1. Family Advocacy Program Army Community Service

2. PORTRAIT OF PROMISE Preventing Shaken Baby Syndrome

3. SBS

4. What is Shaken Baby Syndrome?
Violent Whiplash Injury
Intercranial Bleeding
Unconsciousness
Inflicted, not accidental
Result of violently shaking a baby or child
Causes severe disabilities or death due to brain injury

5. Ages of SBS Victims Few days old --------five years
Average age of six to eight months

6. Inflicted, Not Accidental
Child is violently shaken by caretaker
not “jiggling” or gently playing
any objective observer would say that the child will definitely be injured
child shaken in rage, anger, and frustration

7. Clinical Findings Associated with SBS
Subdural hematoma
Retinal hemorrhages
Cerebral edema
Diffuse axonal injury
Skull fracture
Subarachnoid hemorrhages
“Black brain” on CT or MRI - indicating severe ischemia, characteristic of a severe shake

8. Clinical Signs of SBS*
Subdural Hematoma. Accumulation of blood or blood clot beneath the dura. The dura is a fibrous membrane that surrounds the brain and attaches to the skull.
Retinal Hemorrhages. Bleeding in the back of the eyeball.
Cerebral Edema. Swelling of the brain. This causes pressure on various areas of the brain, some of which control breathing, heartbeat, etc.

9. More Clinical Signs of SBS
Diffuse Axonal Injury. Shearing of nerve fibers in white matter of the brain that destroys brain tissue.
Skull Fracture.
Subarachnoid Hemorrhage. Bleeding under the arachnoid membrane, a membrane attached to the innermost layer of the tissues surrounding the brain. This causes pressure on and injury to the brain.

10. More Clinical Signs of SBS
“Black Brain”. Wasting away of the brain due to lack of blood supply, seen on CT scan or MRI

11. SBS Triad of Injuries Retinal Hemorrhage Subdural Hematoma
Cerebral Edema
The presence of this combination is characteristic of SBS. Other causes for this particular combination are remote.

12. Who Are The Perpetrators of SBS
Male caretakers
Babysitters
Parents under severe stress
Parents who have psychiatric problems

13. How Would You Know If Your Child Has Been Shaken?

14. Warning Signs Unable to turn head Body pulls to one side
Difficulty in breathing
Seizures
Lethargic, hard to rouse
Dilated or pin-point pupils
Eyes don’t respond to light
Blood pooling in eyes

15. Critical Advice If your child has any of these symptoms:
Get medical attention immediately
Be prepared to provide any helpful information to medical staff

16. What Are the Effects of Shaking?
Irreversible brain damage
Blindness
Learning disabilities
Mental retardation
Seizures
Death

17. How Does SBS Occur? Caretaker: Child: Is alone with child
Frustrated by child’s crying
Sees child’s crying as deliberate
Sees child’s crying as defiance
Child:
Crying is the only way the baby can communicate
Cannot protect self against violent assault

18. Use Common Sense
Don’t let anyone take care of a fussy baby by themselves, if:
they have a hot temper
they are afraid of losing self-control
they can’t pay full attention to the baby
they don’t know how to handle a baby who is difficult to comfort
they don’t know how to handle a child who is demanding, crabby or annoying
they think that babies 0-18 months “do things on purpose to make you angry”

19. Caretakers Need to Stay In Top Condition
Get Enough Sleep
Stay Sober
Stay Healthy

20. What Can You Do When Babies Cry?

21. What To Check Is the baby sick? Is the baby hungry?
Does the baby need to be burped?
Does the baby need to be changed?

22. How To Soothe A Crying Baby
Rock the baby
Walk with the baby
Swaddle the baby
Play some music
Rub the baby’s back
Give the baby a pacifier
Read to the baby
Leave a soft light on in the baby’s room
Take the baby for a ride in the car

23. If That Doesn’t Work… Don’t Go It Alone! Get Some Help!

24. How to Get Help Get someone to keep you company.
Telephone a friend, ask for tips on how to handle the situation.
Keep the number of a hot-line handy for support and guidance.

25. Regarding Baby Sitters… It is the Parent’s Responsibility to:
Instruct the babysitter every time that they are not to shake the baby, no matter what happens.
Be sure your babysitters know how to reach you.
Be prepared to come home immediately if your sitter can’t handle the job.

26. When All Else Fails Let the baby cry.
Put the baby down in a safe place. Check on the baby at intervals.
Give yourself a break--find a quiet place for yourself.

27. Better that the Baby Cry than the Baby Die.

28. Video: Portrait of Promise

29. Question & Answer Period

30. For Additional Information
Family Advocacy Program
Pediatric Clinic
Social Work Service