Shaken Baby Syndrome

by Doug Edwards
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Shaken Baby Syndrome (SBS) is the collection of signs and symptoms resulting from the violent shaking of an infant or small child. It is a form of child abuse. In America every year an estimated 1,200 - 1,400 children are shaken for whom treatment is sought. Of these tiny victims, 25 -30% die as a result of their injuries. The rest will have lifelong complications. It is likely that many more babies suffer from the effects of SBS yet no one knows because SBS victims rarely have any external evidence of trauma.

Shaken Baby Syndrome Fact Sheet

□  What is shaken baby syndrome?


Shaken baby syndrome (SBS) is a term used to describe the constellation of signs and symptoms resulting from violent shaking or shaking and impacting of the head of an infant or small child. The degree of brain damage depends on the amount and duration of the shaking and the forces involved in impact of the head.


□  What are the signs and symptoms of shaken baby syndrome?


The most common symptoms of shaken baby injuries are subdural hematoma (bleeding on the brain), cerebral edema (massive brain swelling) and retinal hemorrhages (bleeding inside the eye). Most shaken baby injuries include one or more of these symptoms.


Subdural hematoma – When a child is violently shaken, the motion causes the blood vessels around the brain to stretch and tear.


Cerebral edema – Violent shaking causes the brain to swell, increasing the pressure inside the victim’s head, which can lead to massive brain damage or death.


Retinal hemorrhages – The same kind of violent motion that happens in the brain during shaking also occurs in the eye. This type of bleeding can only be seen with special medical equipment.


□  What is the outcome or prognosis of victims of shaken baby syndrome?


Approximately 20% of cases are fatal in the first few days after injury and the majority of the survivors are left with handicaps ranging from mild - learning disorders, behavioral changes - to moderate and severe, such as profound mental and developmental retardation, paralysis, blindness, inability to eat or exist in a permanent vegetative state.


□  How many children are injured or die from shaken baby syndrome?


This is a frequently asked question and unfortunately there are not good statistics. Until a method for collecting such statistics is established, the true incidence will not be known. It is recognized, however, that it is the most common cause of mortality and accounts for the most long-term disability in infants and young children due to physical child abuse. Based on a North Carolina research project published in the Journal of the American Medical Association in August of 2003, approximately 1,300 U.S. children experience severe or fatal head trauma from child abuse every year. The same study revealed that approximately 30 per 100,000 children under age 1 suffered inflicted brain injuries.


□  How can shaken baby syndrome be prevented?


It is important to note that SBS is preventable. Shaking occurs frequently when a frustrated caregiver loses control with an inconsolable crying baby. It is important to realize that just saying, "don't shake a baby" is not enough. A plan of action or suggestions to deal with the situation needs to be offered. Parents and other care providers need assurance that allowing a baby to cry is okay if all their needs have been met. The care provider should address their stress level and try stress management. Parents should share the message of the dangers of shaking with all who care for their infant or child, including spouses, their own parents, siblings, day care providers and others. Parents need to let those caring for the infant know it is okay to call for help when needed.


□  Can tossing or rough play cause shaken baby syndrome?

Shaken baby syndrome, which may result in severe brain trauma, is caused when a child is violently shaken such that the head is subjected to back and forth motion in one or more directions resulting in rapid repeated severe acceleration and deceleration of the head. Activities involving an infant or a child such as tossing in the air, bouncing on the knee, placing a child in an infant swing or jogging with them in a backpack, do not cause the brain and eye injuries characteristic of shaken baby syndrome.

Pittsburgh Researchers Discover That Certain Chemicals in the Blood May Indicate Brain Injury

New Test Could Assist Doctors in Diagnosing Shaken Baby Syndrome

PITTSBURGH - Feb. 15, 2006 - Researchers at Children's Hospital of Pittsburgh have found that increased levels of certain proteins in the blood or spinal fluid may signal brain injury in infants with vomiting, fussiness and several other common symptoms.

Every year, physicians diagnose an estimated 1,200 - 1,400 infants with shaken baby syndrome (SBS). Experts believe that many more cases go unreported or are misdiagnosed. Twenty-five percent of these babies who are shaken will die as a result of their injuries, and of those who survive, 80 percent have permanent brain damage.

Recently, researchers and physicians at the University of Pittsburgh have been working on an advanced protein matrix technology to diagnose brain injury (including SBS) in infants and young children. Researchers have discovered that brain injury causes the release of small quantities of unique protein biomarkers into the patient’s blood. They have already successfully developed a protein detection matrix able to identify small quantities of these protein biomarkers in the blood.

The next step in this research project is to finalize the development of a practical, low-cost and quick diagnostic tool that can be used across the spectrum of clinical settings – the physician’s private office, and the emergency room. The National Center on Shaken Baby Syndrome recognizes the impact of this research as a key step in helping physicians diagnose SBS.

Some Facts About SBS



  • Often, perpetrators shake an infant or child out of frustration or anger. This most often occurs when the baby won't stop crying. Other triggering events include toilet training difficulties and feeding problems.

What Happens:

  • The brain rotates within the skull cavity, injuring or destroying brain tissue.
  • When shaking occurs, blood vessels feeding the brain can be torn, leading to bleeding around the brain.
  • Blood pools within the skull, sometimes creating more pressure within the skull and possibly causing additional brain damage.
  • Retinal (back of the eye) bleeding is very common


  • Babies' heads are relatively large and heavy, making up about 25% of their total body weight. Their neck muscles are too weak to support such a disproportionately large head.
  • Babies' brains are immature and more easily injured by shaking.
  • Babies' blood vessels around the brain are more susceptible to tearing than older children or adults.

Common Symptoms of Shaken Baby Syndrome:

  • Lethargy / decreased muscle tone
  • Extreme irritability
  • Decreased appetite, poor feeding or vomiting for no apparent reason
  • Grab-type bruises on arms or chest are rare
  • No smiling or vocalization
  • Poor sucking or swallowing
  • Rigidity or posturing
  • Difficulty breathing
  • Seizures
  • Head or forehead appears larger than usual or soft-spot on head appears to be bulging
  • Inability to lift head
  • Inability of eyes to focus or track movement or unequal size of pupils