Shaken Baby Syndrome

Dear ParentLine,

I just read about a case where a baby was shaken to near death, shaken so much that if he lives, he’ll probably be brain damaged. My brother-in-law has talked about when he comes home from working two shifts and hears his baby crying and crying and fussing, the house is a mess, everyone’s stressed, and there’s puke on his only clean work shirt and such, that he’s afraid of handling his baby when so frustrated. Will he be too rough when picking her up and putting her down, that sort of thing? What can they do to help their baby feel better, stop fussing, and calm their household down so there’s less stress?

Signed, Frightened for Baby and Family in Frigid Central NH.

ParentLine urges you to intervene--gently and without judgment—in your sister’s family. There’s profound truth in the statement that it takes a village to raise a child. To be a parent is the most demanding job a person can have, never mind working two shifts to support the family! What you describe is a situation in which the adult players need time out and help right now.

Sometimes, such help simply means to offer an extra pair of hands to rock the baby, to cook a meal, or to help the other children in the family learn to make their beds or pick up their toys. By “being there” for your sister and brother-in-law to help them until they can help themselves establish calm in the place of chaos, you may avert a crisis. Situations like theirs, that are high-stress and emotionally charged environments, can put babies at risk of Shaken Baby Syndrome (SBS).

The basic fact about babies is that they cry because they can’t talk. An infant doesn’t have words to tell Mom or Dad they’re hungry, wet, sick, or just want company. When a baby cries, it’s using the only way it has to tell the grown-up person that it needs something. How the child’s needs are met—whether with a loving response or indifference, anger or worst of all, violence—creates an impact on the way the child’s brain develops.

If, as you suggest, your brother-in-law is exhausted, comes home to chaos, and a crying baby who won’t be placated, this is a situation in which a disaster is waiting to happen. According to JoAnn Cobb, MSW, LICSW, and director of Child and Family Services’ Early Supports and Services and Healthy Families programs, “Families with babies are at risk when there are lots of stressors both outside and inside the home. One of the biggest risks is when a stressed-out parent becomes angry and frustrated with a baby who’s not on the parent’s ‘schedule,’ and may not cooperate or understand that daddy or mommy needs a break.”

Cobb explains, “Babies are really needy in the first six months of their lives. They require patience and understanding because they have no other way to communicate their needs other than crying. Some babies are easier and some cry more than others. This may have something to do with their temperament. When a baby’s schedule is more difficult—meaning they don’t sleep and eat or get soothed like they should—the parent(s) can become very frustrated. For example, if the parent is exhausted and tries to take a nap and the baby starts to cry and won’t stop, this is when the overwhelmed parent may be at risk of shaking their baby.”

Though SBS was first discussed in medical literature in 1972, knowledge about the syndrome continues to develop. SBS can occur when children are violently shaken as part of a pattern of abuse or simply because an adult has momentarily succumbed to the frustration of responding to a crying baby. Research from University of Miami (www.miami.edu) tells us that in the US, there are an estimated 50,000 cases of SBS each year, that in one out of four cases the child dies, and that those who do not die are usually left with severe and permanent brain damage.

Babies have heavy heads and weak neck muscles. Shaking makes their head flop back and forth, causing their brain to slam against the hard skull. This causes bleeding inside the head and increased pressure on the brain, which then causes damage to the brain tissue. Shaking the baby can cause cerebral palsy, developmental delays, hearing loss, blindness, mental retardation, seizures, paralysis, and in about 1/3 of the cases, death. The number one reason a baby is shaken is because of the inconsolable crying that causes the caregiver to become frustrated and angry.

SBS can occur when:

A baby has been crying incessantly
Parents are sleep-deprived
A baby has been slapped or hit in the head
Parents feel frustration and anger toward their baby
A baby has been tossed repeatedly into the air, even in play
In babies 3-6 months old (colic and prolonged crying)
In toddlers 18-24 months old (“terrible twos” behavior)

Urge your sister and brother-in-law to get help. There are family support programs throughout New Hampshire that can help families under stress. A home visitor can come to see your family members and determine how to help them in the most beneficial way possible. When a baby cries….

Try to stay calm—when you are upset, your baby becomes even more upset. Sit down, close your eyes and count to 20. Take a deep breath, and then go to your baby.
Don’t pick the baby up until you feel calm.
Make sure the baby is fed, burped and dry.
Check for discomfort with diaper rash, teething or fever.
Call the doctor if you think that the baby is sick.
Give the baby a pacifier.
Feed her/him more slowly, burp her/him frequently.
Gently hug, cuddle and reassure the baby. Try a different holding position (the “football hold, or hold against your chest), walking, rocking or swaying.
Take him/her for a ride in the car or stroller, or place her in a baby swing.
Play soft music or sing to the baby.
Ask a friend to help you watch the baby.

Additional resources

Shaken Baby Syndrome Prevention Plus: (800) 858-5222

National Center on Shaken Baby Syndrome: www.dontshake.com

American Academy of pediatrics: www.aap.org

Prevent Child Abuse America: www.preventchildabuse.org

ParentLine is a free and confidential service of Child and Family Services, a statewide, independent, nonprofit organization dedicated to advancing the well-being of children and families. Call ParentLine, 1-800-640-6486; write ParentLine, c/o Child and Family Services, P.O. Box 448, Manchester, NH; email parentline@cfsnh.org or visit our website at www.cfsnh.org.