Abusive Head Trauma

What is abusive head trauma?

Abusive head trauma is also called shaken baby syndrome. It’s a form of child abuse that can be deadly or leave a baby seriously injured for a lifetime. Most often, victims of this kind of abuse are less than 1 year old, but it can happen with children up to age 5.

Symptoms of abusive head trauma

A severe case of abusive head trauma in your baby or young child can cause unconsciousness, seizures, or shock.
Other initial symptoms of abusive head trauma can include the following:

• vomiting
• irritability
• unusual drowsiness
• trouble sucking or swallowing
• no interest in eating
• stiff appearance
• changes in consciousness
• no smiling, babbling, or talking
• differently sized pupils
• inability to lift his or her head
• inability to focus eyes or track movement

In many cases, abusive head trauma also leaves a child with long-term problems that affect him or her physically and intellectually. A survivor of abusive head trauma may be dependent on medical, special education, and social services for the rest of his or her life.

What causes abusive head trauma?

Abusive head trauma happens when a baby is shaken violently, hit in the head, thrown, or dropped on purpose. It usually happens at the hands of an overwhelmed parent or caregiver who can’t cope with a baby’s long periods of crying and the demands of caring for a young child.
Violently shaking a young child or hitting him or her in the head causes the child’s brain to shake back and forth inside the skull. This is especially true in babies whose neck muscles aren’t fully developed. The movement causes your child’s brain to swell, bruise, and bleed from the tearing of blood vessels, nerves, and tissue.

How is abusive head trauma diagnosed?

You should go to the emergency room right away if you suspect your child is suffering from abusive head trauma. Because some symptoms of abusive head trauma (for example, vomiting or irritability) are also common in other illnesses, it is important for the doctor to know if your child may have been shaken or hit in the head. The doctor will ask questions about what happened. Unfortunately, the person responsible for the abuse may not be honest about his or her actions.
The doctor will use a number of visual clues and tests to make the diagnosis and find out how severe the damage is. Visual clues include checking the child’s eyes for bleeding; looking for marks on the skull, arms, or legs; and checking for bruises around the child’s neck or chest. Certain imaging tests (for example, an X-ray, CT scan, or MRI) can show evidence of swelling or bleeding in the brain. These tests also can show skull or rib fractures.

Can abusive head trauma be prevented or avoided?

Because this happens due to a caregiver’s actions, it is absolutely possible to prevent abusive head trauma. It is important for everyone who takes care of your baby or young child to learn how to handle stressful situations (for example, when your baby cries for a long time).
One way to handle stress is taking several deep breaths, finding a safe place for your child (for example, the crib), and walking to another room for 10 to 15 minutes to calm yourself. When you feel out of control, call a friend or family member to help with your child or help you regain control. Understanding the consequences of abusive head trauma can help you take an active role in preventing this with your child.
Soothing a crying baby is not easy. However, there are a number of things you can try to calm the baby, including the following:

• sing
• rock
• swaddle
• take him or her for a ride or a walk
• offer a bottle or pacifier
• breastfeed
• lay the baby on his or her stomach across your lap and gently rub or pat the baby’s back

Combining these strategies with “white noise” or rhythmic sounds (for example, music, a hair dryer, or a clothes dryer) can help. You also can try putting your child down for a nap on his or her left side to help with digestion, or on his or her back. If all else fails, be sure to consider whether your child could be sick. Call your doctor for advice.
If you have a caregiver for your child, it’s important to teach your caregiver about the dangers of shaking a baby or young child. Be sure he or she knows what to do if he or she feels stressed while caring for your child. Choose a caregiver carefully and continue to monitor your child’s safety under his or her care.

Abusive head trauma treatment

For more mild cases of abusive head trauma, your child may need medicine, a hospital stay, and at-home observation. In the most severe cases, treatment may begin in the hospital emergency room or operating room with life-saving steps. These steps might include inserting a breathing tube down your child’s throat or doing surgery to stop bleeding or reduce swelling in your child’s brain.

Living with abusive head trauma

Depending on how severe the trauma is, your child may have to be monitored over time. Survivors of abusive head trauma may suffer long-term health problems, such as:

• permanent hearing loss
• visual impairment (including blindness)
• seizures
• developmental, speech, and academic delays
• severe intellectual disability
• memory and attention challenges
• cerebral palsy

Questions to ask your doctor

• How can I tell whether my baby’s symptoms are caused by abusive head trauma or a normal illness?
• Can brain damage be reversed?
• What are some local resources for helping parents cope?