A Guide for Case Workers

Recognizing the Warning Signs of Shaken Baby Syndrome

Recognizing warning signs is crucial when a case worker is investigating whether a child might be a victim of Shaken Baby Syndrome (SBS). According to the Cleveland Clinic (2022) article, SBS is typically caused by violent shaking, which leads to severe injuries such as brain swelling, bruising, and bleeding. A case worker should be attentive to physical and behavioral symptoms that suggest SBS.

First, case workers should observe physical signs such as unusual bruising, especially on the child’s arms or chest, and head swelling. A large forehead or bulging soft spots (fontanelles) on the top of the infant’s head may indicate brain swelling. Other physical signs include bruises around the neck and chest and fractures, especially in the ribs, collarbone, or arms, which could signal past incidents of abuse or improper handling.

Retinal hemorrhages, or bleeding in the back of the eyes, are another critical indicator of SBS. A case worker should ensure the child has undergone an eye examination to check for this. Fractures and subdural hematomas (blood clots on the brain) are also red flags that suggest SBS and should be confirmed with medical imaging such as X-rays or MRI scans (Cleveland Clinic, 2022).

On the behavioral side, a case worker should note if the child displays extreme irritability, difficulty staying awake (lethargy), or cannot lift their head. Additionally, vomiting, seizures, poor appetite, and difficulty breathing are symptoms that may arise immediately after the child has been shaken.

Lastly, a case worker should be aware that the perpetrator of SBS is often an overwhelmed caregiver. It’s common for SBS to occur when the caregiver becomes frustrated with a baby’s persistent crying. Understanding the family dynamics, stressors, and caregiver behavior is vital in identifying the risk factors for SBS.