Shaken baby syndrome (SBS), also known as abusive head trauma (AHT), is an injury to a child's head caused by someone else. Symptoms may range from subtle to obvious. Symptoms may include vomiting or a baby that will not settle. Often there are no visible signs of trauma. Complications include seizures, visual impairment, cerebral palsy, and cognitive impairment.
The cause may be blunt trauma or vigorous shaking. Often this occurs as a result of a caregiver becoming frustrated due to the child crying. Diagnosis can be difficult as symptoms may be nonspecific. A CT scan of the head is typically recommended if a concern is present. While retinal bleeding is common, it can also occur in many other conditions. Abusive head trauma is a type of child abuse.
Educating new parents appears to be beneficial in decreasing rates of the condition. Treatment occasionally requires surgery, such as to place a cerebral shunt. SBS is estimated to occur in 3 to 4 per 10,000 babies a year. It occurs most frequently in those less than five years of age. The risk of death is about 25%. The diagnosis include retinal bleeds, multiple fractures of the long bones, and subdural hematomas (bleeding in the brain). These signs have evolved through the years as the accepted and recognized signs of child abuse. Medical professionals strongly suspect shaking as the cause of injuries when a young child presents with retinal bleed, fractures, soft tissue injuries or subdural hematoma, that cannot be explained by accidental trauma or other medical conditions.
Retinal bleeds occur in around 85% of SBS cases; the type of retinal bleeds are often believed to be particularly characteristic of this condition, making the finding useful in establishing the diagnosis, although this finding is based on circular reasoning and other studies have found that patterns of retinal bleeding cannot be used to make diagnoses. While there are many other causes of retinal bleeds besides SBS, there are usually additional findings (eyes or systemic) which make the alternative diagnoses apparent although again, this claim is based on circular reasoning.
Fractures of the vertebrae, long bones, and ribs may also be associated with SBS. Dr. John Caffey reported in 1972 that metaphyseal avulsions (small fragments of bone torn off where the periosteum covering the bone and the cortical bone are tightly bound together) and "bones on both the proximal and distal sides of a single joint are affected, especially at the knee".
Infants may display irritability, failure to thrive, alterations in eating patterns, lethargy, vomiting, seizures, bulging or tense fontanels (the soft spots on a baby's head), increased size of the head, altered breathing, and dilated pupils, although all these conditions can have alternative causes, and so cannot be used to make a diagnosis of abuse.
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