Shaken baby syndrome: statistics, symptoms, and prevention

Shaken baby syndrome, a type of child abuse, is investigated by law enforcement officials as a criminal assault in the United States and in many countries around the world

("Shaken Baby…," ¶ 3).

Shaken Baby Syndrome Statistics/Symptoms

Each year, approximately 1,000 to 3,000 cases of SBS occur in the United States (U.S.), according to Centers for Disease Control and Prevention (The Face of…). Ann Blake, Contributing Editor, and Jennifer Michael, Managing Editor of Children's Voice report that every day in the U.S., eight children suffer serve injuries or die from Shaken Baby Syndrome (SBS). In the article, "Saving Babies from Shaking," Blake and Michael report that SBS, constitutes a 100% preventable "severe head injury caused by violently shaking an infant or child for as little as five seconds" (¶ 1). Reports during 2006 noted SBS as the leading cause of child abuse deaths in the U.S.; stressing that this contemporary malady afflicts up to 1,400 children yearly. Later reports, however, as the start of this study examining SBS notes, indicate the number of children experiencing SBS may more than double that number and that in the U.S., more than 300 babies die each year die from SBS.

During 2009, Childfind, a leading U.S. non-profit organization for victims of child abuse and neglect, reports the following statistics regarding SBS:

One out of every 3-4 shaken babies (25-33%) dies from injuries, usually within hours or days. Of survivors, only 15% escape permanent damage.

Young males: fathers and mom's boyfriends account for 67% of SBS. Paid caregivers account for 14%, mothers 9%.

The problem occurs in families of all races, incomes and educational levels.

SBS most often occurs prior to age one and seldom occurs after 2, though may occur to age 6 if extreme violence is used. Infants 2-4 months are most at risk.

Twins are at higher risk than singletons to receive a shaking assault.

Guilty caregivers may weave a trivial story of a fall or minor mishap into their story to try to cover their tracks. (Childfind)

Natalie K. Isser, Ph.D., and Lita Linzer Schwartz, Ph.D., both Professor Emeritas of Pennsylvania State University, assert in the article, "Shaken baby syndrome," that experts do not always agree on symptoms of SBS. The following symptoms, however, according to Childfind are commonly noted in victims of SBS.

Lethargy/decreased muscle tone

Extreme irritability

Decreased appetite, poor feeding or vomiting for no apparent reason

Grab-type bruises on arms or chest

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 (Childfind)

Figure 1 portrays two noted symptoms of SBS.

Figure 1: Two Noted SBS Symptoms (A.D.A.M.)

When a perpetrator shakes an infant or toddler, the victim's brain bounces back and forth against his/her skull. In turn, due to the resulting pressure and bleeding in the victim's brain, this may cause his/her brain (cerebral contusion) to bruise and swell. Isser and Linzer explain that:

The large veins along the outside of the brain may tear, leading to further bleeding, swelling, and increased pressure. This can easily cause permanent brain damage or death. Shaking an infant or small child may cause other injuries, such as damage to the neck, spine, and eyes. Eye damage is very common and may result in loss of vision (retinal hemorrhage). Shaken baby injuries usually occur in children younger than 2 years old but may be seen in children up to the age of 5. (Isser and Linzer, What are the…section, ¶ 2).

SBS Perpetrators

The perpetrators of SBS often have been abused as children, and/or they may experience depression, anxiety or other psychiatric disorders. Other factors reportedly contributing to SBS include low self-esteem, which may make the perpetrator unable to endure the stress relating to the care for an infant, particularly when the child experiences colic or a chronic illness. The individual who practices SBS may not be educated in child rearing, parental expectations and/or responsibilities. Alcohol and drugs, forms of substance abuse, may also contribute to SBS. In addition: "Some researchers have cited social isolation and the absence of support for the new family. Domestic abuse may also be a factor in some of the mistreatment of small children" (Isser and Linzer, What are the…section, ¶ 2). Other risk factors include, but may not be limited to, the perpetrator possessing poor impulse control, being illiterate or mentally challenged, or having a low educational level, less than 12 years of formal education. he/she may also possess a noted dependency on others or extraordinary need to be nurtured (Isser and Linzer, What are the…section, ¶ 2).

Isser and Linzer explain that some experts have suggested a number of psychological characteristics appear common to the perpetrators of SBS. "Court records seem to show that family income levels are lower; there were more single parent households, and many more single mothers who have sleep-in boyfriends" (Isser and Linzer, What are the…section, ¶ 2). Even though not conclusive, the evidence indicates that approximately 75% of the time in SBS incidents, the "shaker" is male, with the biological father, mother's boyfriend, and stepfather being the most common perpetrator. The babysitter, the biological mother, the live-in boyfriend and sometimes even the grandparent, nevertheless may also abuse the child by shaking him/her. SBS Prevention

Isser and Linzer purport that a number of entities currently implementing preventive programs in various parts of the U.S. typically experience strong positive outcomes, reflecting a noted reduction in the number of shaken babies. The programs are likely to prove to be "most helpful when they include information about infant development and the nature of caretaking responsibilities, and are offered to new parents at the time of the child's birth, with reminders when the infant is taken for the first post-natal visit" (Isser and Linzer Legal ramifications section ¶17). These educational efforts, however, generally only reach the mothers, not the father or other male more likely to be the future abuse. More programs, however, have begun include the male involved with the mother. Helping parents understanding the infant's needs, development, and behavior, along with educating the parents in the area of proper parenting constitutes vital components for the prevention of SBS.

In the article, "New programs target shaken-baby syndrome," Alex Newman (2008) relates the following prevention tactics:

Check if baby needs to be changed/fed/burped.

Check if baby is too hot/too cold.

Make sure baby's clothes fit comfortably.

Play white noise (radio, TV static, fan, vacuum).

Rock gently or use a baby swing.

Pick up baby and cuddle, hum, sing or talk in a soothing voice.

Take baby for a ride in car or stroller. (Newman)

To help the potential shaker calm a crying child under 2-years-old, he/she could consider these steps:

Put the child in a safe place. Walk away.

Listen to music, read, call a friend to talk.

Check on your baby every 5 to 10 minutes. (Newman)

In "Project baby care: A parental training program for students with Emotional and Behavioral Disorders," Catherine Roberts, Clara Wolman, and Judy Harris-Looby, full-time faculty in the Graduate Exceptional Education Program, Barry University, Miami Shores, Florida, relate concerns regard the annually increase in the rate of reported child abuse fatalities. "Whiplash and other symptoms of shaken baby syndrome (SBS) were reported [in 2004] as the cause of death in 17% of fatal child abuse cases" (Roberts, Wolman and Harris-Looby, ¶ 1). Statistics suggest that those teenage parents with emotional and behavioral disorders (EBD) may be at higher risk of impulsive behavior and use violent and abusive behaviors with their children. Young aggressive, at-risk men are also reportedly more likely than other men to implement injurious parenting strategies with their children.

To counter and prevent SBS, Roberts, Wolman and Harris-Looby stress that students need to be taught parenting skills. This may proffer one of the most "cost-effective ways to reduce violent and abusive behaviors and prevent the transfer of violent behaviors from generation to generation" Roberts, Wolman and Harris-Looby, ¶ 3). Project Baby Care, a contemporary parental training program developed and adapted for adolescents with Emotional and Behavioral Disorders (EBD) costs less than $1,000. This program has proved to successfully increase the student's parental knowledge and skills, as well as improve his/her regarding the care of an infant. The curriculum for Project Baby Care includes two primary components:

1. A practical component of hand s-on experiences involving the interaction of students with computerized doll-babies, and

2. A traditional component of reading, writing, and watching films. (Roberts, Wolman and Harris-Looby, ¶ 3)

Doug Brunk, author of "Studies aim to prevent abusive head trauma," reports that numerous researchers currently educate parents about the "period of PURPLE crying" (¶ 160, a concept Dr. Ronald G. Barr and the National Center on Shaken Baby Syndrome developed. Brunk explains the concept presented in Figure 2 which depicts the letters in "PURPLE," which stand for characteristics of nonstop crying in infants that parents frequently have to contend with.

Figure 2: PURPLE Intervention Program Acronym (adapted from Brunk).

Ways to Respond

Part of the PURPLE intervention includes instructing parents on ways to respond to the baby's crying when it becomes frustrating. The program stresses that the parent also needs to relate this information to other individuals who will care for their child. These messages will be reinforced at well-child visits. (Brunk) Programs such as these offer the opportunity for positive interventions to contribute to prevent SBS.

Michele Poole, a volunteer consultant and fundraiser for National Center on Shaken Baby Syndromen (NCSBS) asserts that more Web sites have begun to relate information the dangers of shaking a baby, as well as information about caring for infants without harming them. In "Living with the Consequences-My Family's SBS Journey," Poole also points out that numerous groups support mandatory education in hospitals. In addition, a number of individuals have shared their personal stories on television or in print, revealing the help they received. In light of the increasing incidents of SBS: "Many states have passed laws to stiffen punishment for perpetrators" (Poole, ¶ 10). More work, however, Poole, stresses needs to be done to combat SBS.

CONCLUSION

Schwartz and Linzer argue that as the State maintains legal responsibility to ensure the welfare of its children, the State needs to legislate statutes to make parents liable when they fail to protect their children. Not every State, albeit, has passed such laws in regard to SBS. Those

States that do enact these laws enable the State to prosecute those passive parents and subject them to criminal penalties for failing to protect their children. Typically, the perpetrator is sentenced to serve a prison term, while the "bystander" may also similarly be sentenced. The length of the prison sentences varies, and may require the abuser and bystander to complete a lengthy probation, along with community service.

What may also prove effective, the researcher asserts, along with investigation by law enforcement officials ("Shaken Baby…"), as noted at this paper's start would be, that no matter where SBS occurs in the world, the abusers also be educated regarding what all SBS actually involves. This would benefit not only for the potential and practicing abuser but also contribute to helping ensure the health and lives of their children do not become statistics of SBS.