Never shake your baby

One momentary lapse in judgement – like shaking your baby out of sheer frustration – can change his life forever.

It’s 2am. You’re dog tired, and your ears are ringing from the incessant crying that’s echoing in your head. Baby is awake. Again!

You’d never hurt your bundle of joy. But, for just a split second, you’d trade the world for a moment’s peace and quiet. It’s in these dark hours when even the most doting and loving parent can easily snap. Abusive head trauma, commonly known as shaken baby syndrome (SBS), is caused when an adult forcefully shakes a baby or toddler, often in an attempt to get them to stop crying. Because infants’ neck muscles aren’t well developed and provide little support for their heads, this violent movement pitches the brain back and forth within the skull, possibly causing lifethreatening injuries.

THE FACTS

While there are currently scant statistics regarding the number of SBS cases in South Africa, an extrapolation of overseas research suggests that we should be recording about 300 cases per year. “South Africa scores highly on a number of risk factors for SBS,” writes Frances Mattes in a 2016 dissertation on the syndrome through the University of Cape Town.

“Poverty, violence and social isolation increase parents’ and caregivers’ levels of stress and frustration, known precipitants of SBS, putting them at greater risk for shaking their babies,” Frances writes. The American Center for Shaken Baby Syndrome estimates that each year between 1 200 and 1 400 children are injured or killed by abusive head injuries in the United States.

The perpetrator is usually a caregiver or parent, with 65 to 90 percent being male. The Teddy Bear Clinic’s Shaken and Abused Baby Initiative is said to see at least one case a month in the Johannesburg area alone. Younger children are at particular risk. Where there are special needs children, multiple siblings, or conditions such as colic or reflux, there’s an increased risk of SBS.

WHAT YOU DON’T KNOW ABOUT SBS

We don’t always realise just how harmful shaking a baby can be.

The late professor Lorna Jacklin, who used to be a consultant paediatrician and neuro-development specialist at Wits and a founding member of the Teddy Bear Clinic, dealt with a number of SBS cases. Prof Jacklin advised caregivers to understand the impact that shaking a baby has on their skull, underdeveloped brain and also their neck muscles, which are still weak because they’re developing. “The brain of a young infant has a relatively large fluid content, and there is a differential density between the white and grey brain matters,” she said. “During episodes of SBS, the brain moves at a different rate to the skull, causing the bridging veins to tear, resulting in subdural haemorrhages.” These are bleeding in the matter around the brain. “In addition, there is bleeding at the interface between the grey and white matter and tearing of the long association fibres. Shaking can also cause bleeding into the back of the eyes. Many babies who are shaken also have broken ribs because they are held forcibly around the chest and squeezed when they are shaken, and can suffer other broken bones.”

SIGNS AND SYMPTOMS

In any head-trauma case, the duration and force of the shaking, the number of episodes, and whether impact is involved all affect the severity of the baby’s injuries. Some of the symptoms of SBS include:

• lethargy or irritability

• vomiting, poor sucking or swallowing

• decreased appetite

• ceasing to smile or talk

• rigidity

• seizures

• difficulty breathing

• being blue due to lack of oxygen

• altered consciousness

• unequal pupil size

• inability to lift the head and focus the eyes or track movement

• broken bones

“Seizures are a reflection of the extent of the damage,” Prof Jacklin said. In the long run, SBS might result in physical, developmental and neurological problems. One-third of children who suffer from SBS die, Prof Jacklin noted, one-third have severe neurological complications at discharge from hospital or care, and a third may appear normal on discharge but later experience significant developmental problems.

Related long-term consequences of SBS include partial or total blindness, hearing loss, seizures, delays in development, impaired intellect, speech and learning difficulties, problems with memory and attention, severe mental retardation and cerebral palsy.

TREATMENT AND CARE

Cases of SBS are treated the same way as brain damage. The children are resuscitated if necessary and then admitted to hospital for further care. SBS survivors need long-term management by a multidisciplinary team. Identifying and managing the predisposing social factors that may have led to the SBS are also key.

It is vital to intervene as quickly as possible. “If a baby is shaken, it is important to seek help immediately, as the more often the baby is shaken, the worse the outcome. A caregiver who injures a child once is likely to do it again,” Prof Jacklin warned.

CAN PLAY CAUSE SBS?

By definition, said Prof Jacklin, SBS is deliberate and never accidental. The normal ways that most of us interact and play with our babies (bouncing them on the leg, swinging them around, jiggling them in our arms or tossing them gently in the air) don’t cause SBS.

An accidental fall (most young children have at least one big fall, and often more) is also extremely unlikely to cause the condition, as it results specifically from a deliberate and violent back-andforth motion.

SPREAD THE WORD

The saddest part of SBS is that it is entirely preventable. While it most commonly happens in families where parents are young and from lower socioeconomic backgrounds, this is not always the case. A lack of emotional support, financial stress and postnatal depression may also be factors.

A key aspect of prevention is increasing awareness of the potential dangers of shaking. Caregivers who’ve confessed to shaking a baby often have little childcare experience, are under stress – due to sleep deprivation, depression and anger, among others – or are simply unaware of the dangers. Finding ways to alleviate the parent or caregiver’s stress at the critical moments when a baby is crying can significantly reduce the risk to a child.

It’s important to tell anyone caring for a baby to never shake them. We need to talk about the dangers of shaking with all our children’s caregivers, and explain how it can be prevented. We also need to be selective when appointing caregivers, and trust our instincts. ●