Shaken Infant Syndrome

The Brain Injury Association of America estimates that each year 50,000 infants in the United States sustain serious injuries from being shaken by their caregivers. The term "Shaken Baby Syndrome" (SBS) was coined in 1972 to describe a recognized pattern of neurological and ocular deficits that occur as the result of violent, non-accidental shaking of an infant. The syndrome is characterized by the presence of specific forms of intracranial and ocular hemorrhage and is most commonly seen in children under one year of age.

The neurological consequences of violent shaking are devastating, and 25 percent of SBS victims die as a result of their injuries. For those who survive, the prognosis is poor. Seizures, blindness, quadriparesis, hypotonia, and developmental disabilities are common long-term outcomes for survivors of SBS; many remain immobile and in a persistent vegetative state.

As a result of these primary deficits, it is common for survivors of SBS to experience frequent pulmonary complications such as:

  • Poor muscle coordination, sensory impairment, and seizures can result in impaired swallowing and susceptibility to aspiration with consequent pulmonary infection.

  • Inadequate control of respiratory muscles due to hypotonia can impair the normal cough reflex and, as a result, interfere with the ability to clear aspirated material and pulmonary secretions from the airways.

  • Retained secretions provide a cultural medium for bacterial pathogens, with consequent recurrent bouts of pneumonia, bacterial colonization, progressive pulmonary compromise and, potentially, respiratory failure.

Aggressive bronchial hygiene, including daily Airway Clearance Therapy, is an essential component in the management of patients with pulmonary complications from SBS. In SBS, conscientious attention to daily secretion clearance may prevent or minimize the pulmonary complications associated with the disorder.

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Sources

Lancon JA, Haines DE, Parent AD. Anatomy of the shaken baby syndrome. The New Anat. 1998; 253: 13-
18.

Conway EE. Nonaccidental head injury in infants: the shaken baby syndrome revisited. Ped. Annals. 1998; 27: 677-690.

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