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Doctors Urged to Look for Shaken Baby Syndrome

Abuse should be suspected without good explanation

MONDAY, July 2, 2001 (HealthDayNews) -- If doctors can't get a good explanation for a baby's internal head injury, they should assume shaken baby syndrome, the American Academy of Pediatrics (AAP) says.

Shaken baby syndrome may be under-recognized and under-diagnosed, the organization says. Doctors should become familiar with its symptoms and ask parents how they respond to their crying baby, the AAP recommends.

"This is a revision of an earlier policy and our committee on child abuse put together this policy," says Dr. Randell Alexander, a professor at the Morehouse School of Medicine in Atlanta. "With all our statements, we bring them up for review every three or four years." While Alexander says there's no surge in reports of shaken baby syndrome, the AAP wants to make sure doctors across the country are aware of the problem and act to prevent it.

"Doctors are pretty good around the country at diagnosing the problem -- there isn't anything that quite looks like shaken baby syndrome," Alexander says. "But a recent article pointed out that when a child has symptoms like not eating well, or is vomiting, or is lethargic and the cause is not some infectious disease, a doctor's first thoughts should be of shaken baby syndrome."

Most cases of shaken baby syndrome result from a parent's frustration at an infant's crying, and the shaking probably lasts about 20 seconds or less, with perhaps as many as 40 to 50 shakes, he says.

"The baby's head is going back and forth about two-and-a-half to three times a second. It's like you shook a pillow so hard that the stuffing is flying around the room; that's the kind of violence we are talking about. That directly damages brain cells, and if enough [cells] are damaged, the brain will swell, putting pressure on vital centers that control breathing and heartbeat," Alexander says.

"Not only are brain cells injured, blood vessels around the brain can be injured, and that's where we get the bleeding between the brain and the skull and behind the eyes," he says.

The National Center on Shaken Baby Syndrome (NCSBS) says approximately 20 percent of cases of shaken baby syndrome are fatal in the first few days after injury. Survivors often suffer from handicaps ranging from mild learning disorders or behavioral changes to profound mental and developmental retardation, paralysis, blindness or a permanent vegetative state.

The center estimates that between 600 and 1,400 children are victims of this form of child abuse each year in the United States.

Alexander says doctors need to anticipate the problem and suspect all parents if the symptoms are suspicious.

"Doctors are like the rest of us. They have biases. They don't think of shaken baby syndrome as much with people of a higher socioeconomic class as they do with those who are poor. One of the things we wanted to do with this statement was to alert physicians to consider the abuse with everyone," Alexander says.

"We track cases of shaken baby syndrome across the country and in other parts of the world, and our studies indicate that babies that are shaken come from all families of all socioeconomic groups, races and cultures," says Marilyn Sandberg, the NCSBS's executive director. "That it can happen in all families is an important message for not only physicians to understand and acknowledge but for public officials, lawmakers and investigators as well."

The AAP is performing a real public service, Sandberg says. The organization's revised recommendations are reported in this month's issue of Pediatrics.

"From the national center's perspective, we are very pleased that these national professional organizations are publicly acknowledging and providing position statements on shaken baby syndrome so that it is very clear to the public, and other professionals, just what the problem is."

What To Do

For more on shaken baby syndrome, see the NCSBS or the AAP.

SOURCES: Interviews with Randell Alexander, M.D., Ph.D., FAAP, professor, Morehouse School of Medicine, Atlanta, Ga., and Marilyn Sandberg, executive director, NCSBS, Ogden, Utah; July 2001 Pediatrics
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