Shaken Baby Syndrome

Syndrome Compiled by Leana Pieris

What and why?

Shaken Baby Syndrome or SBS is the medical term for the resultant injuries that occur to a young child or infant after being shaken violently. SBS is a serious injury and the results can be devastating.

Typical injuries can include brain damage and swelling; blindness or other eye trauma; paralysis/spinal injuries; seizures; subdural haemorrhage; broken bones and/or dislocations; mental retardation; and even death. There may also be some delay in normal development together with impaired motor and sensory skill.

Babies and young infants have very weak, under developed neck muscles and only gradually develop the strength to control their heavy heads, which are proportionately larger than in older children and adults.

This, coupled with their exceptionally fragile brain tissue, means that babies have intrinsically different propensities for brain injuries in the first two years of their life.

Strenuous shaking repeatedly hurls the brain in different directions and these sudden and violent motions can cause some parts of the brain to bleed and/or tear, causing irreparable damage.

When a baby is shaken in anger, the force of just one of these vigorous motions is five or ten times more than it would be if the child had just fallen and bumped his head. Head impact is not necessary but does frequently occur, and generally the shaking must be forceful enough for an unbiased observer to recognise the act as dangerous.

How?

SBS can happen when children are shaken as part of a pattern of abuse. However, it is more often simply a result of an adult (usually a parent or other caregiver) becoming frustrated or enraged with a child, especially in response to a crying baby, and losing control. Many well-intentioned and responsible people who would never dream of hitting their child, think nothing of giving him or her a “good shaking”, little realising the harm such ‘punishment’ can cause.

Sometimes SBS can find a victim when the caretaker of the child, again not realising how much damage this behaviour can do, vigorously throws the toddler into the air or indulges in any other kind of rough play, or even hits a small child too hard on the back.

In fact until quite recently, some medical programs designed to treat infants who are prone to sleep apnoea (and therefore run a higher risk of what is sometimes called ‘Cot Death’) even encouraged the use of “tactile stimulation” as first-aid when the infant stopped breathing in their sleep.

The instructions to parents were “shake gently, then vigorously”, however in the light of these new findings on SBS, the latest research and educational materials specifically caution parents AGAINST shaking their babies, for apnoea or for any other reason whatsoever. This has been now thought to be particular expedient since the caretakers of children who suffer from sleep apnoea are usually stressed and frequently exhausted, thus increasing the chances of physical abuse.

Prevention

The term ‘Shaken Baby Syndrome’ or sometimes ‘Shaken Infant Syndrome’ was first discussed by medical experts in their early 1970s but it is still a relatively new and unrecognised syndrome as knowledge about it continues to develop.

In order to prevent SBS, medical professionals and other types of health workers need to communicate the importance of not touching children in anger - not to frighten parents from touching their children, but to remind them of the special care that must be taken when handling infants and that they must never be shaken for any reason!

This also includes always providing support for the baby’s head when holding, playing with or transporting the child and instructing others who care for the infant in the proper support of the head.

In addition, leading paediatricians advise that parents ensure that all those in contact with their infant fully understand the dangers of shaking, including siblings who may accidentally cause injury in the process of rough play if not adequately warned.

They also need to encourage parents to have a plan or strategy to deal with crying infants or children and also to be cautious about who cares for their children.

It is more common for young males to be the perpetrators of SBS but other caregivers like baby-sitters have also been implicated, most famously in the Louis Woodward case a couple of years ago in the United States of America.

Most often SBS occurs in children prior to age one and more rarely after age two, and experts also indicate that twins are at higher risk than singletons of being the victims of SBS. It is also very likely that many injuries related to SBS go unreported.

How medical professionals/healthcare workers can identify SBS

* An SBS case may have no visible, external signs of injury like bruising or broken bones

* Finger marks may be found on the chest wall or around the shoulders; posterior rib fractures may be present as well

* The triad of subdural haematoma, cerebral oedema and retinal haemorrhage represents a diagnosis of SBS but all 3 may not be present

*Other injuries may precede shaking incidents

*Guilty parents/caregivers may weave a trivial story of a fall or other minor mishap into their account of what transpired to try to cover their tracks.

However, the matter of whether or not social or health workers and medical professionals should intervene into suspected SBS cases remains controversial.

Be safe, not sorry - don’t shake!

Prevention Strategies

The first precaution is to STOP!.... whatever you are doing or trying to do. Leave the child in a safe place and go out of the room for a few minutes. Do whatever it takes to calm your nerves! For example...

*Take lots of slow, deep breaths.

*Sit down, close your eyes, and don’t move. Then try and focus on a pleasant memory or event.

*Call or talk to a friend or neighbour. Avoid talking about your baby if this helps!

*Take a bath, wash your hair, turn on the radio or listen to some soothing music, make a cup of tea and don’t move until you’ve finished drinking it, read a book.

*Pray and/or meditate. Exercise or go for a short but fast walk.

*Exert some of your frustration on an inanimate object or do some strenuous chores, i.e. scrub a floor clean, tidy up a cupboard or room, shake out a rug or mat, polish some shoes.

*Find a piece of paper and a pen and write down a list of the ten best things about yourself. Then make a similar list about the ten best things about your child.

To be continued next week

Integrated medicine - Sri Lanka’s health vision

President Mahinda Rajapaksa in his message to the 46th Medicine Alternative World Congress which opened last Friday Nov. 7 at the BMICH in Colombo describes Sri Lanka’s health vision as integrated medicine.

In his message he says.

I am aware that the Open International University for Complementary Medicines has been an educational foundation that has provided clinical training, accreditation and certification to clinicians, physicians and therapists of alternavite medicines from all parts of the world.

Sri Lanka is a country that has the vision to integrate all forms of healing, both the western and traditional, as well as the scientific and empirical, for prevention, cure and betterment of human life. With the dawn of the new Millennium, the human race has to make a commitment to make available health care and health education for all.

Farsighted initiatives have enabled the field of medicine to embrace the concept of Holistic Medicine. I am aware this was the initiative of the late Prof. Anton Jayasuriya. Let me congratulate Medicina Alternativa affiliated to The Open International University for Complementary Medicines for their achievements in the past.

Their efforts to ensure progress in oriental medicines worldwide is highly commendable.

I am certain that your deliberations at the World Congress will be most fruitful. I welcome the foreign delegates who will be in Sri Lanka for the Congress and wish the event be a complete success.

Laughter the best medicine

I have read an item in a women’s magazine by a woman who had gone to get her car repaired in a garage and finding the bill a little too much for the work done had complained thus to the garage owner.

“Look Mr. Perera recently I went to a medical specialist to get a complete medical checkup done. It took one whole day and didn’t cost so much”.

“Madam”, replied Mr. Perera “You may have paid much less to the doctor for the physical examination. What we have done here to the car includes replacing old wornout parts as well. That’s the difference.”

Sent by M.S. Vittachchi Matara.

Human life respecting study collaboration award to Daily News

Chairman Medicina Alternativa Dr. Githanjan Mendis welcoming the delegates at the 46th World Congress of Medicina Alternativa inaugurated on Nov. 7th at the BMICH in Colombo presenting the media award for Prof.

Colvin Goonaratna centenarian study started in 2001 to the Daily News said,, “This is a social upliftment programme aimed at creating social recognition and respect for human life for those reaching 100 years and becoming centenarians, said this kind of human life respecting programmes has long been awaited in society.

As it could be developed later on to become the first step in a ladder of peace in the world.

He said late Prof. Anton Jayasuriya had realised this in that year 2001 itself and that was why at the 40th World Congress of Medicina Alternativa held that year he invited Sri Lanka’s oldest living Centenarian found by the Prof. Colvin Goonaratna Centenarian Study team 114 year old O.P. Engonona from Galle as a special invitee to the Congress as its opening and honoured her for her life’s living achievement. She was living in a hut, with hardly any education.

Her only achievement was though poor living a respectable life for over 100 years.

Today at this congress we are crediting Prof. Colvin Goonaratna for initiating this Centenarian human life respecting programme considered to be the first of its kind in the world, thus bringing credit to the medical profession as a whole.

We are also crediting and making an award to the Daily News, for join in this much needed human life respecting project, and thereby bringing credit to the media world as a whole.

We are also giving a special award to senior journalist Edward Arambewala in the Daily News for the role he has played in joining with Prof. Goonaratne in bringing about this project.