Shaken Baby Syndrome Never Ever Shake a baby


G. Sarojini1, R. Jothilakshmi2

1Professor, Sacred Heart Nursing College, Madurai, Tamilnadu, India.

2Professor, Sacred Heart Nursing College, Madurai, Tamilnadu, India.

*Corresponding Author E-mail:



Shaken Baby Syndrome (SBS) is a preventable, severe form of physical child abuse resulting from violently shaking an infant by the shoulders, arms, or legs. SBS may result from both shaking alone or from shaking with impact. (CDC)1. Non-accidental head injury in infants is the leading cause of infant death from injury. Clinical features that suggest head trauma (also known as shaken baby syndrome (SBS) or shaken impact syndrome) include the triad consisting of retinal hemorrhage, subdural, and/or subarachnoid hemorrhage in an infant with little signs of external trauma.” The majority of the infants body weight is comprised of the head, neck muscles are weaker, Infants had lack of head control so they cannot resist or minimize the force of injury (leslie Altimier, 2008)2 Evidence based research suggests that programs that teach parents and caregivers about the dangers of shaking a baby, as well as ways to cope with the stresses of caring for a child, are very effective in reducing the incidence of SBS. all hospitals are required to offer new parents the option of viewing a video on Shaken Baby Syndrome, including ways to cope with a crying child. It is important to reach as many current or future caregivers as possible to share this important message with them:6


KEYWORDS: Shaken Baby Syndrome (SBS), Child abuse, Head injury, Hemorrhage and Stress.




Non-accidental head trauma in infants is the leading cause of infant death from injury. Clinical features that suggest head trauma (also known as shaken baby syndrome (SBS) or shaken impact syndromewhiplash shake syndrome.) include the triad consisting of retinal hemorrhage, subdural, and/or subarachnoid hemorrhage in an infant with little signs of external trauma.” (Altimier, 2008)


Shaken baby syndrome is more common in children under age 2, but it can affect children up to age 5. Most cases of shaken baby syndrome occur among infants that are 6 to 8 weeks old, which is when babies tend to cry the most.



Shaken baby syndrome is a serious brain injury resulting from forcefully shaking an infant or toddler. It's also known as abusive head trauma, shaken impact syndrome, inflicted head injury or whiplash shaken infant syndrome.



·      1946 - Signs associated with SBS were first described by Dr. John Caffey.

·      1960 - Child abuse became known as a medical problem; Physicians reported clinical signs that resulted from intentional trauma.

·      1972 - Caffey named “parent-infant-stress syndrome” or “battered baby syndrome” associated with child abuse (from whip-lash-shaking and jerking of infants).  (Altimier, 2008)


Critical Risk Factors for Infants:

·      Inconsolable crying. (most common).

·      Premature infants or those with disabilities.

·      Age < 1 year (mostly < 6 mos. and with incresed crying).

·      Male infants at higher risk. (poss. d/t incresed expectations of development and behaviour).     

·      Colic.

·      Low birth weight.

·      Multiples. births

·      Step-children.

·      Compared with an adult, infants brains have incresed H2O content, less myelination, are more gelatinous and more easily compressed and distorted.

·      Combo of heavy head in relation to body wt, weak neck muscles, soft and quick growing brain, fine skull wall, decresed movement and head and neck control. (Altimier, 2008)

·      Young parents/ Single parent/ Divorced parent/ Drunken father

·      Inability to cope with stress

·      Environment


Low socioeconomic status, unemployment, low education

·      Poor impulse control

·      Males (dad/step-father) most frequent perpetrators

·      Unrealistic child rearing expectations

·      Depression

·      Substance abuse

·      Personal history of childhood abuse and neglect

·      Negative childhood experiences.



·      Complete assessment vital to prevent serious deadly effects.

·      Investigate non-specific symptoms important

·      Head to Toe Assessment, VS (incl. temp.).

·      Palpation of fontanels.

·      Orbital assessment

·      Measurement of head circumference.

·      Observation for signs of trauma.

·      Monitor sleeping/feeding pattern and consolability.

·      Assessment parent/caregiver story.

·      Detailed objective documentation. 


SBS symptoms can vary from mild to severe.  SandS’s may not be easily identified as head trauma, but mistaken for less life-threatening illnesses.


Non-specific symptoms requiring further investigation includes:

·      Poor feeding

·      Failure to thrive

·      Vomiting

·      Fever

·      Lethargy

·      Unexplained seizures

·      Hypothermia

·      Irritability

·      Bulging fontanels (Altimier, 2008)


Common signs of shaken baby syndrome

·      Lethargy/ decreased muscle tone.

·      Extreme irritability.

·      Decreased appetite, poor feeding, or vomiting for no apparent reason.

·      No smiling or vocalization.

·      Poor sucking or swallowing.

·      Rigidity or posturing.

·      Difficulty breathing.

·      Seizures.

·      Head or forehead appears larger than usual or on soft-spot, head appears to be bulging.

·      Inability to lift head.

·      Inability of eyes to focus or track movement or unequal size of pupils



A child who's been forcefully shaken will need to be examined by many different medical specialists, as well as an expert in child abuse.

The doctor will examine the child and ask questions about the child's medical history. Various tests may be needed to detect injuries, including:

·      Skeletal survey. Several X-rays of the bones — possibly including the arms, hands, legs, feet, spine, ribs and skull — may be used to determine whether fractures are accidental or purposeful. Such testing can also help find previous fractures.

·      Eye exam. An eye exam can reveal bleeding in the eye and other eye injuries.

·      Blood tests. Some metabolic and genetic disorders, as well as bleeding and clotting disorders, can cause symptoms similar to shaken baby syndrome. Blood tests can help rule out some of these conditions.

·      Magnetic resonance imaging (MRI). MRI uses a powerful magnetic field and radio waves to create detailed images of a child's brain and spine. It can show brain bruising, bleeding and signs of decreased oxygen. Because an MRI is difficult to perform on a child who's unstable, it's usually done two to three days after the injury.

·      Computerized tomography (CT) scan. A CT scan uses X-ray images to provide cross-sectional images of the body. A CT scan of the brain can help detect injuries that need urgent treatment. A CT scan of the abdomen may also be done to determine if there are additional injuries.


Depending on the extent of the injuries, the baby may need to be monitored in a pediatric intensive care unit.5


Complications from SBS:

If a person violently shakes a baby, even briefly, then the baby may experience SBS. This can cause a variety of complications,4

·      Blindness and impaired vision

·      Physical disabilities

·      Hearing impairments

·      Epilepsy

·      Intellectual disability

·      Cerebral palsy

·      Seizures

·      Spasticity


Prevention of SBS:

There are a number of steps that people can take to prevent SBS. It is important that parents and caregivers understand the dangers of shaking a baby. It is also important for people to understand the triggers and risk factors for abuse.4


SBS mostly occurs as a result of a caregiver’s reaction to continual and inconsolable crying. If a parent or caregiver cannot calm a crying baby, they may wish to try some of the following methods Non pharmacological intervention (Auditary, Tactile, Visual, Kinesthetic)

·      Gently rock the baby

·      Swaddle the baby in a blanket

·      Offer the baby a pacifier

·      Hold the baby close to their bare skin

·      Sing or talk softly to the baby

·      Take the baby for a walk in a stroller

·      Take the baby for a drive in the car


It is also important that a parent or caregiver understands that infant crying is worse in the early months of the child’s life and that it will get better as the child grows.

They should also check for signs of illness if a baby will not stop crying and call the doctor if the child appears to be sick.


If a person is becoming frustrated:

If a parent or caregiver is dealing with an inconsolable child and they feel they are becoming frustrated or upset, it is important that they focus on calming down.


They should put the baby down in a safe place and walk away to calm themselves. While they are calming themselves down, they should check on the baby every 5–10 minutes.


A person should never leave a baby with someone who is easily irritated, has a temper, or has a history of violence.


If a person finds themselves experiencing difficulties in caring for their baby, they should seek support. They should speak with a friend, relative, or the child’s healthcare professional.


For friends and family members of those caring for an infant:

If a person is a friend or family member of a parent or caregiver, they should offer support to that person to help reduce the risk of SBS.

A person can offer support by Trusted Source:

·      offering to give the parent or caregiver a break if they need it

·      explaining that while caring for a crying baby can be frustrating, infant crying is normal and gets better over time

·      encouraging the person to put the baby in a safe place and take a calming break if they need it

·      being sensitive and supportive when speaking to a person who is dealing with a crying baby


If a person suspects child abuse:

If a person suspects child abuse, they can contact 911. In addition, a person can contact their local child protective agency who can assess the situation and help take the appropriate action.


A person can find the contact information for their local child protective services

For more information on how to handle child abuse or neglect, a person can visit the Child Welfare Information Gateway.


Support for parents and caregivers:

If a parent or caregiver is struggling, they can contact charities and organizations for support. Some examples include:

·      Parents Helping Parents: A person can contact the Parent Stress Line at 1-800-632-8188. People can also look for support groups.

·      National Parent Helpline: A person can look for resources in their state

·      Childhelp: Childhelp offer a free and confidential hotline for parents and caregivers experiencing stress. A person can call them at 1-800-422-4453 (1-800-4-A-CHILD). A person can find resources for parents


If a person is experiencing a mental health condition, they can also contact the Substance Abuse and Mental Health Services Administration


Charyk-Stewart T(2011)·conducted  a study on Shaken baby syndrome and a triple-dose strategy for its prevention among children  at Londan : Dose 1 (in-hospital education): pre-post impact evaluation of registered nurse training, with a questionnaire developed to assess parents' satisfaction with the program. The first dose of PURPLE material consisted of peak of crying unexpected resists soothing, pain like face, long lasting, evening  and late afternoon Dose 2 (public health home visits): process evaluation of additional education given to new parents. Dose 3 (media campaign): a questionnaire developed to rate the importance of factors on a 7-point Likert scale He concluded that SBS is a devastating intentional injury that often results in poor outcomes for the child. Implementing a triple-dose prevention program that provides education on crying patterns, coping strategies, and the dangers of shaking is key to SBS prevention. The program increased knowledge. Parents rated the program as useful. The media campaign allowed us to extend the primary prevention beyond new parents to help create a cultural change in the way crying, the primary trigger for SBS, is viewed. Targeting our intervention increased the likelihood that our message was reaching the population in greatest need.3 Targeted approaches to prevention should be provided to those considered to be at higher risk for abusing a child. Those identified by research as more likely to injure children – young parents, males, parents and care-givers burdened by high stress and those with aggressive tendencies – need to be cautioned. These messages can be delivered through professional organizations, public education campaigns such as public service announcements, parenting education programs, parent support networks, school curricula and many organizations that provide services to people.8


The legal perspective of shaken baby syndrome:

The court made certain observations regarding the expert evidence since it was only on that basis that the cases of alleged SBS were decided:

1.    The evidence must not be influenced by any of the parties of the suit and must be an independent product of the expert.

2.    The expert witnesses, while providing opinions for the assistance of the court, should keep in mind that the opinions are within the area of their expertise and unbiased.

3.    The evidence must specifically mention the facts and assumptions based on which the opinion is formed.

4.    If the opinions of the expert are provisional or experimental, then the same must be declared before the court of law.

5.    If the information or research is incomplete or not sufficient to determine a case, then it should also be declared.

6.    If any material evidence or opinion of other experts changes the mind of the witness expert, then it should be communicated to the court and the parties without any further delay.7


The legal implications of Shaken Baby Syndrome involve child welfare and criminal investigations. These investigations will determine whether it is safe for children to remain in their parents' or caregivers' care, and whether an individual is charged with a criminal offence such as assault or homicide. All disciplines involved in this aspect of the problem, including social workers, police officers, lawyers (for the Crown and defence), as well as judges and probation officers require knowledge of the etiology, effects and outcomes for these children so as to provide the optimal intervention.8


“2005 WISCONSIN ACT 165” and had 10 sections. The Act was passed on 4th April 2006. The Commonwealth of Pennsylvania also had a law on prevention of shaken baby syndrome. It is known as ‘Shaken Baby Syndrome Education Act.’ This legislation was passed in the year 2002. This Act exclusively deals with the education programme related to shaken baby syndrome. Illinois, which is a US State, 96th General Assembly in the year 2010, passed a resolution regarding shaken baby syndrome and appoint April 19-25, 2010 as “Shaken Baby Syndrome Awareness Week”.9


Raising awareness:

Many people resort to shaking for the sole purpose of stopping an infant from crying without any intention of causing harm. And since shaking does not show any external signs of abuse, many people believe that it is right to do so.

·      Therefore, it is essential to create awareness among the parents about the danger of shaking which could lead to severe disabilities among their children. Further, campaigns should be organized where parents should be taught soothing techniques that they can use instead of shaking to console a crying infant.7

·      NSPCC - ‘Handle with Care’ guide explains why parents should never shake their baby and suggests ways they can soothe them when they cry. There are tips on how to cope when the crying doesn’t stop or seems too much to handle10



1. › files › Never ...


3.     Leslie Altimier. Shaken Baby Syndrome. Journal of Perinatal neonatal Nursing. 2008.

4.     Tanya Charyk Stewart, Denise Polgar, Jason Gilliland, David A Tanner, Murray J Girotti, Neil Parry, Douglas D Fraser. Shaken baby syndrome and a triple-dose strategy for its prevention” Journal of Trauma. 2011; 71(6):1801-7 DOI: 10.1097/TA.0b013e31823c484a

5. › syc-20366619

6. › prevention › injury_ prevention

7.     Kritika Garg (2020). “The legal perspective involved in Shaken Baby Syndrome”, National Law University, Odisha. Pleadgers

8.     Joint Statement on Shaken Baby Syndrome, Canada. Paediatric Child Health. 2001; 6(9): 663–667.doi: 10.1093/pch/6.9.663

9.     Abhijay Chakraborty and Rituja Sharma. Legal aspect of shaken baby syndrome in India. Aegaeum Journal. 2020; 8(9).





Received on 25.10.2023        Modified on 31.10.2023

Accepted on 08.11.2023     ©AandV Publications All right reserved

A and V Pub J. of Nursing and Medical Res. 2023; 2(4):137-140.

DOI: 10.52711/jnmr.2023.34