Clinical Meaning of the Shaken Baby Syndrome – Child Development Example

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"Clinical Meaning of the Shaken Baby Syndrome" is an impressive example of a paper on child development.   Given the fact that infants have a very fragile structure and unique anatomic features, any violent and sudden movement has the potential to cause minor or even severe forms of injury.   Shaken baby syndrome, also known as abusive head trauma or shaken impact syndrome is a serious injury caused by suddenly and forcefully shaking a baby. The sudden forced movement can potentially damage the brain cells causing severe consequences. In fact, the shaken baby syndrome is one of the most common causes of death or of serious neurological injury among infants.

Although it is highly preventable, development in medical and imaging techniques have contributed significantly towards treatment for the problems. However, owing to poor prognosis almost 25% of infants die with one to few weeks while 75% of survivors live with the physical capability of different kinds and therefore prevention is considered the most important aspect to safeguard babies (Reith, 2009). Clinical meaning In 1974, John Caffey, an American radiologist considered the name “ whiplash shaken syndrome” for the shaken baby syndrome.

The syndrome is an amalgamation of several severe clinical instances such as subdural hematoma, retinal bleeding and prognosis disadvantage caused by severe and powerful shaking of the infant (Reith et al, 2009). Therefore both subdural and retinal haemorrhage are the key markers of head injury. In many cases, the doctors fail to identify and diagnoses the syndrome accurately since no external injury is visible on the baby. Many a times mothers or caregivers are charged falsely of abusing the baby who may have had died because of trauma, Cot death, infection or a misdiagnosed vaccine death.

Therefore, both from a medical as well as legal point of view encephalopathy, subdural haemorrhage and retinal haemorrhage are considered to be indicators of shaking baby syndrome (SBS). However, these triad of indicators are not solely considered and practitioners prefer to conduct routine testing such as MRI, CAT scan, X-ray along with investigating infections, metabolic and possible haematological causes when an SBS case emerges (Richards et al, 2006). In the figure below, we can see a baby being shaken forcibly in an abrupt manner.

The head of the baby goes to-and-fro where the brain strikes the skull repeatedly which leads to the onset of the syndrome. Figure 1: Shaking Baby in a whiplash Manner (Dake, 2014) Cause of Shaken Baby Syndrome The main cause is a severe form of shaking of the baby. Parents or caregivers who often fail to stop a baby from crying engaging in shaking the baby forcibly and with frustration in order to make the baby quiet. Most babies who fall victim to this form of abuse includes babies with colic diseases or babies with special needs who do not normally stop crying and hence are more prone to be abused than other babies.

Babies born into families that live below the poverty line are more likely to be abused than others owing to the socio-economic impact on the psychology of the parents and caregivers. In most cases, the perpetrators of the abusive form of shaking are male, step-parents or caregivers such as babysitters below the age of 20. Physically, babies have very unique anatomical features. A baby’ s head is large compared to its body.

In fact, the head itself makes up almost 25% of the baby’ s body weight. In comparison to this large head, the neck muscles that the baby has is not very powerful to lend support to the large and bulky head. Since the association between the skull and the brain with the neck muscles is so very fragile, any sudden movement or forceful shaking is enough to cause damage to the blood vessels in these regions. When a baby is shaken abruptly and forcibly with a minimal force, the brain of the baby strikes against the skull causing tissue damage.

This is because the neck muscles fail to control and support the head. The damage occurs since the brain bounces to and fro within the skull cavity and the friction initiated causes tissue bruise. The brain tissue swell which creates a pressure that leads to bleeding at the back of the eyes. Too much pressure can even cause blindness. Blood vessels present in the brain also may be damaged which could further lead to abnormalities and other problems.

The damage in some cases will be greater if the episode of the abuse ends with the child’ s head hitting the crib mattress or other objects since the sudden deceleration also has a noticeable impact. It was long thought that the severe shaking injures the bridging veins and causes lateral subdural bleeding; however, neuropathological studies have confirmed that it is not so in all cases of SBS and most cases may not have a traumatic axonic injury while they may have swelling in the brain and hypoxic-ischaemic injury (Squier, 2008).

  The shaking also results in accumulation of blood in the skull area which immediately leads to certain immediate effects such as seizures, vomiting and in case of an extreme form of abuse even coma and death. The shaking also has long term effects on the infant as well. Signs and Symptoms There exist several signs and symptoms that may help identify a case of shaking baby syndrome. In some cases, where the form of abuse is no very severe there might not be any detectable signs and such cases are often left undiagnosed.

In severe forms of shaking the child may also suffer from long-term neurological damage and life-threatening injury to the central nervous system. The most common signs and symptoms other than the important hallmarks i. e. subdural damage and retinal damage include seizures, decreased muscle tone, irritability, vomiting, loss of appetite, difficulty in breathing, the appearance of a larger head or emergence of a bulging soft spot on the head, unequal pupil size and inability to focus eyes. In the figure below we can see the scanned image of subdural damage caused by severe shaking.

The blood has accumulated at the site of tissue damage. Figure 2: Sub-Dural injury (Associated Press, 2011) Treatment for the Syndrome Even though almost 25% of babies from SBS cases die while many are left injured for life, seeking immediate medical attention can help minimize the effects of the incident on the victims. After the incidence occurs, help needs to be taken immediately and a physical examination needs to be conducted along with other tests to ensure a case of SBS. Once it is established, management begins by resuscitation to allow airway securing and obtain oxygenation.

Once the child is stabilized, depending on the degree of injury several options are available such as Hyperosmolar therapy, cerebrospinal fluid drainage, barbiturate therapy, seizure treatment etc. Hyperosmolar therapy includes the administration of agents such as glycerol and mannitol and the therapy is deemed good for head injuries (Huh and Raghupati, 2009). In extreme cases, surgical intervention is deemed necessary and decompressive craniotomy has been known to be effective against shaking baby syndrome. The surgery is conducted to help lower the pressure created in the brain owing to the accumulation of blood and also to control tissue damage in the brain subsequently helping to control further damage.

The surgical intervention helps to reduce mortality and morbidity and also preserve hearing in cases of acute shaking or shaking baby instances (Cho et al, 1995). The survivors may undergo speech and language therapy, vision therapy, occupational therapy as well as physical therapy.

References

Cho,D et al (1995). Decompressive Craniotomy for Acute Shaken/Impact Baby Syndrome.

Pediatric Neurosurgery, 23 (4): 192-198.

Huh, J and Raghupati,R. (2009). New Concepts in Treatment of Pediatric Traumatic Brain Injury.

Anesthesiol Clin.. 27 (2): 213-240.

Reith, W. et al. (2009).Shaken Baby Syndrome. Der Radiologe, 49 (10): 926-931.

Richards,P.G. et al .(2006).Shaken Baby Syndrome.Archives of Diseases in Childhood. 91(3):

205-206.

Scheir,W. (2008). Shaken baby syndrome: the quest for evidence. Developmental medicine and

Child Neurology,50 (1): 10-14.

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