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What is SBS (shaken baby syndrome)?

SBS (shaken baby syndrome) is a combination of serious injuries that can occur when an infant or young toddler is violently shaken.
 
It is the single most preventable cause of serious head injury in babies under one year of age in New Zealand.
 
It may only take one or two hard shakes to seriously injure such a small child. This is because babies and toddlers have relatively big, heavy heads and weak neck muscles. When they are shaken the brain slams back and forth inside the skull, resulting in bleeding around the brain and damage to the brain itself. Some babies may even stop breathing, which can cause further brain damage.
 
In addition, the shaking can cause bleeding into the back of the eyes. Many babies who are shaken also have broken ribs because they are held forcibly around the chest and squeezed when they are shaken. They may also suffer other broken bones during the shaking.

 

Key points to remember

How can SBS happen?

SBS usually happens when a parent or other caregiver shakes a baby or toddler very hard because they are very frustrated with them. The number one reason given for shaking a baby is “I just wanted the baby to stop crying”. Forceful shaking may stop the baby crying, because it causes a head injury.


 

What are the consequences of shaking a baby?

The baby is likely to be significantly unwell from the time they were severely shaken. There may be vomiting, irritability, fits (seizures), drowsiness, and even coma. There is a range of severity in this condition, and some babies may be only mildly unwell. However, it will be clear to a parent / caregiver that their baby is not their usual self from the time that the shaking happened. They may be very fussy and go off their feeds, or vomit.
 
There are serious long-term consequences for babies that are severely shaken. There may be:
Overall, 15 - 35 percent of babies that are shaken die, and there is permanent brain and / or visual damage in 50 percent of survivors.
 

How can you prevent SBS?

SBS happens when parents or caregivers get frustrated with their baby or toddler, often in the case of babies because they are crying.
 
Always remember:
It helps to have a plan of what you will do if your baby keeps crying and you become upset or even angry
 

What if my baby keeps crying?

There is something called "the period of PURPLE crying" which refers to a time period when some babies begin crying more and may be hard to settle. This usually starts at about two weeks of age and peaks at eight weeks. It usually resolves by 12 weeks of age. The letters in PURPLE stand for the common parts of non-stop crying in infants:
 
P – peak pattern (crying peaks around two months of age, then decreases)
U – unpredictable (crying can come and go for no reason)
R – resistant to soothing (baby may keep crying no matter what you do to try to soothe them)
P – pain-like look on baby's face
L – long bouts of crying (crying can go on for hours)
E – evening crying (baby cries more in the afternoon and evening)
 
Parents may feel guilty and angry if they can't soothe their baby. The period of PURPLE crying tells us that if a baby is not ill and parents have tried to soothe baby, it is alright if they cannot stop baby from crying. Some babies are going to cry no matter what. The good news is that the period of PURPLE crying will end!
 
Here are some tips to help you cope with a crying baby:
If you are worried that your baby is crying because they are unwell, see your GP (general practitioner) or after-hours medical centre.
 
If all of the above seem fine and your baby is still crying you could try:

If you have tried everything and your baby is still crying:

What should you do if you think your baby has been shaken?

Take your baby to your nearest hospital’s accident and emergency department straight away.
 
Dial 111 for urgent medical help if your baby is unconscious or having breathing trouble.
 
Don’t let guilt or fear get in the way of your child’s health. If your baby has a serious head injury because they have been shaken, it will only get worse without treatment. Early medical attention may save your baby’s life and prevent serious long-term problems.
 
If your baby seems quite well but is fussy and / or vomiting, it is important that you tell the doctor that you know or suspect your baby has been shaken, so that they can give the proper treatment.
 

What can you do if you think you might hurt your baby?

Put your baby in a safe place and leave the room. Give yourself a break and seek help.
 

Where can you go to for help if you feel stressed?

© The Paediatric Society of New Zealand and Starship Foundation 2005 - 2011

The Paediatric Society of New Zealand
http://www.paediatrics.org.nz 		Starship Foundation
http://www.starship.org.nz