Independent Nursing Studies NURS 420 Student Presentation College of Nursing King Saud University Riyadh, Saudi Arabia Shaken Baby Syndrome   Independent Nursing Studies NURS 420 Student Presentation

Introduction Shaken Baby Syndrome is a form of child abuse. SBS is not just a crime—it is a public health issue. SBS resulting in head injury is a foremost cause of child abuse death in the United States. SBS is preventable. A British neurosurgeon, Guthkelch first described shaking as the cause of subdural hemorrhage in infants. Nearly all victims of SBS suffer serious health consequences and at least one of every four babies who are violently shaken dies from this form of child ill-management.1

Prevalence and Incidence: The National Center on Shaken Baby Syndrome estimates that there are between 600 and 1400 cases in the United States a year. Because there is currently no reliable method of collecting these statistics, the true incidence is unknown. This syndrome is the most common cause of death and long-term disability in infants and young children who are victims of child abuse. Most victims of SBS are less than 1 year old Majority being under 6 months of age

Definition Shaken baby syndrome — also known as abusive head trauma Is a serious brain injury resulting from forcefully shaking an infant or toddler. Shaken baby syndrome destroys a child's brain cells and prevents his or her brain from getting enough oxygen.

Causes Shaking or throwing a child Slamming a child against an object. Causes uncomfortable forward, backward and twisting head movement Brain tissue, blood vessels & nerves tear.

Con… Reason for getting injured Heavy large heads Weak neck muscles that do not hold up the head well Delicate blood vessels in their brain.

Mechanism of Injury The precise mechanism of neurological injury remains unclear. Injuries occur from the rapid and repetitive flexion, extension, and rotation of the head and neck around a relatively stable torso with or without impact injury Shaken baby syndrome involves three main medical symptoms: cerebral edema, retinal hemorrhage, and subdural hematoma

Symptoms Babies suffering lesser damage from SBS may exhibit some of the following: 4, 5 Change in sleeping pattern or inability to be awakened Vomiting Convulsions or seizures Irritability Uncontrollable crying

Con… In more severe cases of SBS, babies may exhibit the following: 6, 7  Unresponsiveness. Loss of consciousness. Breathing problems (irregular breathing or not breathing). No pulse.

Potential consequence of Shaken Baby Syndrome: SBS often causes irreversible damage. In the worst cases, children die due to their injuries. Children who survive may have: partial or total blindness hearing loss seizures developmental delays impaired intellect Severe motor dysfunction (muscle weakness or paralysis) speech and learning difficulties problems with memory and attention severe mental retardation

Diagnosis If shaken baby syndrome is suspected: Bruises around the head, neck, or chest. Review child’s previous history. Physical examination and blood tests. X-ray , CT-scan, MRI. Lumbar puncture to check the spinal fluid for signs of meningitis.

Babies cry because it’s their way of communicating! As nurses we play a major role in educating parents about Shaken Baby Syndrome and how to prevent it.

Interventions Hold the baby Feed burp the baby Change the diaper Go for a car or stroller ride Try a baby swing **Sometimes a baby is trying to communicate that they are sick

Management Hospitalization Admitted in ICU for close monitoring Oxygen therapy may be given to help the child breath Medications are given to help ease brain swelling Cooling mattress to help reduce body temperature &reduce temperature Depending on the severity of injury and bleeding child may require a surgery. Symptomatic management like seizure medicine. Physical therapy can be given Counseling for both parents and children. Long term problems of Shaken Baby syndrome.

Prevention Never shake a baby. Never slap or hit a baby of any age on the face or head. Learn about normal child development and behaviors so that expectations are realistic.

Conclusion Abusive head trauma is 100% preventable. A key aspect of prevention is increasing awareness of the potential dangers of shaking. 13 To prevent potential SBS, parents and caregivers of infants need to learn how to respond to their own stress. It's important to talk to anyone caring for baby about the dangers of shaking and how it can be prevented. 16

References [1] CarbaughSF.Understandingshakenbabysyndrome.AdvNeonatalCare2004;4(2):105–16. [2] WyszynskiME1.Shakenbabysyndrome:identification,intervention,andprevention.ClinExcellNursePract.1999Sep;3(5):262-7. [3] http://floridatraumaticbraininjury.org/abusive-head-trauma-causes-statistics/ [4] CarbaughSF.Understandingshakenbabysyndrome.AdvNeonatalCare2004;4(2):105–16.5Ibid.[5] MiehlNJ.Shakenbabysyndrome.JForensicNurs2005;1(3):111–7.7Encyclopedia [6] Miehl NJ. Shaken baby syndrome. J Forensic Nurs 2005;1(3):111–7. [7] CarbaughSF.Understandingshakenbabysyndrome.AdvNeonatalCare2004;4(2):105–16.5Ibid [8] National Institutes of Health, National Institute of Neurological Disorders and Stroke. NINDS spasticity informationpage[online].2007.[cited2008Oct16.]AvailablefromURL:http://www.ninds.nih.gov/disorders/spasticity/spasticity.htm. [9] MiehlnJ. Shaken baby syndrome. J forensic nurs 2005;1(3):111–7. [10] http://familydoctor.org/familydoctor/en/diseases-conditions/abusive-head-trauma.html. [11] NINDSshakenbabysyndromeinformationpage.NationalInstituteofNeurologicalDisordersandStroke.http://www.ninds.nih.gov/disorders/shakenbaby/shakenbaby.htm.AccessedAug.5,2011. [12] Nevershakeyourbaby!MarchofDimes.http://www.marchofdimes.com/prematurity/28127.asp.AccessedAug.5,2011.[13] BrawermanRs(2011).Abusiveheadtraumaandnonaccidentaltrauma.InwwHayJretal.,eds.,currentdiagnosisand management pediatrics, 20thed., pp 412 .New York: McGraw –Hill. [14] http://www.Thearc.org/document [15] wedMDMedical References from Healthwise [16] Abusiveheadtrauma:Shakenbabysyndrome.AmericanAcademyofPediatrics.http://www.healthychildren.org/English/safety-prevention/at-home/Pages/Abusive-Head-Trauma-Shaken-Baby-Syndrome.aspx.AccessedAug.5,2011. http://www.mayoclinic.org National Center on shaken baby syndrome -American Association of Neurological surgeons