Shaken Child Syndrome - Symptoms and Treatment

At the beginning of a child's life, the prevailing cause leading to the occurrence of diseases and even disability is associated with a head injury. Sometimes it ends in the death of a child. Often this leads to the fact that parents treat the baby carelessly or even cruelly. It is not at all necessary that the baby should fall down and hit its head hard. Sometimes it’s enough just to shake the baby to damage the brain. In 20% of cases, death occurs, the rest significantly injure their nervous system.

Concept of Shaken Child Syndrome (SVR)

For some reason, this problem does not find frequent and wide description in the literature. Only a few authors refer to it.This name is not the only one. This condition is called and in a different way. Some, for example, it is called the traumatic shaking syndrome of the child.

The problem is insidious in that the child does not detect traumatic injuries on the body. They are inside and fraught with unpleasant consequences. A certain imprint imposes the complexity of diagnosis, which causes a delay in the provision of necessary assistance. With a strong shaking, the child’s head makes movements of a different nature. The SVR is characterized by the classic triad:

• Blood pours into the skull.
• Brain swells.
• Pouring blood into the retina.

The main causes of this condition

Shaking children is done by parents or those who care for the baby. Selected cases are clearly violent. Most of them are committed by fathers. It is no secret that all parents have different levels of education and development. Some of them may even have mental disorders. Sometimes parents themselves behave like children. Persons with pronounced impulsivity and single parents may occur.They are completely unaware that, even if they slightly shake the child, he may be injured. Sometimes they can begin to shake the child, being in the heat of passion. It is necessary to consider in more detail the reasons for which the child is subjected to shaking.

It is characteristic that boys at the first 6 months of life are primarily at risk. This also includes premature babies and those that have had various abnormalities in intrauterine development. It is possible that children with a certain natural temperament are at risk.Naturally, this group will include children with various congenital abnormalities, which is caused by the grief-mother’s addiction to alcohol or drugs. A definite imprint on the birth of such people can cause smoking to the mother when carrying a fetus.

The reason may be the fact that with the birth of a baby in a family, the habitual pattern changes. Parents, especially mothers, have chronic sleep deprivation. You can not discount the fact that often with the advent of the baby in the family deteriorates financial situation. In general, relations between family members are heating up, which, of course, affects the little one. Simply put, a stressful situation arises in the family, and the result is that violent emotions spill over the child.

Predisposition of babies

A child at birth has a clear disproportion of parts of his body. The largest of these is the head. If in an adult it is only 3% of the body, then in babies this figure is close to 15%. The skull is a kind of protection of the brain. But it is still soft, since the processes of ossification in it are not completed.There has not yet been a complete closure of the large fontanelle, and the other bones have not fully grown together. Cervical muscles also have weakness. The articular surfaces of the vertebrae are not yet strong.

This causes the head to be extremely mobile. Myelinization of nerve fibers has not yet been sufficient, and the brain contains a lot of fluid. At the time of shaking the brain can act different forces. This can lead to injuries of cerebral vessels, which causes hemorrhages of varying severity.

Note! When a child is shaken, not only the brain but also the spinal cord is affected, and the problem itself lies in the complexity of diagnosis.

How does the SVR

According to research, the average duration of shaking is 20 seconds. For such a short time, the head makes oscillatory movements in the amount of up to 50 times. This may cause dangerous damage. The result will be more disastrous if an additional header takes place (for example, a blow to the changing table). Shaking a baby can be compared to a car accident.

The child may fall off the couch. Practice shows that with a height of less than 1.25 meters, injuries are usually not very heavy.

Injury structure in SVR

If the child is well shaken, he is able to get a number of quite serious injuries. They can be represented as follows:

1. Hemorrhage in the subdural space (KFOR). This area is limited by the dura mater and the arachnoid. It occurs when the superficial veins of the brain rupture. The process is one-way or two-way.
2. Hemorrhage in the subarachnoid space (SAH). It is an area that is limited by the soft and spider sheaths of the brain. The mechanism of occurrence is identical to the previous version.
3. Diffuse damage to axons. When shaking, the long nerve fiber is torn. Of course, the transmission of nerve impulses is partially or completely stopped.
4. Increased pressure in the cranial cavity. This condition will occur without fail when assistance is delayed.
5. Blood is poured into the retina. This is the most common symptom in cases of violent head trauma. Localization can be two-way, or the process is observed only on one side. This state is distinguished by a pronounced vastness. If the cause of hemorrhage in the retina was SVR, then one can observe a pronounced specificity of the process. It is significantly different from similar conditions associated with a different etiology.Often this can occur during an infectious process or a birth injury to the head.
6. Rib fractures. They are possible if you strongly squeeze the baby's chest. Often the place of their localization is the back surface on the left. If the fractures are due to other reasons, then they have a slightly different location.

Clinic

Symptoms can be very different in nature and are determined by the type of brain damage. The severity of manifestations may also be different in their intensity.

Objectively, the pupils of different diameters, the child can not raise his head, there is no possibility of focusing the eye. If convulsions are observed, the child loses consciousness, the respiratory function is disturbed, and the integuments acquire a blue tint, this indicates a pronounced severity of the violations. They are heavy. Sometimes after a child is shocked, he may fall asleep.Parents start scaring his low activity. They again begin to shake him, which only aggravates the situation.

The SVR may have long-term consequences. These include the occurrence of paralysis, hearing loss, and blindness. A child may simply become mentally retarded. Further problems arise in terms of training. Children begin to complain of poor memory. They may well have epileptic seizures. The most unfavorable outcome is death.

Establishing diagnosis

First of all, it is a thorough history taking. Parents need to ask in detail about what happened. Certainly, the data of inspection and objective signs are taken into account. Great help in the diagnosis provide instrumental methods of research:

1. CT scan. With the help of it, the nature of the damage, its vastness and localization are clarified. You can identify signs of swelling of the brain.
2. Magnetic resonance imaging. It is a less sensitive method, but serves as a good supplement to CT.
3. NSG (neurosonography). It can only be done if the child has a large spring.
4. X-rayWith this method, bone fractures can be recognized.

Neurologist also draws other specialists to the diagnosis. For example, if blood is poured into the retina, an ophthalmologist will be required.

Help before the ambulance arrives

At the slightest suspicion of the occurrence of such a condition is required to immediately call an ambulance. If the child has a cardiac arrest, it is necessary to make an indirect massage. It is good, if all parents will be trained in its receptions. In order that the baby does not choke with aspiration waters, it should be laid on its side.

After the child is delivered to a medical facility, he will be provided with comprehensive medical care involving a wide range of narrow specialists.

Video: Shaken Baby Syndrome