Shaken baby syndrome
Introduction
Shaken Baby Syndrome is a type of physical abuse that describes the damage to a child's brain and nervous system as a result of violent shaking. The most frequent way that child abuse results in death or severe neurological damage is shaken baby syndrome. It is unique to the infant stage, when their anatomical features are distinct. Subdural and retinal hemorrhages are indicators of trauma from shaking.[1][2]
PATHOPHYSIOLOGY
The combination of subdural and retinal hemorrhage with brain damage, along with the individual characteristics of each, allows for a reconstruction of the injury mechanism and an evaluation of the amount of force used in the incident that results in shaken baby syndrome. The baby's head rotates as a result of rotational acceleration and deceleration, which rotates the brain inside the skull. Sudden braking permits the brain to continue rotating until the bridging veins are strained and burst, resulting in a thin layer of subdural hemorrhage on the surface of the brain. This lesion does not take up any space; rather, its significance lies in revealing the mechanism of injury. The typically widespread retinal hemorrhages cover a large portion of the world's circumference.[2]
Clinical manifestations
The term "shaken baby syndrome" refers to the signs of brain damage brought on by a newborn or small child being violently shaken. The rotational forces of the head on the trunk and the translational forces that result in the impact of the brain against the skull determine the intracranial and spinal injuries of children who suffer from this severe form of abuse. These forces are made possible by the anatomical features of the newborn and infant, including the particularly voluminous head, the hypotonia of the paravertebral muscles that support the head, and the immaturity and fragility of the brain mass due to axonal myelination deficit.[1]
While cerebral edema, retinal hemorrhages, and spinal damage are the classic triad of symptoms, a complete medical evaluation is necessary for the diagnosis of Shaken baby syndrome.[1]
As is the case in the majority of cases, the clinical picture of SBS can range from vague symptoms that only require supportive care to acute and potentially fatal complications that call for immediate medical attention, such as respiratory failure, severe respiratory distress, intracranial hypertension, loss of consciousness, seizures, and shock. The length and force of the shaking, the child's age, the abuser's constitution, and other factors all affect the symptoms.[1]
Diagnosis
Numerous studies have established the reliability of radiological investigations in locating and capturing, via imaging, clinically insignificant or silent injuries resulting from physical abuse. In order to differentiate SBS from other possible pathologies, a complete blood count with platelets, coagulation tests, electrolytes, liver and pancreatic function, urine analysis, and toxicology are still necessary. Additionally, an examination of the fundus oculi to identify retinal hemorrhages and a thorough physical examination are also necessary. However, brain imaging is still crucial for this diagnosis.[1]
Complications
Determining the shaking duration and intensity that cause the typical SBS injuries and their short- or long-term effects is challenging: The child is usually grabbed around the arms or chest and shaken ferociously for 4–20 seconds, 3-5 times per second. Serious consequences affecting the child's neurological and psychomotor development, including cerebral palsy, physical disabilities, hearing and vision impairments, epilepsy, psychomotor delay, intellectual disability, learning, language, and behavioral disorders, may arise from this severe form of abuse.[1]
The role of primary care pediatricians
In order to prevent child abuse and maltreatment, pediatricians are essential. Since they have a trusted relationship with the child's family, they are in a unique position to recognize behavioral indicators of the child and parental figures as well as risk factors (social, cultural, and environmental). This allows them to watch out for and support any vulnerabilities within the family unit during routine check-ups and outpatient visits that are requested for other reasons.[2][1]
While it may be frustrating for parents, it is equally important for the family pediatrician to teach parents how to identify the symptoms of the "purple" crying period, which is an acronym for Peak of crying, Unexpected, Resists Soothing, Pain like face, Long lasting, Evening. Thus, it's critical to teach parents coping mechanisms for handling the stress that comes with their unresolved child's weeping. In order to achieve this, the family pediatrician can: Train them to spot warning signals of impending extreme frustration: heart palpitations, rapid breathing, clenched fists or jaws, and disparaging remarks or ideas about the child; counsel them to soothe the infant by rocking or swaddling them, placing them in their crib or another secure location, taking a break, phoning a friend or family member, or requesting assistance .[1]
The role of physical therapy
Physical therapy is crucial in the management of motor deficits associated with shaken baby syndrome.
because it aids in enhancing the baby's movement and functionality in response to various interventions.
Restoring impairment was the main objective of physical therapy interventions for kids with Shaken Baby Syndrome. Many therapeutic modalities have been researched, such as goal-directed training, treadmill training, home programs, environmental enrichment, task-specific training, and constraint-induced movement therapy. These modalities have been shown to be mostly beneficial for motor outcomes and are primarily related to the activity domain.[3]
Role of physical therapy in these cases depends on the complications resulting from the problem
If the baby has cerebral palsy we refer Cerebral Palsy Interventions
If the baby has epilepsy, we can refer Epilepsy
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Blumenthal I. Shaken baby syndrome. Postgrad Med J. 2002 Dec;78(926):732-5. PMID: 12509690; PMCID: PMC1757926.
- ↑ 2.0 2.1 2.2 Harding B, Risdon RA, Krous HF. Shaken baby syndrome. BMJ. 2004 Mar 27;328(7442):720-1. PMID: 15044268; PMCID: PMC381309.
- ↑ Furtado MAS, Ayupe KMA, Christovão IS, Sousa Junior RR, Rosenbaum P, Camargos ACR, Leite HR. Physical therapy in children with cerebral palsy in Brazil: a scoping review. Dev Med Child Neurol. 2022 May;64(5):550-560. Epub 2021 Oct 2. PMID: 34601719.