1. ABUSIVE HEAD TRAUMA (Shaken Baby Syndrome) INFORMATION AND PREVENTION April 2009

2. Training Objectives  Define Abusive Head Trauma/Inflicted Traumatic Brain Injury (Shaken Baby Syndrome).  Identify the results of Abusive Head Trauma (AHT).  Recognize the signs and symptoms of Abusive Head Trauma.  Identify ways to prevent Abusive Head Trauma and be able to apply them.

3. What is Abusive Head Trauma (AHT)?  Abusive Head Trauma, also known as Shaken Baby Syndrome, involves the violent shaking or shaking and impacting the head of an infant or young child, usually under 4-years old. These children, especially babies, have very weak neck muscles and do not have support for their heavy heads.

4.  When children are shaken, their brains move back and forth within their skulls. Abusive Head Trauma (AHT), causes destruction of brain cells and causes swelling of the brain. Extensive retinal hemorrhages in one or both eyes are found in a majority of the cases. Fractures of long bones and/or ribs can also be caused by AHT.

5.  The triggering event for shaking is most always the baby’s uncontrollable crying and loss of control by the caregiver. Parents or caregivers may feel that shaking a baby is a harmless way to make a child stop crying. According to Prevent Child Abuse America, 25-50% of parents and caretakers are not aware of the effects of shaking a baby.

6. What Are the Results of AHT?  Blindness or eye damage  Delay in normal development  Damage to the spinal cord (paralysis)  Brain damage  Coma  Hearing loss  Severe mental retardation  Death

7. What are the Signs and Symptoms of AHT? According to the National Center on Shaken Baby Syndrome, these are common symptoms of a child that has been shaken:  Lethargy/Decreased muscle tone  Extreme irritability  Difficulty breathing

8.  Decreased appetite  Vomiting  No smiling or vocalization  Poor sucking or swallowing  Rigidity or posturing  Seizures  Inability to lift head

9.  Inability to focus or track movement with eyes or unequal size of pupils  Head or forehead appears larger than normal or soft-spot on head appears to be bulging

10. How Common is AHT in Missouri?  In the United States, AHT is the second most common cause of death due to trauma in children, and the cause of more than 95% of serious head injuries in infants less than one year of age.  Of the 27 Missouri children who died from inflicted injury at the hands of a parent or caretaker in 2007, 16 (53%) were victims of AHT (or inflicted traumatic brain injury), commonly known as Shaken Baby Syndrome.

11.  Research has shown that 60-70% of perpetrators of AHT are male. In 2007, perpetrators of AHT included six birth fathers, five mother’s boyfriends, three child care providers, one friend of the mother, and in one case, both the birth mother and her boyfriend abused the infant.

12.  In 2007, a six-month-old was left in the care of his mother’s boyfriend. He became frustrated with the infant’s crying and shook him, resulting in a traumatic brain injury.

13.  In 2007, a four-month old was left with a child care provider, who was caring for several children in her home. The infant was found unresponsive and taken to a hospital where he was found to be suffering from a traumatic brain injury. The babysitter later admitted to hitting the child’s head against a changing table.

14. What Can Parents and Caregivers Do to Prevent AHT? When a baby is crying, the American Academy of Pediatrics suggests the following:  Take a deep breath and count to 10.  Take time out and let your baby cry alone.  Call someone close to you for emotional support.  Call your pediatrician. There may be a medical reason why your child is crying.

15. Other Suggestions:  Rock or walk with the baby.  Sing or talk to the baby.  Offer the baby a pacifier or noisy toy.  Take the baby for a ride in a stroller.  Put the baby into a child safety seat in the car and go for a ride.

16. When a Baby Cries, Have a Plan  Stop.  Take a break. Lay your baby down on its back in a safe place.  Sit down or leave the room.  Count to 10 or more.  Talk to another adult. Call a friend for help.  Call your doctor. (Source: The Children’s Trust Fund and the Greater St. Louis Child Fatality Prevention Coalition’s Never Shake a Baby brochure)

17. For More Information, Visit These Additional Websites  The National Center on Shaken Baby Syndrome, www.dontshake.orgwww.dontshake.org  American Academy of Pediatrics, http://www.aap.org/publiced/BR_Shake nBaby.htm http://www.aap.org/publiced/BR_Shake nBaby.htm  Kids Health, www.kidshealth.org/parent/medical/brai n/shaken.html www.kidshealth.org/parent/medical/brai n/shaken.html

18.  National Institute of Neurological Disorders and Stroke, http://www.ninds.nih.gov/disorders/shak enbaby/shakenbaby.htm http://www.ninds.nih.gov/disorders/shak enbaby/shakenbaby.htm  Epilepsy Association of Central Florida, http://aboutshakenbaby.com/ http://aboutshakenbaby.com/  Missouri Department of Health and Senior Services, http://www.dhss.mo.gov/ShakenBabySyn drome/ http://www.dhss.mo.gov/ShakenBabySyn drome/  Missouri Children’s Trust Fund (has both brochures and videos available), www.ctf4kids.org www.ctf4kids.org

19. Missouri Department of Social Services State Technical Assistance Team Address: PO Box 208 Jefferson City, MO 65102-0208 Telephone: (573) 751-5980 (800) 487-1626 (8 a.m. to 5 p.m. CST, Monday – Friday) Email: dls.stat@dss.mo.gov