Rattled by the Shake

What is the shaken baby syndrome?
As the name suggests, the condition is brought on by vigorous shaking of an infant by the arms, legs, chest or shoulders. ‘‘A baby’s head and neck are especially vulnerable to injury because the head is large in proportion to the body and the neck muscles are still weak. In addition, the baby’s brain and blood vessels are very fragile and easily damaged by whiplash motions, such as shaking, jerking and jolting,’’ explains Dr (Col) A K Verma, head of the department, Neurosurgery at Batra Hospital, New Delhi.

What are its symptoms?
The shaken baby syndrome is difficult to diagnose. Doctors often detect the syndrome when a child is brought in for attention to fall injuries, difficulty in breathing, seizures, vomiting, altered consciousness or choking.

‘‘To diagnose the shaken baby syndrome, we look for retinal haemorrhages, blood in the brain and increased head size, which indicates excessive accumulation of fluid in the tissues of the brain,’’ says Dr Verma.

What are the dangers of this kind of abuse?
It is absurdly easy to miss or misdiagnose subtle symptoms of the syndrome, since they overlap with commonplace illnesses such as mild viral fevers, feeding dysfunctions and infant colic. But watch out for prolonged poor feeding habits, unexplained vomiting or flu-like symptoms with no accompanying fever, diarrhoea, lethargy and irritability. ‘‘Without early medical intervention, the child may be at risk for further damage or even death, depending on the continued occurrences of shaking,’’ warns Dr Verma.

What could be the outcome?
Vigorous shaking, especially over a period of time, can result in brain damage and even death. Fewer than 10-15 per cent of the victims recover completely. The others exhibit a variety of disabilities, including partial or complete loss of vision, hearing impairment, seizure disorders, cerebral palsy, sucking and swallowing disorders, developmental disabilities, autism, cognitive impairment, behaviour problems and permanent vegetative state.

The treatment of survivors comes under three heads: medical, behavioural and educational. In addition to medical care, children may need speech therapy, vision therapy, physical therapy, occupational therapy and special education services.

How can the abuse be prevented?
Ignorance is a major contributing factor to the syndrome. Psychiatrists say frustration arising from a child’s incessant crying and toileting problems can lead a caregiver to shake the child severely; few, though, are aware of the dangers and end up harming the child unintentionally.

‘‘The shaken baby syndrome is about taking out adult frustration on the baby. Among caregivers, it can arise from employment-related problems, personal lives and even a quarrel with the child’s parent,’’ says Dr Jitendra Nagpal, senior consultant at VIMHANS, New Delhi.

For caregivers on the edge, doctors have the following advice: