Shaken Infant Syndrome

1. What is Shaken Infant Syndrome?

Answer: Shaken Infant Syndrome, also known as "Shaken-Impact Syndrome," or "Whiplash-Shaken Infant Syndrome," is non-accidental trauma; it is trauma inflicted upon a child. The injuries to the brain are the result of rotational forces acting on the brain. These forces are most commonly produced by severe shaking which flops the infant's head forward and backward. These forces are exacerbated when the shaking motion is interrupted by the head impacting a surface. Even hitting a soft surface can increase the forces on the brain by 50 times. The injuries that result include retinal hemorrhages, intracranial vessel tears with hematoma formation, and diffuse axonal disruption.

2. Who are the victims of this abuse?

Answer: This is a disease seen in children less than three years old, with the majority of cases in the first year of life.

3. Who are the most common perpetrators?

Answer: The perpetrator of the abuse is most often (in descending order) the father, boyfriend of the mother, female babysitter, or the mother.

4. What is the scope of this abuse?

Answer: Each year, an estimated 50,000 infants become victims of this abuse. In the United States, approximately 10 to 12 percent of all the infant deaths that result from abuse or neglect are the result of rigorous shaking.

5. What is the prognosis for the victims?

Answer: Generally, the prognosis for infants victimized by this abuse is poor. Most will be left with considerable disability - affecting their cognitive abilities, and with severe retinal hemorrhages affecting their vision.

As many as 50 percent of severely injured patients will die, usually due to uncontrollable increased intracranial pressure from cerebral edema -- bleeding within the brain or tears in the brain tissue. For those patients who survive, they might have diffuse neuronal and white matter injury and severe cognitive deficits, or cerebral atrophy with compensatory subdural fluid collections and a small non-growing head.

However, even the patients with injuries that appear to be mild may show developmental difficulties, as a result of the diffuse and deep white matter injury. It is likely that in some of these patients, secondary injury results from their decreased level of unconsciousness or induced seizures causing hypoventilation and hypoxia. The abused child may be relatively less injured from the actual abuse, but when subsequently neglected by the attacker, suffers from the more devastating global insult.

6. What diagnostic tests are used to detect such injuries?

Answer: Radiographs are an essential part of the patient evaluation. Typical extracranial findings include lateral or posterior rib injuries, metaphyseal or "bucket handle" fractures. These are subtle findings that must be searched for and, if found, require additional investigation. On occasion, the plain radiographs raise a question of an injury and subsequent nuclear bone scanning or delayed repeat radiographs are necessary.

Computed Tomography (CT) scans are the primary test for evaluating intracranial injury. This includes subdural hematomas and subarachnoid hemorrhage.

Magnetic Resonance Imaging (MRI) is very sensitive in detecting the deep white matter and diffuse brain injuries. It also has a role in detecting small hemorrhage, but is limited in its ability to detect acute hemorrhage.

7. What is the role of the neurosurgeon?

Answer: In those children who have suffered a significant cerebral injury, there is usually a need for neurosurgical care with intubation and ventilator management as necessary, appropriate fluid management, anticonvulsants, and treatment of increased intracranial pressure.

Reference List: Shaken Baby Syndrome/Non-accidental Trauma

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Shaken Infant Syndrome

Reference List: Shaken Baby Syndrome/Non-accidental Trauma

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