Understanding Child Abuse Charges Based on the Shaken Baby Syndrome

Some of the most difficult cases to prove in court are child abuse charges based upon the Shaken Baby Syndrome. The reason for this is made apparent by this objective analysis of the condition and why defending such charges may require a defense expert familiar with the syndrome and why it is difficult to establish from an evidenciary perspective.

Shaken baby syndrome is one form of abusive head trauma. Head trauma, as a form of child abuse, can be caused by direct blows to the head, dropping or throwing the child, or shaking the child. Head trauma is the leading cause of death in child abuse cases in the United States.

Unlike other forms of abusive head trauma, shaken baby syndrome results from injuries caused by someone vigorously shaking an infant. An infant’s brain is relatively small in relation to its head and an infant’s head is one-fourth to one-third of his/her body weight.

In addition, an infant’s neck muscles are not yet strong enough to fully support the neck. So, if a baby is shaken violently, the neck is jerked, the head snaps back and forth similar in fashion to a whiplash. Shaking a baby may cause injuries that may lead to any of the following conditions:

• blindness
• deafness
• learning disabilities or delay in normal development
• paralysis
• seizures
• death

Subdural hematomas (internal brain bleeding) and edema (brain swelling) that can be seen on a computed tomography (CT) scan of the head the infant might have:

• swelling soft spot
• larger than normal head size
• bleeding in the eyes
• irritability
• excessive drowsiness
• sluggish behavior
• seizures
• projectile vomiting
• unresponsiveness, limpness, abnormal breathing or apnea (stops breathing)

If the diagnosis is positive, local law enforcement officials and the department of human services are notified and a criminal investigation ensues.

Shaken baby syndrome is difficult to diagnose, unless someone accurately describes what happens. Physicians often report that a child with possible shaken baby syndrome is brought for medical attention due to falls, difficulty breathing, seizures, vomiting, altered consciousness or choking.

Babies with severe or lethal shaken baby syndrome are typically brought to the hospital unconscious with a closed head injury.

To diagnose shaken baby syndrome, physicians look for retinal hemorrhages (bleeding in the retina of the eyes), subdural hematoma (blood in the brain) and increased head size indicating excessive accumulation of fluid in the tissues of the brain. Damage to the spinal cord and broken ribs from grasping the baby too hard are other signs of shaken baby syndrome.

Computer tomography (CT) and magnetic resonance imaging (MRI) scans assist in showing injuries in the brain, but are not regularly used because of their expense.

A milder form of this syndrome also can be observed and may be missed or misdiagnosed. Subtle symptoms that may be the result of shaken baby syndrome, are often attributed to mild viral illnesses, feeding dysfunction or infant colic.

These include a history of poor feeding, vomiting or flu-like symptoms with no accompanying fever or diarrhea, lethargy and irritability over a period of time. Often the visit to the medical facility does not occur immediately after the initial injury.

Without early medical intervention, the child may be at risk for further damage or even death, depending on the continued occurrences of shaking.

An estimated 1,200 to 1,400 cases occur each year in the United States. One shaken baby in four dies as a result of this abuse (Poissaint & Linn, 1997). Head trauma is the most frequent cause of permanent damage or death among abused infants and children, and shaking accounts for a significant number of those cases (Showers, 1992). Some studies estimate that 15 percent of children’s deaths are due to battering or shaking and an additional 15 percent are possible cases of shaking. The victims of shaken baby syndrome range in age from a few days to five years, with an average age of six to eight months (Showers, 1997).

While shaken baby abuse is not limited to any special group of people, males are usually targeted as suspects because they typically predominate as perpetrators in 65 to 90 percent of cases. In the United States, adult males in their early 20s who are the baby’s father or the mother’s boyfriend are typically the shaker.

Females who injure babies by shaking them are more likely to be baby-sitters or child care providers than mothers (Showers, 1997). Frustration from a baby’s incessant crying and toileting problems have been described as events leading to severe shaking. The adult shaker also may be jealous of the attention that the child receives from his or her partner.