Delaware County, Indiana

Shaken Baby Syndrome / Abusive Head Trauma

Shaken Baby Syndrome (SBS) refers to a complex medical diagnosis for the unique constellation of injuries that are caused by violently shaking a child that results in rapid head movements with acceleration, deceleration and rotational forces.  The repetitive acceleration-deceleration forces without blunt impact to the head, referred to as SBS results in a unique constellation of ocular, intracranial, and sometimes other injuries to the child.  SBS is a subset of the broader medical diagnoses of Abusive Head Trauma (AHT).  AHT is a well-recognized constellation of brain injuries caused by the direct application of force to an infant or young child, resulting in physical injury to the head and/or its contents.  Abusive Head Trauma is a broad medical diagnoses that includes shaking without impact, as well as blunt impact forces to the head.  However, the term “SBS” has become synonymous in public discourse with AHT in all its forms.  SBS is sometimes used inaccurately to describe infants with impact injury alone or with multiple mechanisms of head and brain injury, and focuses on a specific mechanism of injury rather than the abusive event that was perpetrated against a helpless victim.  As a result, in 2009, the Committee on Child Abuse and Neglect of the American Academy of Pediatrics issued a statement regarding the use of the term SBS.  The goal of the statement “is not to detract from shaking as a mechanism of AHT but to broaden the terminology to account or the multitude of primary and secondary injuries that result from AHT, some of which contribute to the often-permanent and significant brain damage sustained by infants and children.”  “This policy statement did not negate the mechanism of shaking as a significant mechanism of injury, but instead merely clarified that the term ‘shaking’ alone was not inclusive of the full range of injury mechanisms.”  The Academy “recognize[d] the utility of maintaining the use of the term ‘shaken baby syndrome’ for prevention efforts.  Just as the public commonly uses the term ‘heart attack’ and not ‘myocardial infarction,’ the term ‘shaken baby syndrome’ has its place in the popular vernacular.”  In 2015, the American Academy of Pediatrics issued a fourth position paper wherein the Academy stated “there is no legitimate medical debate among the majority of practicing physicians as to the existence or validity of AHT/SBS.”  The 2015 statement noted that the 2009 policy statement

has been mischaracterized…to suggest that the [Academy] no longer recognizes SBS as a legitimate diagnoses.  On the contrary, the  [Academy] reinforces the fact that shaking is an important contributor to abusive head injuries and SBS is a subset of AHT.  Additionally, since the release of this statement, peer-reviewed medical literature – including case reports in which adults have admitted shaking an infant or a child–has been published and further underscores the significance of shaking as an important contributing mechanism of injury. 

 It is important to recognize the significant morbidity and mortality that accompany AHT.  AHT is the leading cause of child abuse deaths in the United States.  Approximately 25% of victims die.  Almost 70% of survivors of AHT have some degree of lasting neurologic impairment, learning disabilities, physical disabilities, visual disabilities or blindness, hearing impairment, speech disabilities, cerebral palsy, seizures, behavior disorders, cognitive impairment. Survivors of AHT should be referred at hospital discharge to medical homes where pediatrician scan provide ongoing follow-up and prompt referral to pediatric medical subspecialists when indicated.

Prevention is key.  The PURPLE Crying program is an evidence-based Shaken Baby Syndrome prevention program available since 2007.  The program approaches Shaken Baby Syndrome prevention by helping parents and caregivers understand the frustrating features of crying in normal, healthy infants that can lead to shaking or abuse. The program provides the opportunity for parents to learn about the crying characteristics from over 50 years of research on normal infant crying conducted by scientists worldwide.   Please click here for more information on the The Purple Crying Program 

For more information on SBS and prevention please click on the following links:

The National Center on Shaken Baby Syndrome

The American Academy of Pediatrics

American Academy of Pediatrics Policy Statement on SBS

Shaken Baby Syndrome Fact Sheet

Prevent Shaken Baby Syndrome Booklet

CDC's Guide to Shaken Baby Syndrome: A preventable tragedy