PORTRAIT OF PROMISE

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Family Advocacy Program Army Community Service
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PORTRAIT OF PROMISE Preventing Shaken Baby
Syndrome
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SBS
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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

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Ages of SBS Victims

• Few days old --------five years
• Average age of six to eight months

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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

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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

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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.

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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.

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More Clinical Signs of SBS

• Black Brain. Wasting away of the brain due to
  lack of blood supply, seen on CT scan or MRI

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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.

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Who Are The Perpetrators of SBS

• Male caretakers
• Babysitters
• Parents under severe stress
• Parents who have psychiatric problems

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How Would You KnowIf Your ChildHas BeenShaken?
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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 dont respond to light
• Blood pooling in eyes

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Critical Advice

• If your child has any of these symptoms
• Get medical attention immediately
• Be prepared to provide any helpful information to
  medical staff

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What Are the Effects of Shaking?

• Irreversible brain damage
• Blindness
• Learning disabilities
• Mental retardation
• Seizures
• Death

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How Does SBS Occur?

• Caretaker
• Is alone with child
• Frustrated by childs crying
• Sees childs crying as deliberate
• Sees childs crying as defiance
• Child
• Crying is the only way the baby can communicate
• Cannot protect self against violent assault

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Use Common Sense

• Dont let anyone take care of a fussy baby by
  themselves, if
• they have a hot temper
• they are afraid of losing self-control
• they cant pay full attention to the baby
• they dont know how to handle a baby who is
  difficult to comfort
• they dont 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

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Caretakers Need to Stay In Top Condition

• Get Enough Sleep
• Stay Sober
• Stay Healthy

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What Can You Do When Babies Cry?
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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?

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How To Soothe A Crying Baby

• Rock the baby
• Walk with the baby
• Swaddle the baby
• Play some music
• Rub the babys back
• Give the baby a pacifier
• Read to the baby
• Leave a soft light on in the babys room
• Take the baby for a ride in the car

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If That Doesnt WorkDont Go It Alone!Get Some
Help!
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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.

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Regarding Baby SittersIt is the Parents
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 cant handle the job.

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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.

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Better that the Baby Crythan the Baby Die.
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Video Portrait of Promise
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Question Answer Period
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For Additional Information

• Family Advocacy Program
• Pediatric Clinic
• Social Work Service