Question of the Week

June 20, 2005

Everyone gets upset. Everyone gets frustrated. It is what people do with their anger and frustration that makes all the difference.

"When a baby is vigorously shaken, the head moves back and forth. This sudden whiplash motion can cause bleeding inside the head and increased pressure on the brain, causing the brain to pull apart and resulting in injury to the baby. This is known as Shaken Baby Syndrome, and is one of the leading forms of fatal child abuse. A baby's head and neck are susceptible to head trauma because his or her muscles are not fully developed and the brain tissue is exceptionally fragile. ... Shaken Baby Syndrome occurs most frequently in infants younger than six months old, yet can occur up to the age of three. Often there are no obvious outward signs if inside injury, particularly in the head or behind the eyes. In reality, shaking a baby, if only for a few seconds, can injure the baby for life."

Babies are small and fragile, and they break easily. Even a few seconds of shaking from a frustrated or out-of-control caregiver can change their lives forever. Receiving medical attention right away can improve a baby's chance of survival, and can limit continued damage from internal injuries.

"... Immediate emergency treatment is necessary and usually includes life-sustaining measures such as stopping internal bleeding and relieving increased intracranial pressure. ... Generally, the prognosis for children with shaken baby syndrome is poor. Most will be left with considerable disability."

Shaking can lead to deception. The baby may initially begin to cry more (out of fear), but may soon quiet (as a result of the brain damage that has occurred). No obvious signs of trauma are visible, and the child has given the caregiver the desired result (quiet).

That said:

"Children who survive may have:

  • partial or total blindness
  • hearing loss
  • seizures
  • developmental delays
  • impaired intellect
  • speech and learning difficulties
  • problems with memory and attention
  • severe mental retardation
  • paralysis (some particularly traumatic episodes leave children in a coma)

Even in milder cases, in which babies looks [sic] normal immediately after the shaking, they may eventually develop one or more of these problems."

Each year, hundreds of babies are shaken to death in this country. Those who do survive, will live with the effects for the rest of their lives, and those effects may not be immediately apparent.

"How does it happen?
Often frustrated parents or other persons responsible for a child's care feel that shaking a baby is a harmless way to make a child stop crying. The number one reason a baby is shaken is because of inconsolable crying. Almost 25 percent of all babies with Shaken Baby Syndrome die. It is estimated that 25-50 percent of parents and caretakers aren't aware of the effects of shaking a baby."

"It is estimated that 25-50 percent of parents and caretakers aren't aware of the effects of shaking a baby."

"A number of state lawmakers are pushing a bill in effort to prevent a form of child abuse that leads to brain damage and even death. The Prevent Violence Against Children Act will promote prevention of Shaken Baby Syndrome. ... The proposal would require that all new parents receive information and view a video tape on Shaken Baby Syndrome prevention. It would also include prevention education in school districts."

Not all medical professionals are in favor of this bill, yet others see the need, and see the good that can come from such education.

"Dr. Mark S. Dias was trying to comfort his newborn son in the middle of the night when he felt himself losing control. ... Dias, now a pediatric neurosurgeon at Pennsylvania State University Milton S. Hershey Medical Center, could identify with parents who spin out of control and shake their babies. He cared for such infants in the Buffalo hospital where he worked at the time and had seen the brain damage from violent shaking. That insight eight years ago led Dias to develop a program to teach new parents about shaken baby syndrome. ... Last month, Dias reported in the journal Pediatrics that the incidence of abusive head injuries declined 47 percent in western New York after hospitals began showing parents a short video and offering brochures on how to soothe a crying baby. Dias said the timing of the education program is critical. 'You have to remind the right people at the right time,' he said. 'The right time is before they take their baby home.' ... Since abusers tend to be men, hospitals try to get fathers involved. Recently, Crystal Washington, 32, a single mother in the city's Logan section, watched the video from her bed at Temple University Hospital with her 2-day-old daughter, Kikira. Washington knew that shaking a baby was bad, but she did not fully understand how devastating it could be. 'I didn't know you could even shake that hard,' she said. "That is something I would never do.' ... "The main message we give is that you should walk away from the baby when you're feeling stressed,' Horan said. 'Take a break, don't shake.'"

Once again: "It is estimated that 25-50 percent of parents and caretakers aren't aware of the effects of shaking a baby."

"Strategies must be designed to educate the entire ... population -- adults and youth -- about the dangers of losing control when caring for an infant. Key messages should explain that the most common trigger causing an individual to shake a baby is the child's crying, and that physical discipline has no place in caring for children. The emphasis should be: 'Never shake a baby!', and to seek help if a baby's demands create anger or frustration, making it difficult for a person to maintain control. Parents need to learn that there are alternative strategies for dealing with exhaustion and feelings of frustration toward a baby, and that caution must be taken in choosing alternate caregivers. Great caution should be used in letting inexperienced caregivers, those who have difficulty controlling their anger and those with any resentment toward an infant look after a baby, even for a short time."

Questions of the Week:
What do caregivers need to know before caring for a baby or small child? What do parents need to know before taking their babies home from the hospital? How can the information be presented so that it can be remembered in a moment of frustration? What can parents and other caregivers do when faced with a baby that will not stop crying? What can they do when frustration levels mount?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

Health Community Coordinator
Access Excellence @ the National Health Museum

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