Saturday, January 22, 2011

Never Shake A Baby!

This has gone on for a long time, as long as we have had babies? When will it end?
Will we learn from our family stories? Will our posterity learn from our stories?

Shaken Baby Syndrome is something we have all probably heard about, and hopefully not had firsthand experience with. Infant brains and skulls, and neck muscles are not like those of adults. The skull is not fully ossified (hard and protective of the brain). The brain is not even as firm as set Jello (as normal adult brains are). The neck muscles are not strong enough to support the head, and especially not able to stabilize the head from sudden movements. The human brain grows most of its size by age 2; that is why babies have proportionally larger heads than adults. The brain has high water content. Imagine a glass of water sloshing its contents when shaken.

The anatomy of the brain in the skull is in a little better shape than water just in a glass. The cerebral cortex and brain stem are covered by dura mater (grey matter). It is like a membrane enveloping the brain and it is attached to the skull. There is a space under the dura mater before you get to the arachnoid, which directly covers the cerebral cortex. It is kind of like wearing an under shirt (arachnoid) that is next to your skin (cerebral cortex), and your outer shirt (dura mater), and then you put on your coat (skull) for protection from the cold. Under normal circumstances this all works great. Blood vessels and nerves go through that space (sinuses) and keep the blood flowing smoothly (oxygen, cooling, etc.), with very little stress on them. It reminds me of the spokes of a bicycle wheel, only in 3-D, and these nerves and blood vessels are not so rigid as the spokes of the wheel. Granted, those lines (the blood vessels and nerves) are not exactly having to suspend the whole brain in the skull…. But imagine your bicycle wheel - if something put extraordinary torque on the axle from the side, or even up & down, or twisting – Do you see it? The spokes break a few at first, and then catastrophe!

This is what goes on inside the skull with the brain when a baby is shaken violently back and forth. We have seen the crash dummy videos demonstrating how seatbelts can help keep a person inside the car, and how air bags can lessen the impact in a crash. In a baby’s skull the blood vessels and nerves were never meant to be seat belts – they rupture. Bleeding and fluid buildup might act like an airbag, but you cannot function with the airbag deployed; that in itself is a hazard – that pressure on the brain causes injuries. Back and forth shaking can stretch and tear the nerve tissue that runs up and down the baby’s neck – the nerves that carry the instructions from the medulla for the diaphragm to breathe and the heart to keep beating. Babies are taken to Emergency Rooms primarily because they stop breathing, or are turning blue. CPR is not a cause of Shaken Baby Syndrome.

Babies who are examined because of suspected abuse have the diagnosis of Shaken Baby Syndrome confirmed by an inspection of the retinas in the back of the eyes. Eyeballs are filled with fluid and, like the fluid-dynamic action of the brain, are highly affected by sudden changes in inertia and direction. Tearing of the membranes, supply vessels and optic nerves show in surviving babies with special equipment, or in autopsies. “Retinal hemorrhages are seen in 70-85% of abusive head injuries.” (1)

Lesions on the cerebral cortex from the trauma all over the surface of the brain, deprivation of oxygen and build up of toxins from dead brain cells deteriorating because of Shaken Baby Syndrome cause surviving babies all kinds of problems. “The signs and symptoms seen are mild to severe, on a continuum from a “low-dose” of shaking/impact to a “high-dose” of shaking/impact and severe craniocerebral injury and may run the gamut from decreased responsiveness, poor feeding, irritability, lethargy and hypotonia [low muscle tone and strength] to convulsions, vomiting, tachypnea [rapid , shallow breathing], hypothermia [abnormally low body temperature], bradycardia [slow and irregular heart beat], coma, fixed dilated pupils to death.” (2)

“In comparison with accidental traumatic brain injury in infants, shaken baby injuries have a much worse prognosis. Damage to the retina of the eye can cause blindness. The majority of infants who survive severe shaking will have some form of neurological or mental disability, such as cerebral palsy or mental retardation, which may not be fully apparent before 6 years of age. Children with shaken baby syndrome may require lifelong medical care. “ (3)





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