The number one cause of death for children younger than 2 years old is head trauma, reports John Cowan, Jr., M.D., of the Department of Neurosurgery at the Harbin Clinic, in "Current Diagnosis & Treatment: Surgery." Shaken baby syndrome is due to head trauma. Many infants and children die as a result of it, while others are left with permanent damage.
What Is It?
Shaken baby syndrome refers to the head injuries that infants and small children receive when they have been shaken with a great deal of force. They are injured because they are held by their chests and shaken so hard, that their brains keep hitting the front and back of their skulls. As explained by Robert Shapiro, M.D., Professor of Clinical Pediatrics at the University of Cincinnati College of Medicine in the "Atlas of Emergency Medicine," you will not usually see any physical signs of injury. But there will be a lot of internal damage within the head.
Subdural Hematoma
A subdural hematoma is a type of hemorrhage. You can get this hemorrhage if you have a trauma to your head that causes the bridging veins in your head to rupture. The hematoma, or mass of blood, develops underneath the dura, a layer of the membrane that covers the brain. Dr. Shapiro writes that a subdural hematoma is one of the most common hemorrhages of shaken baby syndrome.
Subarachnoid Hemorrhage
A subarachnoid hemorrhage is another hemorrhage that is commonly seen in shaken baby syndrome. This hemorrhage develops underneath the arachnoid. The membrane that covers the brain is called the meninges; it has three layers. The pia is the layer that is right on top of the brain. The next layer up is called the arachnoid. The third layer up is the dura. In "The Merck Manual for Healthcare Professionals," Elias Giraldo, M.D., Assistant Professor of Neurology and Neurosurgery at the University of Tennessee College of Medicine, explains that a subarachnoid hemorrhage can cause the meninges to become inflamed.
Other Signs
According to Dr. Shapiro, 80 percent of babies with shaken baby syndrome have hemorrhages in the retina of their eyes. These hemorrhages can be in one eye or in both of them. The children may also have cerebral edema, or a swelling of the brain. And they may have cerebral contusions, or bruising of the brain. Their symptoms can include irritability, vomiting, seizures, poor feeding and periods where they stop breathing, called apnea.
Diagnosis
The physician will order a MRI or CT of the head, and possibly an MRI of the spine to check for any spinal injuries. A skeletal survey will check for fractures in the ribs. The survey can also tell if there are fractures in the bones of the arms and legs. An ophthalmologist will check for any hemorrhaging in the retina and monitor any retinal damage if it exists. The infant or child will also be carefully checked for any bruises.
References
- "Atlas of Emergency Medicine"; Kevin Knoop, M.D., Lawrence Stack, M.D. et al.; 2010
- "Current Diagnosis & Treatment: Surgery"; Gerard Doherty, M.D.; 2010
- The Merck Manual for Healthcare Professionals: Subarachnoid Hemorrhage
