Visual Effects of Shaken Baby Syndrome
What is Shaken Baby Syndrome (SBS)? SBS is caused by the vigorous shaking of an infant or child by the shoulder, arms or legs. A single shaking episode results in whiplash-induced bleeding in and around the brain and can lead to death or permanent neurological damage. The most common reason for shaking a baby is that the baby wouldn't stop crying or fussing. Childen 6-8 months are most at risk b/c of their disproptionaly large head and weak neck muscles.
What Happens: The brain rotates within the skull cavity, injuring or destroying brain tissue. When shaking occurs, blood vessels feeding the brain can be torn, leading to bleeding around the brain. Blood pools within the skull, sometimes creating more pressure within the skull and possibly causing additional brain damage. Retinal (back of the eye) bleeding is very common
Common indicators of SBS in children: Subdural hematoma (collecting of blood between the brain and the skull) Cerebral edema (swelling of the brain) Retinal hemorrhage (bleeding behind the eyes)
Common Effects of SBS on the Visual System When a young baby is shaken, the blood vessels of the eye as well as of the brain hemorrhage, leading to loss of sight. Most common visual defects resulting from SBS include: Retinal hemorrhaging (bleeding) Retinal detachment Retinoschisis. Remember that blood vessels in children are inherently weaker than they are in adults. The same is true in their retinas.
Retinal Hemorrhage With a retinal hemorrhage the blood vessels of the retina fill with blood and burst. The effects of this depend on the size and degree of bleeding that occurs. Effects may include: Blurred vision Light flashes Floaters that may be dark or red Complete loss of some visual fields RH’s are highly suspicious of, but definitely not unique to, SBS.
Retinal detachment When the retina detaches, it separates from the back wall of the eye and is removed from its blood supply. The retina will degenerate and lose its ability to function if it remains detached. Central vision will be lost if the macula remains detached.
Traumatic retinoschisis A particularly severe form of retinal injury in SBS, traumatic retinoschisis, is characterized by a dome-shaped cavity in the macula with elevated perimacular folds at the periphery of the cavity. This is where the retina becomes torn and a section hangs apart from the rest.
Long-Term Consequences of SBS Psychological disabilities such as mood swings, anxiety, depression and behavioural issues. Cognitive disabilities including learning difficulties, planning impairment, memory loss, and developmental delays. Physical disabilities such as muscle spasms, partial or total blindness, hearing impairment, paralysis, cerebral palsy, and seizures.
Prognosis The prognosis for children afflicted with SBS is usually not good. A significant number of babies who are mistreated die. Many others suffer serious, long-term damage that will stay with them throughout their lives. Injuries that cause blindness, mental retardation, or loss of motor (muscular) control, for example, are permanent. They can not be repaired. Rehabilitation, however, can help a child learn to live and cope with their new disability.
Prevention The only way to prevent shaken baby syndrome is by educating adults. A common reason given by adults for this type of abuse is frustration with a crying baby. Parents and caregivers can be taught how to deal with this frustration. One general rule is to leave a crying baby alone until the adult has calmed down. Possible reasons for the baby's discomfort should then be considered. A warm bottle, dry diaper, soft music, a bath, or a ride in a swing may calm the child, which in turn may calm the adult. Adults should also be aware that a baby who cries excessively may have a medical disorder and should be examined by a doctor.