important for you? You can help provide education and prevention for other parents You may be the first person to become aware of symptoms of shaken baby syndrome It can save a child’s life

Early Treatment can make a difference! Where do you come in? Plan for crying periods in children under your care…don’t assume it will never happen. Be alert for signs a family is struggling with crying. Offer support and ideas. Watch for sign of shaken baby syndrome: Early Treatment can make a difference!

Where do we come in? Take 5 minutes to discuss one of the following questions at your table: What strategies have you used effectively with babies/children that cry a lot? Who do you think is most important to educate on this topic? What strategies in our community would be effective in preventing shaken baby?

Becca Wachter, RN BSN Fairbanks Regional Public Health Center 451-1632 Becca.wachter@alaska.gov