Shaken Baby Syndrome – What are my legal rights?

By admin

Shaken baby syndrome (SBS), also known as abusive head trauma (AHT), refers to a combination of injuries that occur when an infant or young child is violently shaken. When a baby or young child is shaken violently, its head snaps back and forth or from side to side. Children’s brains are softer than adults’ brains, their neck ligaments are weak and not fully developed, and their heads are large and heavy in proportion to the rest of their bodies. In SBS, the infant’s brain is first pushed against one side of the skull, and then against the other. The bumping action can cause brain tissue to tear, blood vessels to break, and bruises to the brain, causing pressure and swelling of the brain. The large veins along the outside of the brain may tear, leading to further bleeding, swelling, and increased pressure, which can easily cause permanent brain damage or even death. Serious damage can be done in only five seconds of vigorous shaking of the child. SBS can occur if the child receives as few as three rapid shakes. Head impact is not necessary to develop brain swelling and trauma, but often the child is thrown onto a crib mattress or even into a wall.

Crying is by far and away the most common cause of shaken baby syndrome. It is a fact of nature that an infant spends at least two to three hours a day crying. But the caretaker, who may be frustrated in other areas of his or her life, takes out his or her anger by violently shaking the infant. Normal play, such as bouncing a child on one’s knee or gently tossing the child in the air do not cause SBS. The perpetrator is most often a male in his early twenties who is married to the mother or is the mother’s boyfriend. Women who injure babies are more likely to be a babysitter or childcare provider than the child’s mother. The child’s mother accounts for approximately 10 percent of SBS cases.

A baby’s head makes up as much as 25 percent of the baby’s weight, and the baby’s neck muscles are not sufficiently developed to support a disproportionately large head. An infant’s brain is softer than the brain of an adult, and the protective tissue that surrounds the brain only begins to form at birth, making the blood vessels more fragile and easily ruptured.

Shaking or throwing a child or slamming the child against an object causes uncontrollable forward, backward, and twisting head movement. Brain tissue, blood vessels, and nerves tear. The child’s brain can hit the skull with force, causing brain tissue to bleed and swell. The violent shaking can also cause injury to the cervical cord resulting in paralysis, bleeding in the eyes, and even death.

The injuries associated with SBS may not show up immediately. The infant may have nonspecific complaints, such as lethargy, breathing difficulties, irritability, and vomiting, which can be attributed to sources other than the shaking.

Shaken baby syndrome can occur in infants as young as a few days to children as old as five years. The majority of cases involve infants from three to eight months old. 25 percent of all children diagnosed with SBS die from their injuries. An infant or young child that has been violently shaken often requires emergency medical treatment, including life-sustaining measures such as breathing support and surgery to stop internal bleeding and bleeding in the brain.

Many cases of SBS or AHT are brought in for medical care as “silent injuries.” The parents or caregivers don’t admit to the doctor that they had violently shaken the infant or threw the infant head-first against an object. Because of this lack of information, the doctor doesn’t know to look for subtle or physical signs. This can sometimes result in children having injuries that aren’t identified in the medical system and the child’s being returned to the person who violently shook him or her. Unfortunately, in mild cases in which the infant seems lethargic, fussy, or perhaps isn’t feeding well, the doctor will misdiagnose the infant’s condition as a viral illness or colic. Without a diagnosis of child abuse and any resulting intervention with the parents or caregivers, these children may be shaken again, worsening any brain injury or damage from previous shakings.

Without the parents’ or caregiver’s disclosure of how the injuries really happened, shaken baby syndrome can be difficult for the pediatrician or emergency room doctor to diagnose, as there may be no visible symptoms in the baby even when there is extensive damage to the baby’s brain, and the parents or caregiver who inflicted the injury is not going to admit shaking the baby. As the brain swells and presses against the skull, damage to nerves and other areas of the brain may occur. Some of the more serious injuries that may result include blindness, hearing loss, paralysis, speech impairment, mental retardation, learning disabilities, and even death.

Some of the symptoms of SBS are vomiting, seizures, loss of consciousness, bleeding in the eyes, difficulty breathing, convulsions, decreased feeding, difficulty sucking or swallowing, no smiling or making sounds (“vocalization”), rigidity, pale or bluish skin, the head or forehead appears larger or the soft spot on the head appears to be bulging, inability to lift the head, and inability of the eyes to focus or track movement or unequal sizes of the pupils. Children who have been shaken violently may also sustain broken ribs, arms, legs, and neck.

If SBS is suspected, the doctor may look for: 

• Bleeding in the retinas of both eyes

• Skull fractures

• Swelling of the brain

• Subdural hematomas (collections of blood pressing on the surface of the brain

• Fractures of the ribs or “long bones” (the arms and legs)

• Bruises around the head, neck, or chest

If the doctor suspects SBS, in addition to a thorough physical examination of the child, he or she may order a computed tomography (CT) scan or a magnetic resonance imaging (MRI) of the child’s head to check for swelling of and bleeding in the brain.

About one out of every four babies who has been violently shaken or thrown against an object, such as a crib mattress or a wall dies from his or her injuries. Survivors suffer permanent damage in the form of developmental problems, such as seizures, muscle stiffness, mental retardation, blindness or trouble seeing, physical or emotional growth delays, and learning or behavioral problems that may not appear until the child starts school.

Infants who have suffered SBS require emergency care, often including respiratory support and surgery. It is frequently necessary to drain the blood around the brain to decrease the ongoing brain injuries associated with brain swelling. Additional treatment may be required, including obtaining ophthalmologist and neurological examinations.

The prognosis for a baby that has been violently shaken is poor. Up to one in four victims of SBS die of their injuries. Those that survive may suffer from complete or partial blindness, mental retardation, loss of motor (muscular) control, cerebral palsy, neck and spinal cord injuries, learning and physical disabilities, hearing and speech disabilities, seizures, behavior disorders, and cognitive disorders.

A doctor, social worker, therapist or certain other professionals who suspect child abuse—such as violently shaking a baby—is under a legal obligation to report his or her suspicions to Child Protective Services.