Babies as Young as 1 Week Old Are Victims of Abuse or Neglect

A Common and Devastating Form of Abuse

The CDC report highlights the importance of educating parents about one of the most pervasive and severe forms of child abuse in infancy — shaken baby syndrome (SBS), also sometimes called abusive head trauma (AHT). The average age of SBS victims is between 3 and 8 months, although this type of abuse is occasionally seen in children up to 4 years old.

SBS usually happens when a parent or caregiver (usually a male — either the baby's father or the mother's boyfriend) shakes the baby out of frustration or stress when the little one is crying inconsolably. Sadly, the shaking has the desired effect: although at first the baby cries more out of fear, it eventually stops crying as the brain is injured.

When someone forcefully shakes a baby, the child's head rotates about uncontrollably because infants' neck muscles aren't well developed and provide little support for their heads. The violent movement pitches the infant's brain back and forth within the skull, rupturing blood vessels and nerves throughout the brain and tearing the brain tissue. The brain strikes the inside of the skull, causing bruising and bleeding in the brain.

After the shaking, swelling in the brain can cause enormous pressure within the skull, compressing blood vessels and increasing overall injury to its delicate structure.

SBS often causes irreversible damage. In the worst cases, the death rate is almost half of all babies involved. Children who survive may have:

• partial or total blindness
• hearing loss
• seizures
• developmental delays
• impaired intellect
• speech and learning difficulties
• memory and attention problems
• severe mental retardation
• paralysis

Some particularly traumatic episodes leave children in a permanent coma. Even in milder cases, in which babies look normal immediately after the shaking, they may eventually develop one or more of these issues. Sometimes the first sign of a problem isn't noticed until the child enters the school system and exhibits behavioral problems or learning difficulties. But by that time, it's more difficult to link these problems to a shaking incident from several years before.

Normal interaction with a child, like bouncing the baby on a knee, will not cause SBS. But it's important to never shake a baby under any circumstances because gentle shaking can rapidly escalate.

What This Means to You

To prevent potential child abuse, parents and caregivers of infants need help with responding to their own stress levels, which can run particularly high when you're sleep-deprived and taking care of a fussy newborn or colicky baby. And dealing with incessant crying can test anyone's patience and sanity, especially when you're a first-time parent and don't know what to do to calm your baby down.

Finding ways to alleviate a parent or caregiver's stress at the critical moments when a baby is crying can significantly reduce the risk of child abuse. One method that may help is author Dr. Harvey Karp's "five S's":

1. Shushing (using "white noise," or rhythmic sounds that mimic the constant whir of noise in the womb, with things like vacuum cleaners, hair dryers, clothes dryers, a running tub, or a white noise CD or machine)
2. Side/stomach positioning (placing the baby on the left side — to help digestion — or on the belly while holding the infant, then putting the sleeping baby in the crib or bassinet on the back)
3. Sucking (letting the baby breastfeed or bottle-feed, or giving the baby a pacifier or finger to suck on)
4. Swaddling (wrapping the baby up snugly in a blanket for security)
5. Swinging gently (rocking in a chair, using an infant swing, or taking a car ride to help duplicate the constant motion the baby felt in the womb)

If a baby in your care won't stop crying, you can also try the following:

• Make sure the baby's basic needs are met (that the little one isn't hungry or needs to be changed).
• Check for signs of illness, like fever.
• Rock or walk with the baby.
• Sing or talk to the baby.
• Offer the baby a pacifier or a noisy toy.
• Take the baby for a ride in a stroller or strapped into a child safety seat in the car.
• Hold the baby close against your body and breathe calmly and slowly.
• Call a friend or relative for support or to take care of the baby while you take a break.
• Lay the baby on the back in the crib, close the door, and check on the baby in 10 minutes if nothing else works. And call the doctor if nothing seems to be helping, just in case there might be a medical reason for the fussiness.

Whether it's your mother-in-law, a babysitter, your neighbor, or day care personnel, it's absolutely crucial to talk to anyone caring for your baby about the dangers of shaking and other forms of child abuse. Discuss how patience and a few simple preventive steps to calm your little one can prevent senseless injuries or even worse — a tragic death because someone was too frustrated or overwhelmed to take the time to comfort and settle your baby down.

And if you suspect someone is abusing or neglecting any child, call The Childhelp National Child Abuse Hotline at 1-800-4-A-CHILD (1-800-422-4453).

Sources: "Nonfatal Maltreatment of Infants — United States, October 2005–September 2006," Morbidity and Mortality Weekly Report (MMWR), April 4, 2008