shaken baby syndrome

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shaken baby syndrome

FORENSICS

Definition A condition defined as “…acute brain injuries–cerebral contusions or subdural or subarachnoid haemorrhages in infants who have no discernible evidence of blunt head trauma. Associated findings, especially metaphyseal long-bone fractures and evidence of injury to the cervical spinal cord, suggest that the condition is the result of the child’s having been held by the torso and shaken violently, with subsequent whiplash injury to the head, neck, and limbs

NEJM 1995; 332:1425rv.

It is a severe form of child abuse that may be fatal, or leave permanent neurologic sequelae. Severe shaking of an infant–who has virtually no neck muscle tone, may cause bilateral subdural haematomas–due to laceration of veins bridging the dura mater and cerebral cortex. Over half of deaths from nonaccidental paediatric trauma are due to shaken baby syndrome

Short term consequences Skull fractures, subarachnoid haemorrhage, retinal haemorrhage, cerebral oedema, cerebral haemorrhage, subdural haematoma, death

Long term sequelae Microcephaly, mental retardation, learning disabilities, epilepsy, visual impairment, psychiatric problems, death, calvarial thickening, dural changes. 

Pathogenesis The syndrome is caused by rapid acceleration and deceleration which occurs as the chin strikes the chest, and the occipital bone strikes the back, subarachnoid and retinal haemorrhage, cerebral oedema, and cortical contusions without signs of external cranial trauma.

Comments

(1) Skull fractures are uncommon in infants, given the relative softness of neonatal bone; the whiplash shaken infant injury occurs when an adult–often in a state of uncontrolled anger holds the child by the upper body and violently shakes him

(2) Similar lesions may occur when a parent “rough-house” plays with the child and swings him in a circle or tosses him up and down; thus other signs of child abuse must be investigated 

Synonyms Abusive head trauma, shaken baby, shaken impact syndrome, whiplash shaken baby syndrome

References Arch Pathol Lab Med 2003; 127:94-7

Am Fam Prac 1990; 41:1145 

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