He Child abuse syndrome Or shaken baby syndrome (SBS) is a form of childhood physical abuse that is characterized by the existence of a Trauma of the intracranial type (Rufo Campos, 2006).
Among the clinical findings that appear, may appear subdural or subarachnoid hematomas, Cerebral edema Diffuse and retinal haemorrhages, such as (Molina Alpízar and Umañ Araya, 2015). This is the result of a violent shaking of the baby that is grasped from the thoracic area or from the extremities.
In most cases, these brain lesions are going to produce a set of clinical and pathological alterations (Molina Alpízar and Umaña Araya, 2015) that may involve the development of an important cognitive impairment, leading to serious consequences for the baby (Rufo Fields, 2006).
Prevalence of ill-treated child syndrome
Although there is little knowledge of the prevalence of this syndrome, different investigations affirm that it is the most frequent cause of Severe head injuries in infants, before they reach the age of life (Rufo campos, 2006).
The exact frequency of the incidence of shaken baby syndrome in Western countries is imprecise, however, it is thought that the annual rate Of prevalence is between about 11 and 24 cases per 100,000 that presents an age below 12 months of age (Rufo campos, 2006).
The syndrome of the shaken child or baby is diagnosed mainly in children between 2 and 3 months of age, however, it is also possible to document it in Children up to approximately 5 years old (Molina Alpízar and Umañ Araya, 2015; Címbaro Canella et al., 2010).
The prevalence of deaths is estimated between 25% and 30% of cases. In addition, these deaths normally occur in the Damage due to an increase in intracranial pressure due to the presence of cerebral edema or hemorrhage (Molina Alpízar and Umañ Araya, 2015; Canella et al., 2010).
Of all the cases, approximately 30% of the children will come to present permanent sequels as the unilateral blindness or deafness, alterations Persistent motor, or alterations of cognitive type (Címbaro Canella et al., 2010).
Definition
As we have pointed out earlier, shaken baby syndrome is a type of Traumatic brain injury That takes place when the baby is shaken (National Institute of Neurological Disorders and Stroke, 2010).
The earliest descriptions of the shaken baby correspond to those made by The Brithis Medical Journal in 1971 by Guthkelch. Without However, it was first described by the childhood radiologist J. Caffey in 1972 as a type of child abuse Which is characterized by the presence of Retinal, subdural and / or subarachnoid hemorrhages, in the absence of external trauma, or with minimal signs of abuse, in lactating infants (Rufo Fields, 2006).
In most cases the shaken baby syndrome occurs in the following scenario proposed by Molina Alpízar and Umañ Araya (2015):" A baby who cries all the time with young parents or under a lot of stress that at any given moment does not manage to calm the child what causes situations of Frustration overriding impulse control that triggers aggression ".
There are several anatomical factors that make infants and especially infants particularly vulnerable to injury By a jolt (Molina Alpízar and Umaña Araya, 2015).
The neck muscles of the baby are still weak and the head is large and heavy compared to the size of their body (National Institute of Neurological Disorders and Stroke, 2010) so they do not yet have a solid and adequate support (Molina Alpízar and Umaña Araya, 2015).
When the baby is held by the chest Or by the limbs and is shaken vigorously, brain injuries will be caused by the mechanisms of Acceleration and deceleration (Molina Alpízar and Umaña Araya, 2015). This means that the jerks cause the brain to move back and forth Inside the skull cavity (National Institute of Neurological Disorders and Stroke, 2010) and repeatedly hit with it (Department of Health U.S.A, 2015).
Continued pounding of the brain into the skull will cause bruising, swelling, and bleeding (Department of Health U.S.A, 2015). Besides, Different paravertebral fractures of the ribs may also appear (Rufo campos, 2006).
In addition, because of the sudden spinal cord During the jolts, severe focal apneas may appear, producing severe hypoxia Which can lead to an increase in intracranial pressure, increasing cerebral flow and leading to the development of a Cerebral edema and by Both causing significant neuronal damage (Molina Alpízar and Umaña Araya, 2015).
Therefore, brain damage will be caused by both axonal damage and the presence of hypoxia parallel to the shaking caused by Increase in Intracranial pressure And the development of cerebral edema (Rufo campos, 2006).
Recent research has examined the consequences of shaken baby syndrome and points to Acceleration of the baby's head mechanisms that generate forces much higher than the neck of a baby is able to withstand. Therefore, the Shaking produces a high percentage of cases of severe or lethal injury of the cervical spine, brainstem, or brain (Rufo Campos, 2006).
symptom
The clinical picture that these patients can present in the acute phase of the disease is extremely variable (Rufo campos, 2006).
In many cases it is possible that the injuries go unnoticed in the initial moments. The most prevalent signs that can occur in a baby Which has been shaken include (National Institute of Neurological Disorders and Stroke, 2010)
- Lethargy.
- Irritability.
- Inapetencia.
- Respiratory problems.
- Convulsions.
- Threw up.
- Pale or blue skin .
- There may also be a loss of consciousness (Rufo campos, 2006).
In addition, crisis cases Epileptics usually occur between 40-70% of the cases (Molina Alpízar and Umaña Araya, 2015).
Generally, children arrive at emergency services in a state of unconsciousness, with bradycardia and even respiratory disorders Which may involve the development of severe apnea (Molina Alpízar and Umaña Araya, 2015).
Other manifestations that may appear in the initial moments are retinal hemorrhages, present between 50-100% of the cases and usually Be a very important sign for the realization of the difference diagnosis. In addition, it is also possible to identify the presence of fractures in the skull, Ribs or long bones. (Molina Alpízar and Umaña Araya, 2015).
When documenting all these manifestations it is essential to make a good differential diagnosis, since the shaken baby syndrome puts into play Various medico-legal variables.
Some of the differential diagnoses that must be performed are: Hydrocephalus , Sudden infant death, epilepsy , meningitis , Metabolic disorders , Accidents and falls, secondary ocular abnormalities, leukemia , hypertension , Terson's syndrome, deficit Vitamine, Menkes disease , hemophilia , Ontogenesis , etc. (Molina Alpízar and Umaña Araya, 2015).
In summary, Címbaro Canella et al. (2010) show the most frequent symptoms and injuries:
- Neurological dysfunction.
- Coma .
- Vomiting.
- Convulsions.
- Increased cranial perimeter.
- Inability to hold the head.
- Difficulty breathing.
- Hypotension or hypertension .
- Injuries to the spine and spinal cord.
- Esophageal perforation.
- Cerebral edema.
- Bones of long bones and ribs.
- Retinal haemorrhages.
Neurological sequelae
The general evolution of the syndrome is towards secondary brain damage, which usually conditions a Mental retardation More or less marked and / or a deficit Neurological (Rufo Campos, 2006).
Although most of the deaths occur in the acute phase of the syndrome, the surviving children will present different consequences that will condition The normal neurological development. Some of the following pathologies may appear (Molina Alpízar and Umaña Araya, 2015):
- Microcephaly .
- Cerebral atrophy .
- Cerebral palsy .
- Hearing problems.
- Spasticity .
- Partial or total blindness.
- Autistic behaviors.
- Neuronal loss and increased Gliosis .
It is these neurological sequels that are going to imply a serious situation of alteration of the child development with important evolutionary sequels, Motor, intellectual or sensory.
In many cases, after several years of the event, autistic behaviors can be observed, use of loose words and without referential meaning or they are not Capable of obeying simple orders, all of which are associated with evident neuronal loss (Rufo Campos, 2006).
Statistical data show that there is a high rate of disability or sequelae, such as mental retardation, childhood cerebral palsy and epilepsy Associated with the suffering of a baby syndrome shaken during early stages of life (Rufo Campos, 2006).
Treatment and prognosis
In the therapeutic intervention the essential are the life support measures: respiratory support and in many cases, surgery to stop the bleeding Internal or cerebral. Specialists often employ magnetic resonance imaging (MRI) or Computed tomography (TC) to finish The extent and severity of the lesions (National Institute of Neurological Disorders and Stroke, 2010).
Once the acute phase is over, the treatments will be oriented towards the recovery of the sequelae and the various functions lost.
Compared with accidental cerebral trauma in infants, the lesions caused by the jolts present a worse prognosis. The damage of the Retina can cause blindness.
Most babies who survive intense shaking will have some form of neurological or mental disability, Such as cerebral palsy or mental retardation, which may not be apparent until 6 years of age. Children who suffer from shaken baby syndrome May need medical care for the rest of their lives (National Institute of Neurological Disorders and Stroke, 2010).
For these reasons, Cognitive stimulation To promote the correct neurocognitive development of the baby and the attainment of the Effective and optimal development of all their intellectual and cognitive functions.
Prevention
Never shake or shake a baby under any circumstances (Departament of Health U.S.A, 2015). The majority of persons responsible for These events, they may feel feelings of frustration or loss of control due to different factors such as continued crying, difficulties Feeding them, among others (Department of Health U.S.A, 2015).
The US Department of Health (2010) emphasizes that it is important to understand that baby crying is a normal situation since they often use it as Way of communicating with your caregiver. In many cases, babies may have too much cold or heat, seek attention, be tired or have Famine (Department of Health U.S.A., 2015).
In these situations, many caregivers feel overwhelmed and overwhelmed. However, it is essential to tolerate the situation and to use various actions To calm the baby's crying, such as checking if he is hungry, sleepy, if he needs to change his diaper, if he has a fever or is sick, if he feels Nervous (Department of Health U.S.A., 2015).
CONCLUSIONS
We must keep in mind that any person parents or caregivers can get to execute this type of abuse. When this happens, Different legal mechanisms, since the various institutions will act to protect the rights and integrity of minors.
This is a form of severe child abuse, neurological damage will limit the subsequent development of the baby and therefore will condition both your Motor functions, physical as well as intellectual.
References
- Címbaro Canella, R., Clemente, D., González, N., Indart, J., & De Lillo, L. (2010). Description of the case presented in the previous number: Syndrome of the baby shaken / Shaken baby syndrome. Arch Argent Pediatr.
- Molina Alpízar, V., & Umaña Araya, B. (2015). Syndrome of the shaken child. Med. Cost.rica, 32 (1).
- Rufo Campos, M. (2006). Shaken child syndrome. Cuad Med Forensic, 12 (43-44).
- U.S.A, D. o. (2015). Shaken Baby Syndrome.
- Image source.