Abusive injuries can be some of the most heartbreaking types of trauma that healthcare providers deal with throughout their careers. Witnessing the effects of abuse is especially difficult when it leads to lifelong injuries, as is often the case with pediatric abusive head trauma.
Related: Recognizing & Preventing Pediatric Abusive Head Trauma
Pediatric abusive head trauma, or shaken baby syndrome
The National Center on Shaken Baby Syndrome reports that about 1,300 cases of shaken baby syndrome are recorded each year in the United States. Of these, 25% result in the death of the child. About 80% of survivors suffer lifelong disabilities due to their head trauma.
Shaken baby syndrome occurs most frequently in children under 6 months of age. It is the most common cause of child abuse death in the U.S. Crying is the number one trigger for parents who cause this type of injury to their children.
Risk factors for children to experience this type of abusive head trauma include families with:
- Substance abuse in the home
- History of domestic violence in the home
- Parents experiencing financial stress
- Poor parental mental health
- Unmarried parents
- Maternal smoking
- More than two siblings in the home
- Young parental age
Identifying pediatric abusive head trauma
Unfortunately, some children experiencing pediatric abusive head trauma do not exhibit external evidence of the abuse. A fussy or lethargic baby without external bruising or visible injuries may be misdiagnosed, delaying treatment and causing further harm to the child.
Signs of pediatric abusive head trauma or shaken baby syndrome include:
- Vomiting
- Posture in which the head is bent back and the back arched
- Breathing difficulty
- Slow and shallow respiration
- Altered level of consciousness
- Drowsiness
- Extreme irritability
- Dilated pupils that do not respond to light
- Decreased appetite
- Convulsions or seizures
- Coma
- Cardiac arrest
- Death
Babies presenting with these symptoms should be screened for head trauma. Screening may include fundal assessment, CT scans, MRI of the brain, a thorough family history report, spinal x-ray, and bloodwork.
Parents of crying babies may not understand how fragile their babies’ bodies are, and how easily they can be gravely injured. According to the American Association of Neurological Surgeons, some of the most serious consequences of abusive head trauma include:
- Subdural hematoma
- Subarachnoid hemorrhage
- Retinal hemorrhage
- Skull fractures
- Hypoxic brain injury
- Shearing of axons in the brain
- Spinal cord injuries
- Death
Preventing pediatric abusive head trauma
Preventing pediatric abusive head trauma begins with educating parents about shaken baby syndrome. Programs such as the Period of PURPLE Crying Program help parents by explaining that frequent and inconsolable crying in infants can be normal. The program also gives parents strategies for managing their response to episodes of frequent crying.
Parents and caregivers of newborns and young children may need to be reminded that episodes of crying will eventually end. If a parent begins to feel overwhelmed by their crying baby, it is okay to put the baby down somewhere safe and walk away for a few minutes.
Healthcare providers such as nurses and pediatricians should educate parents on the following:
- When feeling overwhelmed, parents can call services such as the Washington State Family helpline at 1.800.932.HOPE (4673)
- Stay 10 feet away from your baby when you are feeling very frustrated or angry with your baby. Return when you are feeling calmer.
- Remember that it is normal for babies to cry.
- Try to leave your house at least once a day. Taking your baby for a walk can help both parents and baby feel better.
- Ask for help whenever you need it. Asking family members, friends, and neighbors for help will reduce stress and allow you to take a much-needed break.
- Educate your babysitters on the dangers of shaking a baby. Remind them to call you if they are feeling overwhelmed.
Differentiating between abuse and an accident
Many parents who shake or intentionally harm their children realize that they have made a mistake and seek medical care. Often, fearing that they will lose their child or face other consequences, the parents will make false claims that an accidental fall caused the injuries.
Any head injury in a child should be assessed for other signs of shaken baby syndrome or intentional harm, especially severe head traumas. According to research published in Pediatrics, the chance of death of an infant caused by a short fall is less than one in a million.
In addition, parents and providers should understand that shaken baby syndrome is not caused by jostling a baby to get them in a car seat, bouncing them on a knee, or any other typical playful behavior. It takes a significant amount of force to cause the shearing and trauma associated with abusive head trauma.
Severe head injuries in infants and young children should always be thoroughly investigated.
Self-care for healthcare providers
Dealing with any sort of non-accidental trauma is difficult for healthcare providers. Seeing a child suffer as a result of adult behavior can lead to feelings of anger, resentment, and even hopelessness. Some providers can even experience secondary traumatic stress disorder, severe burnout, and compassion fatigue when dealing with victims of child abuse.
It is essential that nurses caring for these patients find a good support system, take time off from work when possible, and find a trusted friend, colleague, or therapist to talk to. Charge nurses should do their best to ensure that their team is rotated through abusive head trauma cases, meaning that no single nurse or caregiver is constantly exposed to victims of abuse.
