Shaken Baby Syndrome: Symptoms, Causes & Treatment

Shaken baby syndrome is a serious brain injury caused by forcefully shaking a baby back and forth without properly supporting the head. This movement can trigger bleeding and reduce oxygen delivery to the brain. It can lead to symptoms such as extreme irritability, vomiting, or difficulty breathing. Because the injury can worsen quickly, symptoms should be treated as an emergency.

Shaken baby syndrome can happen up to age 4 or 5, but it is most common in babies around 6 to 8 weeks old. It may occur during seemingly harmless play (like tossing a child into the air) or when a caregiver tries to stop a baby from crying, which is the most common cause.

Treatment for shaken baby syndrome is managed by a pediatrician or pediatric neurologist and depends on how severe the brain injury is and which area of the brain is affected. Treatment may include oxygen therapy, medications, or surgery.

Shaken baby syndrome symptoms

The main symptoms of shaken baby syndrome are:

• Difficulty breathing;

• Excessive irritability or unusual sleepiness;

• Poor appetite or refusing to feed;

• Slowness, apathy, or less interaction than usual;

• Body stiffness or tremors;

• Low body temperature or chills;

• Dizziness or vertigo;

• Seizures or coma.

Other symptoms may also occur, such as vomiting, pale or bluish skin, fractures of the bones, ribs, or skull, bleeding behind the eyes, bruising, purple marks on the baby’s body, or a bulging or sunken soft spot (fontanelle).

It is important to watch for changes in the baby’s behavior and seek immediate care at the nearest hospital or emergency room if any symptoms of shaken baby syndrome appear. Delays in diagnosis and treatment can lead to serious long-term complications and may be life-threatening.

Confirming a diagnosis

A pediatrician or pediatric neurologist diagnoses shaken baby syndrome by reviewing the baby’s symptoms, when they began, and the infant’s medical history. According to the American Academy of Pediatrics (AAP), the evaluation includes checking for intracranial and retinal findings.

The doctor typically performs a physical examination and a dilated eye exam (fundoscopy) to look for signs such as bleeding behind the eyes. Imaging tests, such as X-rays, magnetic resonance imaging (MRI), or computed tomography (CT) scans, are ordered to detect brain changes or bone fractures.

Laboratory tests may also be requested, including a complete blood count (CBC), comprehensive metabolic panel, liver and kidney function tests, and urine testing, to evaluate the baby’s overall condition. These tests can also help rule out other conditions that cause similar symptoms, such as brain infections, bleeding disorders, cerebral arteriovenous malformations, or glutaric aciduria type 1.

What causes shaken baby syndrome

Shaken baby syndrome happens when a baby is forcefully shaken back and forth without head support. This can make the brain move inside the skull and cause severe head trauma and brain injury, including swelling, bleeding, or hematomas. According to the CDC, violent shaking and/or blunt impact can cause bleeding around the brain or behind the eyes.

Factors that may contribute to a caregiver shaking a baby abruptly include:

• Attempting to make the baby stop crying;

• Unrealistic expectations about parenting;

• Difficulty breastfeeding;

• Toilet training;

• Chronic and frequent colic;

• Stress or depression, including postpartum depression;

• Heavy alcohol use or use of illicit drugs;

• Family instability or domestic violence;

• History of childhood abuse.

Although shaken baby syndrome is often linked to shaking intended to stop crying, it may also happen during attempts to revive a child in a life-threatening situation. Examples include choking or a severe coughing episode.

Treatment options

Treatment for shaken baby syndrome should begin as quickly as possible in the hospital and is guided by a pediatrician or pediatric neurologist. The approach depends on how severe the injuries are and which part of the brain is affected.

In general, the first step is oxygen therapy to support breathing, reduce respiratory distress, and increase oxygen levels in the baby’s body and brain. In more severe cases, intubation and mechanical ventilation may be needed.

The doctor may also give intravenous fluids and electrolytes to support blood pressure and help stabilize blood glucose levels. Intravenous medications may also be given to reduce intracranial pressure and brain swelling.

In some cases, surgery may be needed to stop bleeding in the brain, lower intracranial pressure, or remove damaged brain tissue.

It is also important for parents and caregivers to seek support from a therapist to help manage stress and anger and to learn calmer ways to respond to a baby’s crying. One factor linked to shaking is a baby crying in a way that feels uncontrollable to the caregiver.

Possible complications

Possible complications of shaken baby syndrome include:

• Microcephaly or hydrocephalus;

• Blindness or other vision problems;

• Hearing loss, which may be permanent;

• Developmental delays or speech delays;

• Learning difficulties or intellectual disability;

• Behavioral problems;

• Cerebral palsy;

• Weakness or poor motor coordination;

• Involuntary increases in muscle contraction;

• Seizures or epilepsy.

A child’s brain remains very sensitive up to age 2, but the most severe complications occur mainly in babies younger than 6 months.

In the most severe cases, coma and death may occur due to rupture of blood vessels or damage to nerves that reach the brain.