SHAKEN BABY SYNDROME
By David Mallory, M.D.

    Cathy and Steve Sanders remember their eight week old son, Ryan, as a happy, active baby who was starting to smile at his relatives. But one day, Ryan's development was abruptly halted. On that day, a baby sitter, fed up with Ryan's crying, grabbed him around the chest and shook him vigorously, permanently damaging his brain and eyes. Now at age two, Ryan suffers from cerebral palsy, mental retardation, and blindness.

    "His brain is not even on the charts anymore. As far as I am concerned, what happened was murder," said Steve Sanders.

    Ryan is a victim of what is called "shaken baby syndrome," or SBS. There are no exact statistics, but researchers estimate each year between 800 and 1,200 children nationwide are shaken so severely they require an emergency visit to a hospital. Probably many more suffer milder symptoms and are never treated. Twenty-five percent of shaken baby syndrome victims die. The rest may have mental retardation, cerebral palsy, and blindness.

    The head of an infant or young child is disproportionately larger and heavier than the rest of his or her body, but the neck muscles are weak and undeveloped. Severe shaking of a child age five or under, but especially in the first year of life, causes the brain to smash or whiplash back and forth against the skull. It is estimated that the force on a shaken baby's brain is 30 times the force of gravity. Fighter pilots black out at less than one-third of that force.

    Bleeding in shaken baby syndrome (SBS) occurs not only in and around the brain, but in the eyes as well, especially in the retina that lines the inside of the eye and is the actual "seeing" part of the eye. These hemorrhages occur in up to 80 percent of shaken babies and in 70-100 percent of children dying of SBS. It has also been shown that the severity of the retinal hemorrhages can be a reliable predictor of the degree of brain damage. Retinal hemorrhages may even come before any brain injury can be detected on C-T scan or MRI imaging. A child with convulsions and lethargy may have as the only objective finding of shaken baby syndrome hemorrhages in the retinas of the eyes.

    In almost all cases, the person shaking the baby is trying to get him or her to stop crying. Many parents who would never consider striking their child, may resort to shaking as a less violent approach. Five studies conducted between 1982 and 1990 showed that 25-50 percent of teenagers and adults did not know that shaking a baby is dangerous. The anguished cry of the father who said "I just wanted the baby to stop crying. I only shook him for a few seconds, but he'll be blind for a lifetime!" is not easily forgotten. Shaking a baby is a very, very violent act!

David Mallory, M.D. is a cataract, intraocular lens and laser surgery specialist in practice at the Southwest Eye Clinic.



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