Chances are, when you first brought your baby home from the hospital, you were willing to do just about anything to help him or her fall asleep. For many infants, rocking—or using another kind of rhythmic movement—works as a natural sleep aid, since it reminds them of being inside their mother’s body.
While some babies have a strong preference for one particular type of movement, the truth is, there are many ways to soothe an infant. In addition to swaying him or her in your arms or rocking together in a chair, some parents bounce while wearing the infant in a carrier, push the little one in the stroller, or even drive around town with the baby strapped into a car seat. There are plenty of products that facilitate rocking, vibrating, and swinging, too, including bassinets, bouncers, and swings that can work manually, as well as automatically. The one common theme: Babies love to move.
While rocking or bouncing your baby to sleep can feel like a lifesaver during the early weeks and months, for some parents, it can turn into a burden down the road. That’s because rocking your infant to sleep, just like nursing or singing your little one to sleep, can create what’s called a sleep association. The risk is that your baby will get hooked and won’t be able to fall asleep without you. In other words, because your infant is used to being rocked to sleep, he or she will expect to rock every time—including anytime he or she wakes up in the middle of the night. And that can become exhausting as a parent.
That doesn’t mean that you shouldn’t rock your baby at all. After all, rocking your little one can be relaxing for both of you. But you might find that by rocking your infant until he or she is drowsy but still awake, and then putting him or her in the crib to finish falling asleep solo, you get the best of both worlds.
Is your baby already used to falling asleep in your arms? Try to gradually shift to a different sleep association that doesn’t require your input. For example, add a white noise machine or CD while you rock for a few nights. Once he or she starts to associate those sounds with sleep, you can turn on the white noise and try to eliminate the rocking. Or transition from rocking to gently bouncing the mattress or rubbing your infant’s back while he or she falls asleep. Then gradually do less and less until your child is able to conk out on his or her own.
People convicted of killing their babies by violently shaking them could find new grounds for appeal in research which suggests even mild shaking can cause an infant to die.
Up until now, babies were thought to die from injuries caused by prolonged, violent, malicious shaking, which caused their brains to bang against their skulls.
But a team led by Jennian Geddes, a neuropathologist at the Royal London hospital, has found that most babies thought to have died as a result of brain injury from shaking or being struck died because they stopped breathing.
They believe the weak spot is less the brain than the point where the brain meets the spinal cord, uniquely vulnerable in babies because of the weight of the head compared to the weakness of neck muscles.
A rocking motion at this point, known as the craniocervical junction, can damage the part of the spinal cord which controls breathing.
The research by the Geddes team, described in today’s New Scientist, does not suggest normal mothering or fathering of a baby – rocking a child on the knee or shoulder, for instance – could do damage. But it does suggest ignorance or carelessness could play a bigger role in apparently violent baby deaths than previously thought.
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What Is Shaken Baby Syndrome?
The shaken baby syndrome is a serious brain injury caused by forcefully and violently shaking a baby. Other names for this condition include abusive head trauma, shaken impact syndrome, and whiplash shake syndrome. A shaken baby syndrome is a form of child abuse that causes severe brain damage. It can result in as little as five seconds of shaking.
Babies have soft brains and weak neck muscles. They also have delicate blood vessels. Shaking a baby or young child can cause their brain to hit the inside of the skull repeatedly. This impact can trigger bruising in the brain, bleeding in the brain, and brain swelling. Other injuries may include broken bones as well as damage to the baby’s eyes, spine, and neck.
Shaken baby syndrome is more common in children under age 2, but it can affect children up to age 5. Most cases of shaken baby syndrome occur among infants that are 6 to 8 weeks old, which is when babies tend to cry the most.
Playful interaction with an infant, such as bouncing the baby on the lap or tossing the baby up in the air, won’t cause the injuries associated with the shaken baby syndrome. Instead, these injuries often happen when someone shakes the baby out of frustration or anger.
You should never shake a baby under any circumstances. Shaking a baby is a serious and deliberate form of abuse. Call 911 right away if you believe that your baby or another baby is a victim of a shaken baby syndrome. This is a life-threatening condition that requires immediate medical treatment.
Would you believe that the number one reason a child is shaken is that a parent or caregiver becomes so frustrated with a baby’s crying that they lose control and just shake them? Believe it! Research has shown that frustration with a child’s crying is the number one reason a person shakes a baby. This can be hard to understand unless you have been in a situation where no matter what you tried to calm your crying infant, nothing worked.
As described more fully in another section on this website, all infants go through a stage in their development when they cry more than any other time in their lives. This period, which begins at about two weeks of age, peaks around two months and eventually levels off around four-five months, is referred to as the Period of PURPLE Crying. This period can be one of the most frustrating times in your child’s development, mostly because many parents don’t know anything about it. Consequentially it is the time when most infants are shaken and abused.
You might be wondering, “How could anyone do this to a baby?” and the answer is most people don’t mean for it to happen. Most people charged with shaking their baby have no previous history of violence. They are usually average people who in the heat of their frustration and anger lose control and shake their child.
Children are most susceptible to being injured during the first year of life because their neck muscles and brains have not developed enough to withstand the violence of being shaken. When shaken, an infant’s head moves back and forth with their chin coming in contact with their chest and the back of their head touching the upper back. As an infant is shaken their brain bounces around inside the skull, causing severe bleeding and swelling. There is also sheering and tearing of the retina inside the eye, causing more bleeding and eventually leading to blindness in most cases of SBS.
What Causes Shaken Baby Syndrome?
The shaken baby syndrome occurs when someone violently shakes an infant or toddler. People may shake an infant out of frustration or anger, often because the child won’t stop crying. Although shaking does eventually make the baby stop crying, it’s usually because the shaking has damaged their brain.
Babies have weak neck muscles and often have difficulty supporting their heads. When an infant is forcefully shaken, their head moves uncontrollably. The violent movement repeatedly throws the baby’s brain against the inside of the skull, causing bruising, swelling, and bleeding.
Many people ask what types of activities other than shaking can cause SBS. For example, one concerned grandparent asks, “My son was bouncing my grandson on his knee, and his head was moving all around, is he going to get shaken baby syndrome,” the answer to these questions is usually always the same. Shaken Baby Syndrome is caused by a violent and forceful shaking of a child. It is something that most anyone would recognize as extremely dangerous and potentially life-threatening. Playful activities like bouncing a baby on a knee or whisking them through the air, while not recommended, are not going to cause SBS.
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Symptoms and Signs
There is often no obvious external evidence of injury or physical sign of violence, resulting in under-diagnosis of this syndrome. Caregivers and even physicians who are not aware of what has happened to a baby may not detect primarily internal injuries, attributing the baby’s fussiness to an underlying cause such as a virus.
Symptoms vary and are caused by generalized brain swelling secondary to trauma. They may appear immediately after the shaking and usually reach a peak within 4-6 hours. The following signs and symptoms may indicate shaken baby syndrome:
- Altered level of consciousness
- Drowsiness accompanied by irritability
- Convulsions or seizures
- Dilated pupils that do not respond to light
- Decreased appetite
- Posture in which the head is bent back and the back arched
- Breathing problems and irregularities
- Abnormally slow and shallow respiration
- Cardiac arrest
How Is Shaken Baby Syndrome Diagnosed?
To make a diagnosis, the doctor will look for the three conditions that often indicate shaken baby syndrome. These are:
- encephalopathy, or brain swelling
- subdural hemorrhage, or bleeding in the brain
- retinal hemorrhage or bleeding in a part of the eye called the retina
The doctor will order a variety of tests to check for signs of brain damage and to help confirm the diagnosis. These tests may include:
- MRI scan, which uses powerful magnets and radio waves to produce detailed images of the brain
- CT scan, which creates clear, cross-sectional images of the brain
- skeletal X-ray, which reveals the spine, rib, and skull fractures
- ophthalmic exam, which checks for eye injuries and bleeding in the eyes
Before confirming shaken baby syndrome, the doctor will order a blood test to rule out other potential causes. Some symptoms of shaken baby syndrome are similar to those of other conditions. These include bleeding disorders and certain genetic disorders, such as osteogenesis imperfecta. The blood test will determine whether or not another condition is causing your child’s symptoms.
Prevalence and Incidence
This syndrome is primarily seen in children younger than age two, with the majority of cases occurring before the baby’s first birthday. The average victim is between three and eight months old. However, children up to age four have been victims of this abuse. The perpetrator of the abuse is most often the father, boyfriend of the mother, female babysitter or the mother. Parents experiencing stress because of environmental, social, biological or financial situations may be more prone to impulsive and violent behaviour. Those involved with domestic violence and/or substance abuse may be at higher risk of inflicting this abuse.
The National Center on Shaken Baby Syndrome estimates that there are between 600 and 1400 cases in the U.S. a year. Because there is currently no reliable method of collecting these statistics, the true incidence is unknown. This syndrome is the most common cause of death and long-term disability in infants and young children who are victims of child abuse.
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How Is Shaken Baby Syndrome Treated?
Call 911 immediately if you suspect your child has shaken baby syndrome. Some babies will stop breathing after being shaken. If this occurs, CPR can keep your baby breathing while you wait for medical personnel to arrive.
The American Red Cross recommends the following steps to perform CPR:
- Carefully put the baby on their back. If you suspect a spinal injury, it’s best if two people gently move the baby, so the head and neck don’t twist.
- Set up your position. If your infant is under age 1, put two fingers on the middle of the breastbone. If your child is over age 1, place one hand on the middle of the breastbone. Put your other hand on the baby’s forehead to keep the head tilted back. For a suspected spinal injury, pull the jaw forward instead of tilting the head, and don’t let the mouth close.
- Perform chest compressions. Press down on the breastbone and push about halfway into the chest. Give 30 chest compressions without pausing while counting out loud. The compressions should be firm and fast.
- Give rescue breaths. Check for breathing after the compressions. If there’s no sign of breathing, tightly cover the baby’s mouth and nose with your mouth. Make sure the airway is open and give two breaths. Each breath should last about one second to make the chest rise.
- Continue CPR. Continue the cycle of 30 compressions and two rescue breaths until help arrives. Be sure to keep checking for breathing.
In some cases, the baby may vomit after being shaken. To prevent choking, gently roll the baby onto their side. Make sure to roll their entire body at the same time. If there’s a spinal cord injury, this method of rolling reduces the risk of further damage to the spine. You mustn’t pick up the baby or give the baby food or water.
There’s no medication to treat the shaken baby syndrome. In severe cases, surgery may be required to treat bleeding in the brain. This may involve placement of a shunt, or thin tube, to relieve pressure or to drain excess blood and fluid. Eye surgery may also be needed to remove any blood before it permanently affects vision.
So now you are probably wondering, “What does all this mean for me?” “It is obvious now that shaking a baby is dangerous and that almost anyone could become frustrated and shake a baby, so how do I make sure this never happens to my baby?” It is very important that you share the information contained in the Period of PURPLE Crying with everyone who cares for your baby. They need to know that when your baby cries and even after they have tried everything they can think of to calm them and they continue to cry, that this is completely normal. If they get frustrated, they should set the baby in a safe place and call you to come and pick up the child. For more information about sharing this information with other caregivers, please see the childcare section of this website.
It is important always to remember that all babies cry, some more than others, and it is okay to get frustrated. It is what you do with your frustration that is important. For tips for coping with your frustration and anger, please click here. Never respond to your frustration with a crying or otherwise difficult baby by shaking them. This is the most dangerous thing you can do to your baby.