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Points To Make For Shaken Baby Slides

 

Index

Slide 1A. What Is Shaken Baby Syndrome?

Slide 2A. Ages of SBS Victims.

Slide 3A. Inflicted, Not Accidental

Slides 4A-7A. Clinical Findings Associated with SBS

Slide 8A. Diagram of brain.

Slide 9A. SBS Triad of Injuries

Slide 10A. Who Are The Perpetrators of SBS?

Slide 11A. How Would You Know If Your Child Has Been Shaken?

Slide 12A. Warning Signs

Slide 13A. Critical Advice

Slide 14A. What Are The Effects Of Shaking?

Slide 15A. How Does It Occur?

Slide 16A. Use Common Sense

Slide 17A. Caretakers Need To Stay In Top Condition

Shaken Baby Slides Set A

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Slide 1A. What Is Shaken Baby Syndrome?

SBS is caused by a violent whiplash injury. Delicate blood vessels between the brain and the skull are ruptured and bleeding occurs, forming blood clots (subdural hematomas). The pressure that results from these clots, combined with the swelling of the brain results in damage to the brain. If swelling extends and involves the brain stem, and medical treatment does not control this pressure, breathing and heartbeat are interrupted, and the child dies.

This is a traumatic brain injury, and the child is frequently either left dead or with a handicapping condition. Pre-school children are at high risk, with babies at extreme risk.

According to a report, (A Nation’s Shame: Fatal Child Abuse and Neglect in the United States 8-9; U.S. Advisory Board on Child Abuse and Neglect, April 1995), Shaken Baby Syndrome accounts for an estimated 10-12 percent of all deaths due to abuse and neglect. Approximately one-quarter of all SBS victims die, and 41 percent of SBS victims are under the age of one year.

Question: Is the child always hurt this severely when it is shaken?

Answer: Usually, but not always. It depends upon the age and health of the child, the severity of the shaking, how hard the baby’s chest was squeezed by the abuser during the shaking (increases the pressure within the blood vessels), and whether the baby received additional injuries from being thrown against furniture, on the floor, etc. The most frequent victims of SBS are infants, and they are severely injured by violent shaking, with or without external impact. This is a head injury roughly comparable to an injury received from falling from the height of at least one story.

Question: Can SBS be from a "re-bleed of a prior injury?

Answer: No. SBS injuries occur immediately prior to the symptoms becoming apparent. A child would not have received a SBS injury, then appeared and behaved normally, later collapsing, unconscious and in danger of death from the [prior] injury.

Note: (from physicians responding to a case which received national attention): "Infants simply do not suffer massive head injury, show no significant symptoms for days, then suddenly collapse and die. Whatever injuries [a child] may or may not have suffered at some earlier date, when [the child] is presented to the hospital in extremis [the child] was suffering from proximately inflicted head injuries that were incompatible with any period of normal behavior subsequent to the injury. Such an injury would and did produce rapidly progressive, if not immediate, loss of consciousness.

The shaken baby syndrome (with or without evidence of impact) is now a well characterized clinical and pathological entity with diagnostic features in severe cases virtually unique to this type of injury - swelling of the brain (cerebral edema) secondary to severe brain injury, bleeding within the head (subdural hemorrhage), and bleeding in the interior linings of the eyes (retinal hemorrhages)".

Prompt recognition of the symptoms of SBS and immediate medical treatment can minimize the damage caused by the shaking.

Note: If sufficient violence is used, any person is at risk for traumatic brain injury. There is one documented case of an adult prisoner dying from being shaken.

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Slide 2A. Ages of SBS Victims.

This is the usual range. It is possible for a child to die from SBS at any age, if the shaking is violent enough and prolonged enough.

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Slide 3A. Inflicted, Not Accidental

SBS is not a result of innocent play with a child, nor the result of an accidental fall. These are inflicted injuries, and any reasonable person observing the action would know that shaking a child that violently would result in severe injuries. The person who shakes a child that violently is frustrated and enraged, usually because they were unable to make the child stop crying.

Think of the phrase: "I’ll give him a good shaking".

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Slides 4A-7A. Clinical Findings Associated with SBS

Slide 4A is an optional summary slide.

Slides 5A-7A include definitions.

Subdural Hematoma -- accumulation of blood/blood clot beneath the dura (the fibrous membrane the surrounds the brain and attaches to the skull.

Retinal Hemorrhages -- in SBS they tend to be massive, covering large areas of the retina. Fifty percent to 100 percent of children with SBS have retinal hemorrhages, and 70 percent to 100 percent of SBS fatalities have retinal hemorrhage. The majority of hemorrhages are bilateral (BNA Criminal Practice Manual, Vol. 11, Special Reprint Issue, Number 2-2)

Cerebral edema -- swelling of the brain

Diffuse axonal injury -- shearing injury of nerve fibers in the white matter of the brain. It is secondary to severe head trauma.

Skull fracture

Subarachnoid hemorrhages -- bleeding underneath the arachnoid membrane, a membrane attached to the innermost layer surrounding the brain by web-like fibers that allow for movement of cerebrospinal fluid.

"Black Brain" -- seen on CT or MRI. This indicates tissue injury and subsequent atrophy due to interruption of the brain’s blood supply. "The brain appears to have ‘melted away’ " (Showers, J., 1996).

(Executive Summary: The National Conference on Shaken Baby Syndrome, 1996.

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Slide 8A. Diagram of brain.

Diagram of brain with subdural hematoma and "black brain" illustrated.

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Slide 9A. SBS Triad of Injuries

These three signs, in combination, demand the consideration of SBS as a diagnosis.

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Slide 10A. Who Are The Perpetrators of SBS?

A study of 151 infants in Colorado revealed that fathers were the abusers 37% of the time; mother’s boyfriends 20.5% of the time. Female child care providers were perpetrators 17.3% of the time and mothers, 12.6% of the time.

In an article: Starling, S., et al., Abusive Head Trauma: The Relationship of Perpetrators to their Victims; Pediatrics, Vol. 95, No. 2 (February, 1995), studying 161 infants, researchers found that male perpetrators numbered 68. 5 percent and female perpetrators 31.5 percent. Thirty-seven percent of the perpetrators were fathers; 3.1 percent were stepfathers; mothers’ boyfriends, 20.5 percent; mothers, 12.6 percent; female baby-sitters, 17.3 percent; and male baby-sitters, 3.9 percent. Source: BNA Criminal Practice Manual, Vol. 11. No. 2-2 (1/15/97).

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Slide 11A. How Would You Know If Your Child Has Been Shaken?

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Slide 12A. Warning Signs

These are indicators of possible neurological injury.

These symptoms may range from very mild manifestations to severe, obvious signs of life-threatening injury. In all cases, children should receive immediate medical attention, and the doctor should be advised that you know/suspect/believe that the child was shaken.

CT scans and MRI will be used to assist diagnosis. These imaging techniques will examine the child for evidence of new or old bleeding within the skull. In many cases, the child will also receive skeletal x-rays to survey for new or old fractures.

Studies suggest that 15% to 30% of the children die, and all but 15% of the remainder suffer permanent damage.

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Slide 13A. Critical Advice

Parents need to take their child to the nearest emergency room immediately. They will be asked about the circumstances surrounding their child’s condition.

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Slide 14A. What Are The Effects Of Shaking?

Listed. These effects vary from moderate to severe. The financial costs of treatment, rehabilitation and continuing care to the family and the community are enormous, especially when calculated over the lifetime of the victim. Additionally, the human costs to family members is substantial.

Note: It is important to recognize that the effects on the child impact other members of the family as well.

Some of the effects on the family include (discuss):

1. Anger and bitterness, and (sometimes) mental health problems for parents and siblings when a baby-sitter caused the child’s injury. This is exacerbated if the sitter is not prosecuted or receives a light sentence. Extreme conflict and family stress occurs when a parent caused the injury. Is jail/prison/divorce inevitable? What about safety if the family stays together? Can the non-offending parent forgive the spouse who hurt their child?

2. Financial strain on family resources that could otherwise be available for other family needs.

3. Emotional impact. Stigmatization of parents, embarrassment/resentment of siblings, emotional cost of being reminded each and every day of the loss of their hopes for this child’s future.

4. Fear for the future. How long will they be able to care for their disabled child? When - or will - their child need to be institutionalized?

 

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Slide 15A. How Does It Occur?

This is a crime that occurs when the caretaker is alone with the child. No witnesses; nobody to intervene and save the baby. (The simplest and best precaution is that the child never be left in the care of only one person. When using baby-sitters, this might be do-able.)

Caretakers who shake a baby violently usually believe that the baby is deliberately crying in order to defy their authority. They cannot "make the baby stop" so they vent their rage on the infant.

Caretakers often fail to understand that there are periods in a child’s life when they cry more than other times. When babies are tiny, they often have colic; when older, they can have pain from teething or be stressed from being overtired. Sometimes caretakers simply need to allow the baby to "cry it out", after they are assured that the baby’s basic needs are met.

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Slide 16A. Use Common Sense

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Slide 17A. Caretakers Need To Stay In Top Condition

Being "left alone with a screaming baby when a person is exhausted, drinking too much and ‘trying to relax’ by watching their favorite team in the Super Bowl game -- when a person knows that they have a hot temper and can’t stand crying --".

This hypothetical scenario calls for someone else to be taking care of the baby, no matter what the cost.

Fatigue and alcohol play a part in parental stress. The positive effects of staying healthy help keep children safe.

 

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