It is important to remember that there may be no bruising, scrapes or outward signs of physical trauma in victims with Shaken Baby Syndrome. The infant or child, however, may display one or more of the following alarming signs or symptoms:
• change in behavior
• poor appetite
• weak swallow or suck reflex
• generalized weakness
• irritability - both from brain swelling and from pain
• low or excessively high muscle tone in the extremities or trunk
• the head may stay turned to one side in a resting position
• head control may be absent in an older infant that previously had head control.
• excessively sleepy/lethargic
• pale skin color
• cool skin temperature
• difficulty breathing and sudden respiratory arrest.
Once SBS is diagnosed, other evidence of abuse may be discovered. Infants with SBS and non-accidental head trauma may but do not necessarily have co-occurring injuries such as skull fractures, neck strains and fractures, spinal strains and fractures, rib fractures, extremity fractures and bruising on the chest and/or abdomen and extremities. There may but not necessarily has to be evidence of new and old fractures on the ribs from multiple episodes of shaken baby syndrome and child abuse.
One of the most-recognized classic signs associated with SBS is retinal hemorrhage, or bleeding. The infant’s eyes may get injured and diffuse bleeding (hemorrhages) of both retinas may be present for several days after the injury. Retinal hemorrhages may clear up if the condition occurs in mild cases of SBS. But, in severe cases, blindness or permanent visual impairment may result from SBS. Subtle symptoms such as not focusing or tracking items may be the only physical finding that an infant demonstrates on an eye exam. Pupils may be small or large, or unequal in size. Unequal pupils are a “late” sign of brain trauma in babies, meaning that there is significant, new and additional pressure inside the brain sufficient to have caused the nerves controlling the pupil size in one eye to change from its normal size, while the pupil size on the other side remains normal. Absent or diminished pupillary reflexes may be present which is, again, another sign of increasing damage inside the brain.
The second and most damaging sign associated with SBS is damage to the brain, including damage to the blood vessels in the brain. The brain bleeds in many areas from the shaking forces with or without bruising, contusions and skull fractures. The bleeding in the brain will cause high pressures inside the cranium and globes of the eyes. If timely and effective treatment for the bleeding and swelling within the brain does not occur, serious neurological damage will likely occur or death may result from increased intracranial pressure and brain herniation. Improperly or untimely treated SBS may cause paralysis, deafness, learning disabilities, cerebral palsy and seizure disorders.
If you are trying to learn more specifics about the location within the brain that is damaged by shaking a baby, read on as we give a little background about specific head injury patterns often associated with SBS or abusive/non-accidental head trauma.