National Child Abuse Awareness Month: Shaken Baby Syndrome

Prevent Child Abuse ribbonIn my lifetime, I’ve worn many hats, had many experiences, seen many things, both beautiful and ugly.

As a pediatrician, I’m grateful for the thousands of beautiful yummy babies who have passed through my hands: such a blessing, such a privilege.

As a parent, I’m grateful that I have a beautiful grownup son, who as a child provided me both with joy that surpasseth understanding and with countless sleepless nights.  This in turn provided me with the experience that I needed so that I could properly empathize with the parents of a subset of my patients: the ones that would not sleep.

My beautiful, wonderful son.  I have never loved him the less, even though he never slept through the night until he was five years old.  He had a traumatic birth; and literally from birth was afraid to close his eyes and sleep.  He cried all night, and I cried too, from a mixture of sadness for him and exhaustion for me.

Sometimes it would get too much for me, and I would feel the edges of anger creeping in: why don’t you just go to sleep, damn it?  And then I knew it was time to put him down safely in his crib, shut the door, put in earplugs or the Walkman, and go for a walk in the yard, or around the block, do jumping-jacks, dance and sing, whatever was needed to get back in equilibrium so that I would NOT SHAKE THE BABY.

Sometimes it hangs on such a fine thread.  I’ve seen parents, usually young and inexperienced, bring their pale, limp six week old in to the Emergency Department in the middle of the night.  We just found him like this, Doctor.  He was fine when we put him down.  No, he hasn’t been sick.

Physical exam: Pupils fixed and dilated.  Anterior fontanel bulging.  Otherwise negative, except that the patient is dead.

Postmortem findings consistent with Shaken Baby Syndrome.

Shaken Baby Syndrome doesn’t just only come from shaking.  It happens when the baby is shaken and then thrown down on a surface, usually a bed or crib.  What causes death is the combination of the shaking and the sudden deceleration that causes tearing of blood vessels in the tissues surrounding the brain, which usually results in death.

Why do people shake their baby?  I know exactly why.  That is why I used to put my baby somewhere safe and go outside and walk around the block, or whatever I needed to do to keep myself sane and the baby safe.  It is because the incessant crying of a hard-to-console baby can and will grate on anyone’s nerves.  Some babies have piercing, high-pitched cries that go off like sirens.  And if the caregiver lacks the emotional resources necessary to take a deep breath and step away, the thing can happen in the blink of an eye.

In the blink of an eye, things can go from having a healthy yet frustrating baby, to having a dead baby.  All in the blink of an eye.

Who does this happen to?  I saw a pattern.  The perpetrator was almost always male, usually under 30, high school graduate or less, often not the baby’s biological father.  The motivating factor was “wanting the baby to shut up and stop crying.”  The problem: lack of impulse control.  If only he had taken that deep breath, turned around and walked out that door….but he wanted the baby to stop crying.  Now the baby will never cry again.

And what about the mothers?  My heart broke for them.  Her boyfriend killed her baby.  How will she ever live with herself?  And so often I saw a dreadful conflict: the mothers would lie to the investigators, to try to protect the boyfriend.  Some even claimed to have done it themselves!  It was so sad, so tragic.

To be fair, I did see a few cases in new parents who were “white, educated, middle class”.  A very few.  The vast majority were from economically and educationally underprivileged families, across all ethnic groups.  It is a kind of death that discriminates against the uneducated, the young, the disenfranchised, the controlled.

How do we prevent Shaken Baby Syndrome?  Sure, we can put up “Don’t Shake The Baby” posters everywhere.  But that doesn’t do a thing to solve the social problems that underlie the issue.  We can’t solve the problem of young women getting into relationships with impulsive, controlling men–who by the way are quite as likely to shake and shove the mother around–although she, being full grown, is able to absorb more physical shock than a six week old.

To me, Shaken Baby Syndrome is emblematic of the price we are paying for allowing our girls to grow up in a system of intergenerational abuse that starts at home and continues into serial abusive relationships.  The solution is not a quick and easy one.  It really does take a village to save one child.

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6 Comments

  1. Do you think more parental supports would be helpful? An outside person to help them adjust? This would probably be especially helpful for new parents.

    Reply
    • Absolutely! The incidence of child abuse decreases markedly when there is strong family and/or community support. It still happens, but it’s much less likely if there’s a strong safety net.

      Reply
  2. i know exactly how it feels to just want the baby to just be quiet right now. i had that experience with my first child, a son. he had a high piercing cry, he hardly ever slept, and almost always howled. my husband was gone at work til midnight, taking our single car, so i was trapped. it was winter in the midwest, and i had nowhere to go , literally, not even outside. i know how close i came, how strong the urge was, to shaking him. but thank goodness, i never did. anyone, any mother, no matter how emotionally healthy and with all the resources in the world, can still get to this point in a flash, not just the underprivileged, undereducated (although i agree the numbers in that group could very well be higher).

    Reply
    • You are so right. It CAN happen to anyone, in the blink of an eye. Thank God you were able to muster your own strength and get through that awful night. That is what I mean by having resources: the inner resources that enable us to just keep holding on one minute by one minute, until the sun comes up and somehow the little darlings’ horns go in and their halos come out. Ever notice that? My son, after an entire night’s work of screaming, would begin to smile and coo the instant the sun peeped over the horizon. Perhaps that is why he is still alive today…I shouldn’t joke about these things but sometimes I think that God has a strange sense of humor.

      Reply
  3. ilenva

     /  April 4, 2013

    Wow. Being a single person with no children, I haven’t thought about shaken baby syndrome in a very long time. I don’t ever hear about it outside of headlines.. Mom Murders Baby! Angry Boyfriend Kills Child!
    Honestly? I feel for those parents. It’s incredibly saddening. I cannot stand the sound of a crying baby. If I was to be around a crying baby for extended amounts of time, I can honestly see myself wanting to shut. it. UP. Of course I would never intentionally harm a child, but I guess what I’m trying to say is I can empathize with a parent who shakes their baby in a sudden (or built up) moment of hopelessness and helplessness.*

    Parents need more supports. New parents even more so. It really boggles my mind that something so important and complex and difficult is just assumed to be “instinct”. How on earth is someone supposed to know how to Be A Parent!? It’s normal and recommended and even expected for people to take courses, become knowledgeable, BEFORE they do something. We need to learn HOW before we can DO. Why is it any different for parenting? I strongly feel that parenting classes need to be made the norm, rather than them being stigmatized as they are (only ‘bad parents’ need parenting classes, etc. etc.).
    I’m taking a course on FASD currently, and this reminds me a bit of my course – the lack of discussion, the stigma attached to the parent(s), the judgement, the lack of knowledge.. it’s so disheartening.

    * (I seriously hope I wrote this in a way that makes sense. Please, no one think that I’m like.. condoning shaking babies or anything of the sort :c)

    Reply
    • Wow, what a great comment! You’ve really covered the globe here. Yes, it is tragic for the parents, because in an instant of time, one instant of loss of control, many lives are wrecked.

      Parenting classes ARE a good idea. One thing that always drives me nuts as a pediatrician is that during the pregnancy parents are barraged with information, and they are so focused on the pregnancy that it’s really not until the new small human emerges howling from the birth canal that they are suddenly hit with the incontrovertible fact that they are the permanent “owners” of this new creature that they will take home and hopefully nurture; unfortunately very few have picked up a book on baby and child care or picked out a pediatrician. Parenting classes during pregnancy would be ideal.

      The very best scenario is to have a wide base of support in family and community, to help out in the first difficult months and afterward, but that rarely happens in white families. I often see it in black families, where the maternal grandmother ofter acts as primary caretaker for the baby.

      No, I didn’t get the sense that you were condoning shaking the baby. Your comment is very clear in its intent to show that it could happen to anyone, given the circumstances.

      Reply

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