Shaken Baby Syndrome (SBS)

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Successful completion of this Programmed Learning Packet will provide you with 30 minutes of training.

Training Objectives:


  • caregiver will be able to describe the potential biological hazards within the brain due to SBS.
  • caregiver can describe the limitations of brain cell growth.
  • caregiver can list the possible hazardous outcomes of SBS.
  • caregiver can state the causes of behaviors leading to SBS.

I.    What is Shaken Baby Syndrome?

Shaken  Baby Syndrome (SBS) is the medical term used to describe the violent shaking and resulting injuries sustained.  It is one of the leading forms of fatal child  child abuse.  When a baby is vigorously shaken, the head is moved (or snapped) back and forth.  This whiplash motion can cause delicate veins inside the head to rupture, and bleed.  The brain actually bounces inside the skull  cavity, which bruises the brain tissue.  Once the bleeding  begins to pool, it causes swelling and pressure.  Bleeding occurs behind the eyes, (retinal bleeding) which can cause blindness.  When the blood vessels to the brain are torn away, brain damage results.  Once the brain cells are damaged, they are never regenerated or replaced and cannot be repaired.  In addition, the swelling and pressure causes the brain to push and squeeze down on the brainstem, which controls vital functions such as breathing and heartbeat.  If the swelling and pressure are not controlled, (usually through medications and/or surgery) vital functions may stop and the child could die.

Almost 25% (one out of four) of babies with SBS die.  The death usually occurs within hours or days.  It occurs most often in infants under 6 months old, but can occur in children up to age 3.  Severe signs and symptoms of SBS include breathing problems, seizures and unconsciousness.  More moderate symptoms that indicate severe shaking has occurred are inability to suck, eyes glassy or unfocused, grimacing or twitching and lethargy.  The milder symptoms are poor feeding, vomiting irritability or poor sleeping.

The survivors often suffer from varying degrees of cerebral palsy, paralysis, seizures, blindness, hearing loss, or developmental delays.  It could also cause speech difficulties, behavioral problems or a vegetative state.  About 15% of the victims may have no permanent damage.

II.    How does it occur?

A  baby's head and neck are susceptible to head trauma because their heads are large and heavy (making up to 25% of their total body weight) and their neck muscles are not developed enough to support the force of shaking.  The brain tissue is also very fragile.  When a child is shaken in anger or frustration, the force is multiplied five or ten times more than if the child had simply fallen or tripped.

Most of the time, Shaken Baby Syndrome occurs when an angry or frustrated adult shakes a child that will not stop crying.  Inconsolable crying, whether from colic, illness, pain or just plain fussiness is the number one reason that sparks shaking.  Infant cry most between the ages of  6 weeks and 4 months.  Other incidents that provoke SBS include trouble with toilet training or misbehavior such as interrupting.  The shaking may be intended to emphasize the disciplinary measure.  It is estimated that 25% - 50% of parents and caregivers are not aware of the effects that shaking a baby can cause.  Many experts believe that, in most cases, no serious hare was intended - they just wanted to stop the crying or the undesirable behavior.  They loose control and don't stop and think first.

The majority of the perpetrators of SBS are male (70% or higher) and most of the time it is the baby's father, yet the mother's boyfriend, male child-care provides or stepfathers are also responsible.  Female child-care providers make up about 17% while the mothers are responsible in aobut 13% of the cases.  The victims of Shaken Baby Syndrome are boys 60% of the time.

III.    What can be done to prevent Shaken Baby Syndrome?

Taking care of a child can be very difficult work.  The most effective way to prevent SBS is to educate parents, child-care providers, baby sitters, family members and siblings of the dangers of shaking a baby.  Also being aware of the appropriate ways to help a baby stop crying is helpful.  Infants use crying to communicate needs of sometimes relieve stress.

Suggestions for Caregivers
  • Check the baby's diaper and change it, if needed
  • Hold the baby against your chest and walk with him
  • Make sure the baby is fed, and burped
  • Lay the baby down across your lap and rub or pat his back
  • Make sure the clothing is not too tight
  • Hud and cuddle the baby gently
  • Sing or talk to the baby
  • Put the baby in a swing
  • Play soft music
  • Offer the baby a pacifier
  • Rock the baby gently, either in a rocker or by swaying back and forth
  • Take the baby outside for fresh air
  • Gently rub the baby's head
  • Reassure with soft words
  • Offer a noisy toy or rattle
  • Do slight knee bends while holding the baby
  • Message the baby's body or limbs gently
  • Gently touch the soft surfaces of the baby's face
  • Take the baby for a stroller ride
  • Swaddle the baby in a blanket

Babies are fragile.  Please don't shake a child.

The more relaxed you remain, the easier it will be to console the child.  Babies are sensitive to the tensions around them.  Letting your frustrations turn to panic or anger can intensify the infant's crying.  When you are feeling stressed, do not pick up the baby until you feel calm.  You could sit down, close your eyes and count to 20.  Try taking slow, deep breaths.  You may be better off asking for another caregiver to take over for a while.

IV.    "An ounce of prevention is worth a pound of cure"

Funding for prevention programs continues to be limited although the benefits of prevention can fare outweigh the costs for a surviving Shaken Baby Syndrome child over their lifetime.  It is estimated that just the initial hospitalization for a SBS child is $75,000 - $95,000.  This does not include continuing rehabilitation or medical expenses incurred after the child goes home.  Most of these costs are absorbed by society through insurance, government assistance, and increase special education costs.

The 1999 Texas Legislative session (Human Resources Code Section 43.0421.b) mandated a new training requirement for caregivers who provide care for children under 24 months old in day care centers, group day care homes and registered family homes.  The child-care providers are required to receive annual training regarding

  1. recognizing and preventing shaken baby syndrome

  2. preventing sudden infant death syndrome, and

  3. understanding early childhood brain development.  Also, before a new employee works with this age group, they must have completed the training.

If you become aware of a situation where a child has been shaken, make sure the child gets immediate medical attention.  The bleeding inside the brain needs to be treated as soon as possible.

A complimentary Shaken Baby Syndrome kit with facts sheets and poster can be obtained from the Foundation for the Prevention of Child Abuse/National Exchange Club by calling 1-800-924-2643.

Internet websites with additional information include:

Test Questions:

1.    A possible outcome of Shaken Baby Syndrome could include veins inside the head to to rupture and bleed.


2.    Once brain cells are damaged in may take months for them to repair themselves.


3.    What percent of babies with SBS die.

a. 10%
b. 25%
c. 35%
d 50%

4.    Classify the following symptoms according severity or not symptomatic:

                S = severe,     M = moderate,     L = milder,     N = not a symptom



  M    L    N vomiting



  M    L    N scratchy throat



  M    L    N glassy eyes



  M    L    N irritability



  M    L    N seizures



  M    L    N breathing problems

5.    Long term problems of SBS could include paralysis, blindness, behavioral problems and Parkinson's Disease


6.    Most of the time, SBS occurs when an angry or frustrated adult shakes a child that will not stop crying.


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Shaken Baby Syndrome (SBS)

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