This part of the conversation is not about spanking. It’s not even about abuse. It’s about learning who is most likely to cause harm to your child, intended or not, and what places your child most at risk. This Straight, No Chaser takes an additional look at Abusive Head Trauma (AHT)/Shaken Baby Syndrome and provides you with information to better understand the risks and the signs that your child may be suffering.
Abusive head trauma is 100% preventable but not predictable. You’d do well to heighten your sensitivity about what places a child at risk for this most devastating consequence of child abuse, and you’d do very well to understand the connection of risk for AHT to stress. Finding ways to alleviate the parent or caregiver’s stress at the critical moments when a baby is crying will significantly reduce the risk to a child. You must develop the discipline not to strike a child when you’re angry – in any part of the body. Parents and other caregivers should be aware of their own behaviors that may feed into punitive activities that can injure a child. It’s important to tell any and everyone caring for a baby or young child to never shake him or her.
Beyond the key component of a caretaker’s inability to manage their own stress, the following list includes conditions and situations that have been shown to increase the risk of a child being exposed to AHT. That said, anyone has the potential to harm a baby if he or she isn’t able to handle stressful situations well, has poor impulse control, or has a tendency toward aggressive behavior.
- Children with special needs
- Children with multiple siblings
- Children with conditions that promote crying, like colic or gastroesophageal reflux disease (GERD, reflux)
- Boys are more likely to be victims of AHT than girls.
- Children whose families live at or below the poverty level are at an increased risk for AHT and other components of child abuse.
- The perpetrators in about 70% of cases are males, typically either the baby’s father or the mother’s boyfriend. These males are often someone in their early twenties.
- Substance abuse often plays a role in AHT.
Unfortunately, children don’t always exhibit definitive symptoms. Sometimes this is the case because they aren’t brought in for evaluation immediately after, or perhaps the history given to the physician didn’t include the components of shaking or other activities. Children may look normal after an abusive episode and may not have problems noticed until they enter the school system. At this time, it is significantly more difficult to trace the symptoms back to a single causative episode of abuse. It is much more likely that the child’s intelligence level will be interpreted as being “what it is.” Please don’t ever deem that a child’s head injury is insignificant or fail to obtain a medical clearance evaluation after any injury. Alternatively, different types of interactions with a child such as bouncing a baby on a knee or tossing the baby up in the air will not cause these injuries.
Here are the symptoms of AHT. Of course, ongoing and/or severe episodes can increase the severity of symptoms. Mild symptoms include the following:
- altered consciousness
- an inability to lift the head
- an inability to focus the eyes or track movement
- blue color (due to lack of oxygen)
- decreased appetite
- difficulty breathing
- irritability
- lessened or lack of smiling and verbalizing/vocalizing
- lethargy
- poor sucking or swallowing
- rigidity
- seizures
- unequal pupil size
- vomiting
More severe immediate injuries may include the following:
- brain swelling
- bruises around the head, neck, or chest
- hemorrhages in the retinas of the eyes
- rib and long bone (bones in the arms and legs) fractures
- skull fractures
- subdural hematomas (blood collections pressing on the surface of the brain)
Recall that 1 in 4 cases of AHT results in death. Even when death doesn’t occur, other long-term effects may include the following:
- cerebral palsy
- developmental delays
- hearing loss
- impaired intellect
- partial or total blindness
- problems with memory and attention
- seizures
- severe mental retardation
- speech and learning difficulties
What makes AHT so devastating is that it often involves a total brain injury in a developing brain, meaning there will be incredibly widespread manifestations. For example, a child whose vision is severely impaired won’t be able to learn through observation, which decreases the child’s overall ability to learn. The development of language, vision, balance, and motor coordination, are particularly likely to be affected in any child who has AHT.
The irony of AHT is you’ve seen many cases of it in your casual activities. You simply haven’t associated those cases with a child having been abused. Consider thinking proactively, learn to adjust your stress and the way you interact with children in times of discipline to minimize the risks. Their developing brains will thank you.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
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