The American Academy of Pediatrics defines Shaken Baby Syndrome as follows: it is a term often used by physicians and the public to describe head trauma that occurred as a result of abuse perpetrated on infants and young children. Although shaking an infant can potentially cause neurological injury, violent impact or alternating shaking and violent impact can also cause damage.

An infant’s brain contains a higher percentage of water and less myelination than an adult brain; it is also more gelatinous and is easily compressed and deformed inside the skull during shaking. When shaken, an infant’s brain moves by rotating with a different speed than the skull, which tends to remain more stable: this generates rotational and angular forces of the head. The latency that occurs between the slower movement of the skull and the faster movement of the brain creates stretching and in some cases tearing of blood vessels. Vessel injury leads to cerebral hemorrhage or subdural hemorrhage.

The action of shaking the child is usually enacted as a response to an inconsolable cry of which the adult does not grasp the communicative meaning, so he or she may feel helpless to the extent that, in an attempt to calm the child, he or she unknowingly activates inappropriate behaviors, such as shaking. The perpetrators of SBS/AHT are predominantly parents, but they are joined by all the educational figures with whom child care is shared (caregivers): grandparents, babysitters, daycare providers, etc.

A subdural hematoma, or hemorrhage, is usually caused by head trauma severe enough to lead to rupture/laceration of blood vessels. This can lead to a buildup of blood between the bone and the brain (below the dura mater), which compresses the brain itself. Head trauma tears the blood vessels that run the surface of the brain.

The injuries seen in SBS/AHT cases are caused by violent shaking and in some cases, impact. These are due to the rapid and repeated acceleration and deceleration of the victim’s head, which swings back and forth and from side to side in a disorderly manner, causing damage to intracranial structures (blood vessels, neurons, nerve bundles).

Shaking injuries are not caused by random or accidental movements in daily child care or play, but involve, to be generated, the exercise of massive and violent force by the caregiver. Even a single shaking is enough to cause traumatic injury to the infant/infant’s brain.

The retina is a light-sensitive layer located at the bottom of the eye, covering about 65 percent of its inner surface. Photosensitive cells in the retina, called cones and rods, convert light energy into nerve signals that are transmitted to the brain through the optic nerve. Simply put, the retina is the inner lining of the eye.

The same kind of violent movement that the brain is subjected to while being shaken also occurs in the eye. When a child is shaken violently, the eyeball and its contents move back and forth and in many directions within the eye socket. The forces produced during shaking can cause the retinal layers to slide over each other, resulting in stretching and tearing of retinal vessels, causing hemorrhages in the retinal layers, more or less severe depending on the force exerted.

Bleeding within the layers of the retina is called retinal hemorrhage. Retinal hemorrhages, especially those occurring in the ora serrata and those involving several layers of the retina, are frequently observed in SBS/AHT cases and are infrequent in other types of head trauma. Retinal hemorrhages usually affect both eyes (bilateral), but can also be unilateral (only one eye). This type of bleeding can only be detected by a physician with specialized instrumentation.

Other injuries that may occur as a result of shaking are: cerebral edema (swelling of the brain), brain contusions (brain bruises), external head bruises/hematomas, bruises/hematomas on the body, skull fractures, rib fractures, long bone fractures (e.g., femur or humerus), neck and spine injuries, or other injuries that cannot be explained by organic medical pathology or accidental trauma.

Accidental falls, even falls from stairs, are generally not responsible for brain injury in infants. Household accidents, such as falls from furniture or stairs, most commonly result in minor injuries. Damage caused by high-speed impacts, falls from great heights, or on extremely hard surfaces can cause more serious injuries, similar to those observed in SBS/AHT cases.

Parents have the important task of learning to correctly listen to and understand their child’s crying; in fact, especially during the first few months, the caregiver should learn to decode the different forms of crying enough to know how to respond with the corresponding most functional behavior (nurturing, protection, comfort, etc.). Such attunement may be compromised by parental risk factors such as: experiences of powerlessness, unresolved personal issues, traumatic experiences, family conflicts, unrealistic parental beliefs, substance abuse, young age of parents, economic issues, and finally belonging to a culture that involves violence in educational practice.

CT (computed axial tomography) is an X-ray technique that provides a detailed cross-sectional image of tissue structure. An MRI (nuclear magnetic resonance imaging) is a diagnostic imaging technology that allows images of organs and various structures of the body to be made; it provides different information about the body from that which is produced with an X-ray, ultrasound or CT scan.

A CT scan has sufficient resolution and detail to allow a physician to assess an acute brain injury in an abused child. MRIs are to be performed a few days to a week after the injury to more accurately diagnose the types of brain injuries and to detect changes in brain tissue. Most skull fractures are best documented with an X-ray.

History or medical history, physiological data, and imaging are three (3) sources of information that physicians use to date injuries (brain, spinal, retinal).

The outcomes of SBS/AHT victims depend greatly on the severity of the abuse. One third (1/3) of SBS/AHT victims who develop symptoms either do not have particularly disabling conditions or their outcomes are not so well defined. Intermediate outcomes include learning, cognitive/mental, or behavioral disorders. Other children suffer from seizures or mental or psychomotor developmental delay. Many children have blindness, profoundly reduced mental capacity, spastic diplegia (paralysis of both sides) or quadriplegia (of all sides). Some children develop cerebral palsy or live in a persistent vegetative state.

Prevention of child abuse/maltreatment, and especially SBS/AHT, includes: trainings for parents/caregivers on normal crying patterns of infants; increased public awareness; relief intervention for overwhelmed parents/caregivers; and an action plan for parents who feel angry or exhausted while they are caring for the infant/child. When the crying is inconsolable and the parent feels he or she can’t take it any longer, it is necessary to: leave the baby in a safe place and walk away until a certain demeanor has been regained; ask other family members or friends for help; and let a doctor visit the infant/child if there is any doubt about the infant’s/child’s health.