Family Advocacy ProgramArmy Community Service

PORTRAIT OF PROMISE Preventing Shaken Baby Syndrome

SBS

What is Shaken Baby Syndrome? Violent Whiplash Injury

• Intercranial Bleeding• Unconsciousness

Inflicted, not accidental Result of violently shaking a baby or child Causes severe disabilities or death due to

brain injury

Ages of SBS Victims Few days old --------five years Average age of six to eight months

Inflicted, Not Accidental Child is violently shaken by caretaker

• not “jiggling” or gently playing• any objective observer would say that the child

will definitely be injured• child shaken in rage, anger, and frustration

Clinical Findings Associated with SBS

Subdural hematoma Retinal hemorrhages Cerebral edema Diffuse axonal injury Skull fracture Subarachnoid hemorrhages “Black brain” on CT or MRI - indicating severe

ischemia, characteristic of a severe shake

Clinical Signs of SBS* Subdural Hematoma. Accumulation of blood or

blood clot beneath the dura. The dura is a fibrous membrane that surrounds the brain and attaches to the skull.

Retinal Hemorrhages. Bleeding in the back of the eyeball.

Cerebral Edema. Swelling of the brain. This causes pressure on various areas of the brain, some of which control breathing, heartbeat, etc.

More Clinical Signs of SBS Diffuse Axonal Injury. Shearing of nerve fibers

in white matter of the brain that destroys brain tissue.

Skull Fracture. Subarachnoid Hemorrhage. Bleeding under

the arachnoid membrane, a membrane attached to the innermost layer of the tissues surrounding the brain. This

causes pressure on and injury to the brain.

More Clinical Signs of SBS “Black Brain”. Wasting away of the brain due

to lack of blood supply, seen on CT scan or MRI

SBS Triad of Injuries Retinal Hemorrhage Subdural Hematoma Cerebral Edema

The presence of this combination is characteristic of SBS. Other causes for this particular combination are remote.

Who Are The Perpetrators of SBS

Male caretakers Babysitters Parents under severe stress Parents who have psychiatric problems

How Would You KnowIf Your Child

Has BeenShaken?

Warning Signs Unable to turn head Body pulls to one side Difficulty in breathing Seizures Lethargic, hard to rouse Dilated or pin-point pupils Eyes don’t respond to light Blood pooling in eyes

Critical AdviceIf your child has any of these symptoms:

Get medical attention immediately Be prepared to provide any helpful

information to medical staff

What Are the Effects of Shaking? Irreversible brain damage Blindness Learning disabilities Mental retardation Seizures Death

How Does SBS Occur? Caretaker:

• Is alone with child

• Frustrated by child’s crying

• Sees child’s crying as deliberate

• Sees child’s crying as defiance

Child:• Crying is the only way the baby can communicate

• Cannot protect self against violent assault

Use Common Sense Don’t let anyone take care of a fussy baby by

themselves, if:• they have a hot temper

• they are afraid of losing self-control

• they can’t pay full attention to the baby

• they don’t know how to handle a baby who is difficult to comfort

• they don’t know how to handle a child who is demanding, crabby or annoying

• they think that babies 0-18 months “do things on purpose to make you angry”

Caretakers Need to Stay In Top Condition

Get Enough Sleep Stay Sober Stay Healthy

What Can You Do When Babies Cry?

What To Check Is the baby sick? Is the baby hungry? Does the baby need to be burped? Does the baby need to be changed?

How To Soothe A Crying Baby Rock the baby Walk with the baby Swaddle the baby Play some music Rub the baby’s back Give the baby a pacifier Read to the baby Leave a soft light on in the baby’s room Take the baby for a ride in the car

If That Doesn’t Work…Don’t Go It Alone!

Get Some Help!

How to Get Help Get someone to keep you company. Telephone a friend, ask for tips on how to

handle the situation. Keep the number of a hot-line handy for

support and guidance.

Regarding Baby Sitters…It is the Parent’s Responsibility to:

Instruct the babysitter every time that they are not to shake the baby, no matter what happens.

Be sure your babysitters know how to reach you.

Be prepared to come home immediately if your sitter can’t handle the job.

When All Else Fails Let the baby cry. Put the baby down in a safe place. Check

on the baby at intervals. Give yourself a break--find a quiet place for

yourself.

Better that the Baby Crythan the Baby Die.

Video: Portrait of Promise

Question & Answer Period

For Additional Information

Family Advocacy Program Pediatric Clinic Social Work Service