Slide 1 BABY SHAKING SYNDROME

Bor Anastasia, student, 4th year, faculty of General Medicine, USMF Nicolae
Testemianu, Chisinau, Republic of Moldova
Academic adviser: urcanu Tamara D.Med.Sc., Associate Professor,
Department of Pediatrics, USMF Nicolae Testemianu, Chisinau, Republic of
Moldova

Slide 2 Overview:
Shaken baby syndrome has become a very special and sad chapter in the
spectrum of trauma in children.
Unlike other forms of inflicted head trauma, abusive head trauma results from
injuries caused by someone vigorously shaking a child.

Slide 3 Definition
Shaken baby syndrome (SBS) is a triad of medical findings: subdural
hematoma, retinal hemorrhage, and cerebral edema from which some
physicians, consistent with current medical understanding, infer child
abuse caused by intentional shaking


Slide 4 Why this happen
The perpetrators in these cases are most often parents or caregivers. Common
triggers are frustration or stress when the child is crying. Unfortunately, the
shaking may have the desired effect: although at first the baby cries more, he or
she may stop crying as the brain is damaged.

Slide 5 Mechanism of injury
Rotational injury is especially damaging and likely to occur in shaking trauma.
The type of injuries caused by shaking injury are usually not caused by falls and
impacts from normal play, which are mostly linear forces.It has been suggested
that the mechanism of ocular abnormalities is related to vitreoretinal traction,
with movement of the vitreous contributing to development of the characteristic
retinal hemorrhages. These ocular findings correlate well with intracranial
abnormalities.



Slide 6
In any abusive head trauma case, the duration and force of the shaking, the number of
episodes, and whether impact is involved all affect the severity of the infant's injuries.
In the most violent cases, children may arrive at the emergency room unconscious,
suffering seizures, or in shock. But in many cases, infants may never be brought to
medical attention if they don't exhibit such severe symptoms.

Slide 7 Signs and symptoms
lethargy
irritability
vomiting
poor sucking or swallowing
decreased appetite
lack of smiling or vocalizing
rigidity
seizures
difficulty breathing
altered consciousness
unequal pupil size
an inability to lift the head
an inability to focus the eyes or track movement

Slide 8 Diagnosis
If shaken baby syndrome is suspected, doctors may look for:
hemorrhages in the retinas of the eyes
skull fractures
swelling of the brain
subdural hematomas (blood collections pressing on the surface of the brain)
rib and long bone (bones in the arms and legs) fractures
bruises around the head, neck, or chest

Slide 9 How is shaken baby syndrome diagnosed?
To confirm a diagnosis of shaken baby syndrome, a doctor will:
Ask about the child's medical history, including when changes in behavior began.
Do a physical exam to look for signs of injury and increased blood pressure.
Do imaging tests such as a CT scan or an MRI to look for bleeding or other injury
in the brain.
Take X-rays to check for broken bones.

Slide 10 A rethinoscopy
Slide 11 A CT
SLIDE 12 What can happen to a baby who is shaken?
It depends on how long and hard the baby has been shaken. Some of the most common
effects include:
eye damage or blindness
hearing impairment
speech disabilities
damage to the neck and spine
learning disorders
behavioral problems
permanent vegetative state
developmental problems or mental retardation
seizures
paralysis
death

Slide 13 Treatment and Prognosis
Treatment involves monitoring of intracranial pressure (the pressure within the
skull), draining of fluid from the cerebral ventricles, and, if an intracranial
hematoma is present, draining of the hematoma
Prognosis depends on severity and can range from total recovery to severe
disability to death when the injury is severe. One third of these patients die, one
third survives with a major neurological condition, and only one third survives in
good condition. The most frequent neurological impairments are learning
disabilities, seizure disorders, speech disabilities, hydrocephalus, cerebral palsy,
and visual disorders.

Slide 14 Real situation
In Moldova, officially, is registered only one case of child death caused by
Shaken baby syndrome.
Sadly, not many physicians know about this type of trauma, that`s why many
causes remain undiscovered in Moldova.

Slide 15 Real stories
On this pictures e can see real stories. Child abuse is very common, not only in moldova,
but worldwide.
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Slide 18 The end.