"Shaken Baby Syndrome"
Early in my medical training I was on a 6 week rotation in Pediatrics. I was on a team in one of the teaching hospitals and this was a very busy service, even as a medical student. When our team was on call, we admitted all the patients that came in for that 24 hour period. This usually meant very little sleep and we still had studying to do for exams when we weren’t actually admitting patients.
Jeremy was already in the hospital when I started my rotation. He was 8 months old and had been shaken by his father. No one ever came to visit him. The nurses would talk to him as they took care of him, but he really didn’t have any family. He never cried, he never indicated any wants. He had a feeding tube as he didn’t have the ability to swallow.
The first time I held Jeremy was in the middle of the night. His nurse and I got along well. She had to take care of another baby and asked me to hold him for a minute. I sat in a rocking chair and she handed him to me and left. The lights in the Intensive Care Unit (ICU) were soft and coming mostly from monitors and computers. It was quiet, the other babies were asleep. Heartrate and breathing monitors beeped softly in the background, otherwise it was just me and Jeremy.
At first I was uncomfortable holding him as he didn’t respond to me, but I shifted him so we were eye to eye. He seemed to look at me and I started to talk to him. I didn’t talk about anything in particular; I told him about growing up in the country and not really being used to city life. I talked about riding bikes with my brothers when I was younger and about fishing in the river and swimming in gravel pits in the summer. I don’t have a singing voice, but I sang to Jeremy that night. I have never sung to anyone else. The only song I could think of was “American Pie” by Don McLean. Jeremy made my upcoming exams and my troubles in general less that night, and I came back to hold him at other times during my rotation. Even though he couldn’t cry, I cried for both of us when I held him.
What did he do to bring this upon himself? Likely what all babies do. He cried, he needed changing and feeding. He woke up in the middle of the night. He got sick. He asked his dad to grow up before he was ready. He cried some more.
What was taken from him? What did he miss? He missed learning how to walk, he missed saying that first funny sentence all kids put together when they learn how to talk. He missed splashing in puddles in the spring, he missed the thrill of seeing baby ducks swimming single file behind their mother. Being told “happy birthday”, trying to stay in the lines when he was coloring, learning his ABC’s and how to count. Riding a bike, being scared the first time he had to read aloud in front of the class. The teacher will never call on Jeremy.
He would be about 17 years old now. I wonder what kind of person he might have been. Quiet and shy; a bookworm? Or strong and fast, maybe a football star in high school. He would certainly have experienced that queasy feeling in his stomach and the quivery feeling in his spine when he was falling in love. You remember that feeling, don’t you?
Jeremy’s case was pretty severe. I don’t know what his eventual outcome was. He didn’t change in the few weeks that I knew him. There is a wide range of symptoms depending on the degree of damage. Babies are especially prone to this because they have relatively large heads and weak neck muscles. In addition, the brain tissue and blood vessels are very delicate and soft at this age. Violent shaking back and forth causes the brain to slam repeatedly into the skull. This tears blood vessels on the surface and inside the brain and in the eyes. The bleeding and subsequent swelling can cause tremendous pressure inside the skull, which worsens the damage. Most babies who suffer shaken baby syndrome are under one year of age, but it can happen up to age 5. About 60% are male. Babies that survive can have symptoms such as blindness or deafness, seizures, learning and developmental disabilities, impaired intellect, memory problems and behavioral problems. Severe cases can end up in a comatose state.
Shaken babies don’t only happen to bad parents. Anyone can get stressed, and a baby who won’t stop crying when you’ve done everything you can think of is very stressful. All of us get angry, everyone has been mad at someone at some point. It turns out that life sometimes is not fair. Relationships are strained with a crying baby in the house, things are not the way they used to be. Shaken baby syndrome happens in SECONDS, and the consequences are for life. For parents, trying soft music, rocking the baby in a swing, changing a diaper or feeding a baby may be what’s needed. Sometimes those things don’t help. If you’re really at the end of your rope, gently putting the baby in bed and walking away for 10 minutes is a reasonable thing to do. Take turns with your partner. Give each other a break. Respect each other.
What can the rest of us do? It turns out small things work. Offer to babysit, be a support. Listen. If you see a stressed out parent at the grocery store with small kids, let her in front of you. Carry her groceries. Remember, we’re trying to prevent 5 seconds of tragedy. Small acts could save a life.
And Jeremy? Wherever you are – “Happy Birthday.”