Shaken Baby Syndrome

Shaken Baby Syndrome

In this month’s article we take a look at the subject of shaken baby syndrome.

Shaken baby syndrome is a serious issue and one that makes the headlines on lots of occasions. Not only can shaking a baby kill a baby it can, at the very least, leave the child with lifelong lasting damage that cannot be repaired.

1 in 4 shaken babies DIE!

So, in this month’s article we thought we would look at what shaken baby syndrome is, and look at a few examples from the headlines.

What is shaken baby syndrome?

Shaken baby syndrome is also referred to as abusive head trauma, shaken impact injury, inflicted head injury or whiplash shake injury. In its simplistic form shaken baby syndrome is a baby or a child being shaken violently, and sometimes repetitively over and over. It is also caused by the child being thrown or slammed against another object; however, the head does not necessarily have to hit an object in order to cause damage, the shaking of the brain inside the skull can be enough.

The damage caused to the child includes, but is not limited to, damage to the brain, bleeding around the surface of the brain, bleeding in the retinas of the eye, and fractures.

As we have already mentioned, shaken baby syndrome can at the very least cause a child to grow up with long-lasting injuries that can affect them for the rest of their lives or can cause death.

Children under the age of 1 are most at risk of shaken baby syndrome due to the nature of the age range, and obviously they tend to cry a lot more, however any child of any age is at risk.

The simple truth here is that NO child should be shaken, EVER.

Estimates show that between 14 and 33.8 per 100,000 children suffer ‘non-accidental head injuries’ each year according to the NSPCC, this includes shaken baby syndrome. To give this some context, if you base population on 800,000 children, between 112 and 270 of these children would be suffering from these non-accidental injuries each year.

The cause of shaken baby syndrome

Babies have weak neck muscles which often struggle to support the weight of the child’s head. Therefore, these muscles are not strong enough to prevent the shaking motion when a baby is shaken with force allowing the brain to be shaking inside of the skull.

One of the most common causes of shaken baby syndrome is the adult’s frustration at the child’s crying. This can cause the adult, usually the parent to ‘snap’ if the child’s crying is persistent over a long period, and in a bid to stop the child crying the adult ‘snaps’ and shakes the baby to stop their crying. In that split 3 to 5 seconds a lot of damage can be caused.

This is NOT an acceptable excuse, STOP and think before you act. Have a plan – Take a break!

Other reasons that have been seen over the years is one parent’s jealousy of another, resulting in taking it out on the child or by causing the child an injury the parents have to come together and therefore the guilty party gets the attention from the other parent that they were seeking. We will look at this particular reason in due course when we look at 2 cases from the news headlines.

Jealousy is no reason to harm a child EVER!

Another cause of shaken baby syndrome can actually be a complete accident, where the child has slipped out of the grasp of the parent’s arms and has shaken their head as they fall to the floor, as well as hitting their head potentially on the floor as well as any other hard surface as they fall to the floor from their parent’s grasp or from the nappy changing table, or even bed. Of course, it is perfectly feasible that a parent could fall over accidently while they are walking with their child and this too can cause the child to suffer from shaken baby syndrome.

Some parents/child carers have unrealistic expectations of the child in their care and therefore lash out at the children through frustration because they are not achieving what they feel is achievable for the child. This could be because of the expectations that they had placed on them by their parents, therefore causing a vicious cycle that repeats itself.

Another risk factor of shaken baby symptom is when the parent is a single parent and therefore trying to cope with looking after a child on their own, maybe with little or no support; it may also be that they are coping with the break-up of a relationship as well as having to meet the needs of their baby. It may be the case that the parent of the child is young and may not have the support of others or little life experience and is unsure of how to soothe and meet the child’s needs.

Other situations that could cause a parent to lash out and shake their baby could be that they are in unstable family relationships or are suffering from domestic abuse. It could be the case however that the domestic abuser is shaking the baby in order to punish the victim for something that the abuser has deemed they have done wrong.

Depression can impact on a parent’s treatment of their child and therefore can result in them shaking a baby.

The final common risk factor for shaken baby syndrome is concerned with alcohol and substance abuse. Being under the influence of these substances can impair the parent’s rational thoughts and when the child cries or pushes for something reasonable, the parent who is under the influence can react in ways that are irrational and once they have sobered are likely to realise that they have behaved in a manner that is not how they would have behaved in another situation.

Statistically men are more likely to cause baby shaken syndrome than women

What damage can shaken baby syndrome cause?

Shaking a baby or infant can damage and destroy the brain cells preventing the brain from getting enough oxygen, and, as we all know, oxygen is the fuel for life. Shaken baby syndrome is a type of child abuse resulting in permanent brain damage at the very least and potentially also death.

Signs and Symptoms of shaken baby syndrome:

There are some signs and symptoms that should be looked out for in the instance that you are worried a child has been shaken, they are as follows:

  • Facial bruises,
  • Extreme fussiness or irritability,
  • Difficulty to wake,
  • Breathing problems,
  • Eating problems,
  • Vomiting,
  • Pale, bluish skin (Cyanosis),
  • Seizures,
  • Paralysis,
  • Coma.

Although these are all signs that can be seen sadly, due to the nature of the injury inflicted to the child, there may be signs that you cannot see. Injuries that may not be immediately obvious to see include bleeding on the brain, or in the eyes, spinal cord damage, fractures to various bones of the child’s body including, the skull, ribs, and legs as well as any of the other bones in their body.

In mild cases, the child may not actually show any of these signs at all, and may also appear perfectly fine, until much later when they may develop physical or behavioural issues.

No Child should be shaken EVER

If you suspect that a child in your care has been injured by being shaken violently you should seek medical advice immediately. Acting fast and immediately may save the child’s life or prevent serious health issues from occurring. It is worth noting that health practitioners do have a legal duty to report any cases of suspected abuse to the police, however, in the interests of the child this should be seen as a positive step and not a negative one.

Shaken baby syndrome IS child abuse

First Aid textbooks say gently shake

Textbooks that are aimed at adult casualties state that the casualty should be gently shaken in order to determine whether they are responsive or otherwise. Whilst this is written in textbooks and is up-to-date advice from the Resuscitation Councils of Europe and the UK, the key word in that sentence is ‘gently’. This is important for many reasons including not causing any further unnecessary injury to the spine of the casualty. Anyone that has attended one of our first aid courses will be aware that we advise first aiders to press on the clavicle (collarbone) to cause a gentle pain to the casualty rather than gently shaking. This gets away from shaking the casualty and causing further spinal damage. However, some first aid textbooks, including the ones that we use on all our first aid courses state that for a child or an infant under the age of 1, you should gently tap the shoulders and depending on the age of the casualty ask loudly ‘are you all right’ or simply shout loudly to try to wake the casualty. Again, there is no sign of the words ‘gently shake’.

However you decide to try to get a response from a child casualty, you should never shake the child in order to get the response.

Shaking a baby is NOT first aid

We thought at this stage of the article we would have a look at some simple tips parents can use to help soothe their child. We have based our top tips on the advice provided by The Canadian Paediatric Society.

How to soothe your child:
  • Check to see whether the crying is a signal that your baby needs something specific, for example:
  • A nappy change,
  • Food,
  • Relief from being too hot or too cold,
  • Attention, or
  • Does your child have a fever.

These may seem the simplest things but sometimes, it really can be the simplest act that soothes a child the most and quickest; it is always worth checking this specific needs’ list.

  • Hold your baby.

Some parents hold a fear that if I ‘give in’ to my child and I hold them too much they might become clingy or spoiled because I gave them too much attention, however, simply holding your child will not spoil them. Although you should be aware that some babies do not like being passed from person to person.

  • Wrap or swaddle your baby.

Tightly wrapping your child can soothe them as they feel protected, could provide some pain relief to the child, and can improve sleep, as long as it done safely it can be a good technique to use. The Canadian Paediatric Society has provided the following advice on how to swaddle a child:

  • Turn off the lights and keep surroundings quiet.

Too much stimulation can trigger crying or make it worse.

  • Soft music, white noise or a gentle shushing noise can soothe some babies.

A top tip that we would suggest and has worked well over the years is the use of low volume panpipe music being played in the background as the child drifts off to sleep.

  • Many babies are soothed by motion.

You could try walking with baby in a sling or in a stroller. Rock or sway with baby in a gentle, rhythmic motion. Or try going for a car ride, many a child has fallen asleep with the gentle motion of the car in transit; some parents however find that this works until the car comes to a halt and the sudden lack of movement and/or engine can cause the child to wake up.

  • Sucking sometimes helps babies to calm and relax.

You can provide this by allowing your baby to breastfeed, or by offering a dummy or even a teething ring. Some children will not want any of these things to suck on and may need a reminder that they can suck their thumb which is their natural soother.

  • Give your baby a warm bath.

The warm water will help to wash over the child, like it does with an adult, it can have a calming effect and then gently aid the child to fall asleep once they are dried.

What can I do if my child keeps crying and it’s getting to me?

If you have checked that your child does not have any specific needs as we discussed earlier, then maybe it is time for you as the childcarer/parent to help yourself feel calmer.

One of the most important things that you can do is to be aware of how you are feeling, whether it be upset, angry or frustrated. In this situation take a moment to relax.

One of the things that parents worry about is leaving their child to cry. If you leave a child in their cot to cry for a few minutes it is not going to do them any harm, and in the meantime you are able to breathe and relax for yourself without snapping and causing further harm to your child. One of the things that you can do is take some slow deep breaths to help you calm and bring your breathing back under control.

If you are feeling emotional and have the urge to cry, then cry. Don’t be afraid to let your emotions out, if you let the tears out it can help you to come back to the child fresh and ready to take the challenge of the child’s needs again.

If you feel that it will help you, you could take a 5 minute shower to let the warm water fall over your body and the sensation of the falling water can actually help you relax and feel calm. Add your favourite body wash scent and a calmer parent should emerge from the shower.

We would always encourage you to talk to someone who you feel that you are able to trust, so that they can potentially support you and your needs, and maybe if you ask them they can look after your child longer than a 5 minute break to help you have some me time and come back all refreshed.

Should you feel that you are at risk of hurting your child the best thing you can do is to place the child safely in their cot, and walk away, calling for help, whether it be a family member, neighbour, support line, social services or the police. The best thing to do is to have a look in your local telephone book for advice lines and local support numbers. We would suggest that you have these in a plan for when these stressful, I can’t cope, I’m going to hurt my child moments occur.

2 Cases from the headlines

To end this month’s article we thought that we would look at 2 cases that have made the news’ headlines in recent years, one of which occurred in the United States and one more recently from the UK. This recent news story was sent to us and is the inspiration for this article.

The Case of Matthew Eappen

In 1997, a British au pair living in the United States of America was convicted of the involuntary manslaughter of 8-month-old Matthew Eappen while he was in her care in Newton, Massachusetts.

On February the 4th 1997, Matthew Eappen was admitted to hospital, where he fell into a coma and died 5 days later from a fractured skull and a subdural haematoma. Matthew was found to have other injuries including a fractured wrist and an unidentified, untreated month-old injury. An ophthalmologist at the hospital also noted that Matthew had retinal haemorrhages, which was judged as a major characteristic of shaken baby syndrome.  

In her police statement, 19-year-old British au pair, Louise Woodward stated that she had popped Matthew onto the bed. This became a controversial phrase for her to use as it has double meaning depending on the country you are in. In the UK, popped would suggest that she had placed or put Matthew on the bed, in America the phrase implies violence. In addition to the use of the word popped, police maintained that Louise had also said that she had dropped him on the floor and been a little rough with him. The police officer who interviewed her immediately after the incident is adamant that Louise had not used the word popped but rather dropped.

Louise Woodward was arrested on February the 5th for assault and battery, which was upgraded to murder on the death of Matthew Eappen. A grand jury in the US judiciary decided on a first-degree murder charge and she was refused jail and held at a high security prison until her trial.

Obviously, leading up to and including her trial there was a lot of interest in this case not just in the United States but also in the UK as Louise was one of their own.

During the trial, the prosecution used evidence from 8 physicians including:

  • A neurosurgeon,
  • An ophthalmologist,
  • A radiologist,
  • 2 pathologists,
  • An expert in child abuse.

All of these physicians testified to their belief that the injuries received by Matthew were as a result of violent shaking and from his head hitting a hard object.

The defence however argued that this cannot be the case; the child in question did not have any neck injuries to him that they would have expected had he received the injuries that the prosecution was alleging. The prosecution initially claimed that the child’s injuries were equivalent to the child having fallen from a 2-storey building however equivocated over this throughout the course of the trial.

The defence also highlighted in their submission that Matthew had some injuries that could have occurred some three weeks earlier than his death, implying that his parents who were both doctors could have been responsible for the injuries to their child. They also said that he had an old wrist injury which could have been caused before Louise even entered the household. She herself under cross-examination stated that she never noticed any slight bumps, marks or any abnormal behaviour prior to his admittance to hospital.

Her defence team even requested that the jury not be given the option of determining manslaughter, but that they should only have the choice of guilty of murder or not guilty. Under direct questioning from the judge, Louise agreed with her defence team; she was found guilty by the jury on October 30th 1997 after 26 hours of deliberation and was sentenced the following day to a minimum of 15 years in prison.

This was not the end of the case!

An appeal hearing commenced on the 4th November 1997, in which her defence team were aware that the original jury were split over the murder charge and the jurors who were convinced of an acquittal were convinced to switch to the murder side. This fact is of no legal consequence, one of the jurors is also quoted as saying that ‘none of the jury thought she had tried to kill him’.

In a post-conviction hearing on the 10th November, Judge Zobel stated, ‘the circumstances in which the defendant acted were characterised by confusion, inexperience, frustration, immaturity and some anger, but not malice in the legal sense supporting a conviction for second-degree murder.’ He added ‘I am morally certain that allowing this defendant on this evidence to remain convicted of second-degree murder would be a miscarriage of justice,’ as he reduced her charge to involuntary manslaughter.

Her sentence was reduced to time served, a total of 279 days and she was freed. There was a prosecution appeal against this which was unsuccessful, and on June 16th 1998, Louise Woodward returned to the UK.

This story does seem to hold questions even today from the evidence that was heard, the question being was the right person in the dock, or had the parents had something to do with the little boy’s death. However, once Woodward was no longer subject to criminal exposure she did admit to ‘lightly shaking the child to revive him’.

Shaking a baby is NOT First aid!

After all these years it is still one of the highest profile shaken baby syndrome cases, and is still talked about in newspapers and magazines on both sides of the Atlantic. In 2007, Woodward was described by Boston law magazine, Exhibit A, as the ‘most notorious criminal convicted in Massachusetts’.

The Case of Mehmet Tufan

Finally, we turn our attention to the article that is the basis for this month’s article; this news story was in the Liverpool Echo and other news’ outlets on June 22nd this year. In the Liverpool Echo the headline read:

Baby robbed of normal life by dad’s angry outburst is only the latest in a line of tragedies

This news story revolves around the court case of Mehmet Tufan who left his son permanently brain damaged by shaking him. The child and mother in the case are not able to be named under court rules. The story highlights everything that we have discussed throughout this article and that parents should be aware of the dangers.

The story of this little boy’s injuries starts on a night in April 2018 when Mehmut was jealous that he was left to look after his 5-week-old son alone as the mother had gone on a night out. After an argument over text messages about a lad asking the child’s mother to dance, Mehmut pretended that the child was seriously ill in an effort to make her come home to him and the 5-week-old child.

Mehmut was scolded by his partner and the baby boy’s mother for trying to make her panic and he later inflicted a catastrophic head injury on to the child. The court heard that he had shaken his son for a ‘matter of seconds’ these few seconds were enough to leave the child unable to walk and blind.

The mother told the court that the child nearly died from his injuries which doctors described as ‘an extensive brain injury, blood in his spinal cord and extensive retinal haemorrhages’ which have left the child in a special wheelchair.

Mehmut pleaded guilty to inflicting grievous bodily harm in what the prosecutors had described as ‘a momentary loss of control’, he was sentenced to 2 years in prison, although the judge added that no sentence whatsoever would help the child to ‘live a life to which he was entitled’. The judge had accepted that Mehmut had suffered from anxiety and nervousness and panicked after the incident.  

In summary of this month’s article:

NO child, of any age, should EVER be shaken,
Shaking a child is NOT First Aid
Jealousy is no reason to harm a child EVER.

Shaken baby Syndrome IS Child Abuse.

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