The Child Safety Project: Shaken Baby Syndrome

The Child Safety Project was created to prevent the injury or even death of very young children (aged 0-4). To reach our desired impact on families, our specialists organize information and counseling sessions for parents and caretakers whose children are at risk of developing Shaken Baby Syndrome (SBS). One particularly important demographic is the parents of children hospitalized in state health facilities, both those in which Fundația Inocenți runs Child Life programs and various others. This subject is also brought up by our specialists in their work with the beneficiaries of our educational support programs.

We believe awareness and educational campaigns to be useful in preventing SBS and its devastating immediate and long-term effects on children’s health. Currently, Romania does not officially report statistics on SBS incidence, but given statistics from many Western countries, it is probable that this is a failure on Romania’s part to diagnose SBS.

In 2006, Fundația Inocenți implemented a pilot program at the Alessandrescu-Rusescu Institute for Mothers’ and Children’s Health. Here, specialists inform and educate those mothers hospitalized with their infants about SBS prevention. This project was made possible with the help of the “Lift the Children” Foundation and was implemented by Conf. Dr. Tatiana Ciomârtan, PhD, who has by now instructed thousands of participants (doctors, nurses, medical students, social workers, psychologists, educators, and parents). Another crucial part of project’s implementation was the three years of financial support we received from the American Academy of Pediatrics. Using this grant, we were able to create the material necessary to implement our program and disseminate SBS prevention information. All these activities are being continued to this day in the locations Fundația Inocenți operates. Along the years, more partners have lent their support to our campaign, primarily the Holt Romania Foundation, Sensiblu Foundation, Sf. Pantelimon Clinical Emergency Hospital and Polizu Maternity.

Shaken Baby Syndrome

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Shaken Baby Syndrome is a type of traumatic brain injury brought on by child abuse, which happens when a parent or caregiver violently shakes an infant to make it stop crying. According to the Committee on Child Abuse and Neglect of the American Academy of Pediatrics, SBS “results from extreme rotational cranial acceleration induced by violent shaking or shaking/impact, which would be easily recognizable by others as dangerous.”

What happens when a baby is shaken?

During a period of violent shaking, the child’s brain is subjected to strong shearing forces which cause permanent injury in the form of swelling and internal bleeding. The same movements can cause blindness by rupturing small blood vessels inside the eye. Often, this is accompanied by rib fractures inflicted when the person shaking the baby grabs it by its chest. Arm and leg fractures may occur as well, as limbs move back and forth erratically during the shaking.

The damage being shaken inflicts upon babies is particularly severe because of some unique characteristics of their small, developing bodies:

  • Infants’ heads are quite heavy, making up approximately 25% of total body weight;
  • Their neck muscles are much less developed than the adults’, being thus unable to limit the head movements when violently shaken;
  • The space inside the skull surrounding a child’s brain is larger than the same space in an adult, allowing their brains to travel larger distances and accelerate more before impact;
  • Babies’ brains are not fully developed and thus prone to injuries caused by acceleration. Their blood vessels are fragile and loosely anchored, so they can easily tear.

Click here to learn about the 4 most frequent and easily diagnosable injuries caused by SBS.

Surface brain bleeding: when shaken, the vessels that link the brain to its protective membranes tear. These ruptures cause bleeding on the surface of the brain, which in turn harms the nervous cells and can determine loss of function in the injured area.

Brain swelling: as the brain hits the skull during violent shaking, it swells as a response to this repeated impact trauma and thus creates pressure on brain tissue. If the swelling doesn’t diminish, this brain tissue starts to die. Children who survive this form of abuse can suffer from long-term disabilities such as blindness, seizures, cognitive deficiencies, loss of motor control, and cerebral palsy.

Hemorrhaging in the back of the eye: the whiplash generally affecting the skull appears more specifically in the eye sockets as well. A child’s eye has more space to move inside its socket than an adult’s would and thus the acceleration when, shaking, their eyes hit the back of their sockets is higher. The resulting injuries cause a unique type of retinal hemorrhage which can permanently affect the optic nerves, which in turn leads to long-term blindness and even eye loss.

Spinal cord injuries: When an infant is being shaken, it undergoes a rotational movement which, in extreme cases, leads to sectioning of the spinal cord.

It is possible for an incident of shaking to leave no obvious signs of injury, which makes diagnosing SBS harder, leaving many of its victims undiagnosed. Many aggressors deny having shaken their baby or offer other reasons for his or her injuries. Doctors who see inexplicable head and/or eye injury along with rib fractures must investigate the possibility of head trauma caused by abuse. Otherwise, in the long term, the injured child may experience stunted growth, seizures, permanent cerebral palsy and even SIDS (Sudden Infant Death Syndrome). In this last case, autopsies will often uncover older injuries that betray SBS.

DON’T SHAKE BABIES. EVER.

Hold them. Caress them. Love them…

Crying

  • Crying is NORMAL and is a part of healthy child development.
  • Crying is a way in which your child communicates (for infants, they might have no other way to do it!)
  • A baby cries an average of 2.5 hours every day.
  • It’s often the most difficult part of caretaking, especially when the child will not stop crying.
  • Children don’t cry to anger or upset us.

Why is the baby crying?

It could be because it…

  • is hungry;
  • needs to burp;
  • wants to nurse or suck on a pacifier;
  • needs its diaper changed;
  • is too cold or too hot;
  • is sick and cranky;
  • has a diaper rash;
  • is teething;
  • is tired;
  • is excessively stimulated;
  • has cramps;
  • has some minor discomfort from intestinal gas;
  • has a fever;
  • is in pain;
  • is bored and needs an activity;
  • needs to be held and caressed;
  • reacts to the stress of its caretaker.

What can you do to soothe a crying baby?

  • create a new, gentle sound to distract the baby;
  • show the baby something new to look at;
  • sing to the baby;
  • gently rock the baby;
  • give the baby a warm bath;
  • place the baby in a different position or gently stroke its back;
  • push the baby around in a stroller;
  • take the baby on a walk;
  • if the baby is sick, seek and follow the advice of a doctor.

Recommendations for caretakers:

  • reduce your own stress (take a walk, have a warm bath, call a friend);
  • find a support person that you can call to help you;
  • remind yourself that THE CRYING WILL STOP.

Partner organizations to the Child Safety Project

  • Lift the Children, USA
  • The Alessandrescu- Rusescu Institute for Mothers’ and Children’s Health
  • The Bistrița Emergency Hospital
  • The Dr. Victor Gomoiu Clinical Children’s Hospital for Children

Useful links:
www.liftthechildren.org
www.aap.org
www.realityworks.com

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