MEDICAL SURFARI: NEVER SHAKE A BABY. EVER!

As a neurosurgeon, I take care of patients who have had head trauma. Most of the time this is the result of a motor vehicle accident or a fall. Sometimes it is a result of a violent act of one against another. One of the most disturbing types of head injuries, and unfortunately a fact of life for many children, is a result of child abuse called "shaken baby syndrome". This syndrome is caused by vigorous shaking of an infant or child and is usually the result of an adult's inability to manage their anger or frustration because the baby will not stop crying. This type of injury does not occur from casually playing with a child but rather occurs because young children, especially babies, are still developing and the tissues and organs of their body are very fragile. They especially have weak neck muscles and cannot fully support their relatively heavy heads. Forceful shaking causes the brain to move back and forth within the skull, resulting in injury that is often permanent and sometimes even fatal.

These types of brain injuries may lead to delays in normal child development, seizures, spinal cord injury resulting in paralysis, blindness, hearing loss, cerebral palsy and/or mental retardation. Almost 25% of all babies with shaken baby syndrome die. Forceful shaking of a child may create forces against these fragile tissues that are multiplied five to ten times over what the child would experience with a simple trip and fall.

What can be done to prevent this tragedy? Talk to your babysitter, daycare workers, friends and relatives that sometimes care for your children so that they are also aware of the dangers of shaking a child. The number one reason a baby is shaken is because of inconsolable crying. There is no question that a baby's constant crying can be stressful but for some people this may serve as a dangerous trigger, leading to this form of violent abuse. Since a baby has not developed language, crying is its only way of signaling its mother or caregiver that it doesn't feel well or that it needs something like a diaper change or feeding. If a baby continues to cry after you have made sure that these basic needs are met, stay calm and ask yourself if you are upset or frustrated. If you recognize this and feel that you may loose control, place your child in a crib and walk away to another part of the house until you are able to calm down or get some help. Do not lose your temper! Don't pick the baby up again until you feel calm. If all else fails, call your doctor.

If you or someone else shakes a baby, either accidentally or on purpose, call 911 or take the child to the nearest emergency room immediately. Don't let embarrassment, guilt or fear get in the way of your child's health or life. If your child has been shaken, the injury to the brain will only get worse without treatment and getting medical care right away may save your child's life. Shaken baby syndrome has been referred to as a hidden form of child abuse because generally there are no outward signs of any injury. Symptoms include changes in behavior, irritability, sleepiness or loss of consciousness, pale or bluish skin, vomiting and seizures. Generally the prognosis with this syndrome is poor but without medical help the prognosis is even poorer. Unfortunately, this occurs in the United States 50,000 times per year. Babies and children are fragile. Please don't shake a child. Ever!

World Wide Web Resources

National Shaken Baby Syndrome Campaign

www.preventchildabuse.com/shaken.htm

The National Exchange Club Foundation for the Prevention of Child Abuse started a nationwide campaign in September, 1998, dedicated to educating the public on the dangers of shaking a baby.

American Academy of Pediatrics

www.aap.org/family/preshake.htm

The American Academy of Pediatrics provides a simple handout for parents and others about shaken baby syndrome.

Dr. Scott Gibbs is a Cape Girardeau neurosurgeon and editor-in-chief of Mosby's Medical Surfari. You may e-mail questions to him at drgibbs@semissourian.com or write in care of the Southeast Missourian, P.O. Box 699, Cape Girardeau, Mo., 63702-0699.