Shaken Baby Syndrome: Simple Review Article

Shaken Baby Syndrome (SBS) occurs in infants when the head is subjected to excessive acceleration and deceleration. Guthkelch first identified SBS when he noticed that infants with subdural hematoma did not always have gross markings, indicating the possibility of a baby shaking. The rotational force pushes the brain against the skull, causing various types of head and neck injuries. Ophthalmologic testing for retinal haemorrhages and ocular fundus, which can rule out SBS, is one of the tests for SBS. Immunohistochemical staining for -amyloid precursor protein (-APP) and magnetic resonance imaging (MRI) accurately identify brain injuries and bleeding, resulting in a more accurate diagnosis of SBS. SBS symptoms are shared by other etiologies, making it difficult to determine the true cause of infantile injury. Experiments using biomechanical models to recreate the whiplash movement have not revealed subdural haemorrhaging, but limitations in the models have doubt to these results.

Fractures and skin lesions in pediatric abusive head trauma: a forensic multi-center study

Abusive head trauma (AHT) and its most common variant, the shaken baby syndrome (SBS), are predominantly characterized by central nervous system-associated lesions. Relatively little data are available on the value of skeletal and skin injuries for the diagnosis of SBS or AHT. Thus, the present study retrospectively investigated 72 cases of living children diagnosed with the explicit diagnosis of SBS during medico-legal examinations at three German university institutes of legal medicine. The risk of circular reasoning was reduced by the presence of 15 cases with confession by perpetrators. Accordingly, the comparison with the 57 non-confession cases yielded no significant differences. Skeletal survey by conventional projection radiography, often incomplete, was found to be performed in 78% of the cases only. Fractures were found in 32% of the cases. The skull (43%) and ribs (48%) were affected most frequently; only 8% of the cases showed classic metaphyseal lesions. In 48% of the cases, healing fractures were present. Skin lesions (hematomas and abrasions) were found in 53% of the cases with the face (76%), scalp (26%), and trunk (50%) being the major sites. In 48% of the cases, healing skin lesions were observed. Nearly 80% of the cases with fractures also showed skin lesions. The data prove that SBS is frequently accompanied by other forms of physical abuse. Therefore, skeletal survey is indispensable and should always be done completely and according to existing imaging guidelines if child abuse is suspected.

Non-pharmacological therapy for infantile colic

Infant colic is an inconsolable cry of unknown cause in healthy babies. Observed in about 20% of infants, the most common reason for seeking medical attention at an early age. Colic is associated with maternal stress and the most significant risk factor for shaken baby syndrome, and can also cause premature breastfeeding termination. Informing and supporting parents with crying babies is increasingly important, and some guidelines recommend it as a cornerstone of intervention in families with a baby with colic. Because of the high quality randomized trials, none of the behavioral, dietary, pharmacological, or alternative interventions can be recommended as the only effective treatment. Unfortunately, many mothers around the world associate their child’s anxiety with “dietary mistakes” in their diets, leading to further dietary restrictions as a preventative measure. At the same time, according to the recommendations of the experts of the IV Rome Criteria, dietary restrictions for infant colic in breastfeeding mothers can be recommended only if there is a suspicion of suspicion of tolerance of cow’s milk protein. It is also possible for any type of feeding to prescribe fennel and chamomile preparations, in particular, in the form of aqueous infusions, and when breastfeeding it is desirable to use a bottle and excessively large volumes, which can reduce the amount of milk in a woman. It is desirable to exclude unreasonable dietary restrictions in breastfeeding mothers by excluding the so-called “gas-forming products” and ineffective therapy, in particular simethicone preparations.

Effectiveness of Educational Materials Designed to Improve Knowledge Regarding Crying and Shaken Baby Syndrome in Mothers of Hispanic Population

Background: Caregiver frustration with inconsolable crying is a commonly cited antecedent factor of Abusive head trauma (AHT) in infants. Objective: To assess the effectiveness of an educational intervention to improve patients’ knowledge of normal crying patterns in infants and the implications of AHT among women of Hispanic population. Methods: The Period of PURPLE Crying program was piloted as part of Centering Prenatal Care at an outpatient clinic site in the Harris County Health Department system, which cares for a primarily underserved and Spanish speaking population. Educational material and direct counseling were delivered by the clinician. Demographic data was collected and a pre- and post-test survey was administrated to assess participant’s knowledge and behavior. Results: Between April 2017 and April 2018, 63 Hispanic women were included in this study. Prior to implementation of the educational tool, most of the survey questions were answered incorrectly. After the intervention, knowledge regarding normal infant crying patterns was significantly improved in all questions. However, knowledge gaps persisted especially in relation to the adequacy of parents’ ability to soothe a crying infant and normalcy of excessive crying. Conclusions: The educational curriculum was an effective tool for improving knowledge about normal infant crying patterns in Hispanic mothers.

Trends in shaken baby syndrome diagnosis codes among young children hospitalized for abuse

Objective To investigate national trends of SBS diagnosis codes and how trends varied among patient and hospital characteristics. Methods We examined possible SBS, confirmed SBS, and non-SBS abuse diagnosis codes among children age three and younger who were hospitalized for abuse between 1998 and 2014 using a secondary analysis of the National Inpatient Sample, the largest US all-payer inpatient care database (N = 66,854). A baseline category logit model was used based on a quasi-likelihood approach (QIC) with an independent working correlation structure. Results The rate (per 100,000 census population of children age 3 and younger) of confirmed and possible SBS diagnosis codes was 5.4 (± 0.3) between 1998 and 2014, whereas the rate of non-SBS abuse was 19.6 (± 1.0). The rate of confirmed SBS diagnosis codes increased from 3.8 (± 0.3) in 1998 to 5.1 (± 0.9) in 2005, and decreased to 1.3 (± 0.2) in 2014. Possible SBS diagnosis codes were 0.6 (± 0.2) in 1998, increasing to 2.4 (± 0.4) in 2014. Confirmed SBS diagnosis codes have declined since 2002, while possible SBS diagnosis codes have increased. All abuse types were more frequent among infants, males, children from low-income homes, and urban teaching hospitals. Conclusions We investigated seventeen-year trends of SBS diagnosis codes among young children hospitalized for abuse. The discrepancy between trends in possible and confirmed SBS diagnosis codes suggests differences in norms for utilizing SBS diagnosis codes, which has implications for which hospital admissions are coded as AHT. Future research should investigate processes for using SBS diagnosis codes and whether all codes associated with abusive head injuries in young children are classified as AHT. Our findings also highlight the relativity defining and applying SBS diagnosis codes to children admitted to the hospital for shaking injuries. Medical professionals find utility in using SBS diagnosis codes, though may be more apt to apply codes related to possible SBS diagnosis codes in children presenting with abusive head injuries. Clarifying norms for SBS diagnosis codes and refining definitions for AHT diagnosis will ensure that young children presenting with, and coded for, abusive head injuries are included in overall counts of AHT based on secondary data of diagnosis codes. This baseline data, an essential component of child abuse surveillance, will enable ongoing efforts to track, prevent, and reduce child abuse.

Prevention of Shaken Baby Syndrome Among High-Risk Neonates: Program Implementation and Evaluation

Background: Studies suggest that the implementation of high-quality education and support services for caregivers may reduce the incidence of unplanned harm to infants and young children under high-stress circumstances. Purpose: This pilot study evaluates the usefulness of the Period of PURPLE Crying program in a high-acuity NICU at The University of Chicago Comer Children’s Hospital based on six measurable objectives. Methods: The pilot study utilized a Likert-style pretest-posttest survey design to evaluate how NICU nurses perceived the Period of PURPLE Crying program. Nurses were educated on the program content during an in-service to teach participants how to utilize the Period of PURPLE Crying program materials to support and educate families about Shaken Baby Syndrome (SBS). Results: The intervention effectively increased nursing confidence in delivering the SBS and Abusive Head Trauma (AHT) education and increased accessibility to available resources pertaining to SBS and AHT. Questions pertaining specifically to the Period of PURPLE Crying presented exclusively on the post-test were met with an overwhelmingly positive response, with the majority (n=33, 97%) of respondents agreeing that the intervention was useful in standardizing SBS education, providing meaningful, effective information on this topic area, and delivering SBS and AHT information promptly.

Knowledge of Shaken Baby Syndrome among Hospital Nurses in Erbil City

Background and objectives: Shaken baby syndrome and pediatric abuse head trauma are the most common causes of mortality and morbidity due to physical child abuse. Nurses have a main role in parents’ education regarding child abuse prevention. This study aimed to assess nurses’ knowledge regarding shaken baby syndrome in Erbil City. Methods: A descriptive study was conducted at postpartum units, the delivery room and the ward at the Maternity Teaching Hospital, and the inpatient and intensive care units at Rapareen Pediatric Teaching Hospital in 2017 in Erbil City. A purposive sample of 50 nurses was recruited to the study. The data collection was performed using a questionnaire for interviewing the study participants, and the data were analyzed using descriptive and in-ferential statistical analysis. Results: The study findings revealed that the majority of the study participants were 19-25 years old and most did not have enough knowledge regarding the signs and symptoms of the shaken baby syndrome (irritability, lethargy, poor feeding breathing problems, uncon-trollable crying, vomiting, bluish skin, changes in sleeping pattern, convulsions or seizures and unresponsiveness). Nurses also had insufficient knowledge about the risk factors of this condition. Only a quarter of nurses knew that domestic violence is a risk factor and less than a quarter of them recognized depression and substance abuse of the caregiver as a risk factor. Regarding knowledge of the complications, the study found that a quarter of nurses knew that brain damage, cerebral palsy and blindness are complications of the shaken baby syndrome. Conclusions: Majority of nurses had poor knowledge about causes, signs, symptoms, risk factors and complications of the shaken baby syndrome.