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Durban - South African couple Malinda Marshall and Bradley Connor were sentenced to 10 years in prison recently for abusing their baby, Michael. It led to his death.
The child was repeatedly hit and throttled and his head was bashed with fists, leaving him blind and brain-dead.
While these actions inflicted visible injuries, doctors also found that Michael suffered from something called shaken baby syndrome, which causes immense harm, but may not present any immediate signs.
Abuse can go unnoticed in such instances, either causing immediate harm or cognitive problems later on in life.
Shaken baby syndrome is also known as abusive head trauma, inflicted traumatic brain injury or shaken impact syndrome.
It is caused by direct blows to the child’s head, dropping or throwing a child or shaking. In the US it is said to be the leading cause of death in child abuse cases.
Durban paediatrician Das Pillay says: “Little babies have poor neck support, so when someone forcefully shakes a baby, the head rotates about the neck uncontrollably. The violent movement sends the brain backward and forward in the skull, rupturing blood vessels and nerves.
“The brain may strike the inside of the skull, causing bruising and bleeding.
“If the child is then dropped, hitting the floor or a bed mattress even, the impact and damage is worse. It creates swelling and haemorrhages, which lead to a build up of pressure within the baby’s brain.
“Because of the anatomy of little babies, vigorously shaking puts them at particular risk for injury from this kind of action.
“These babies become lethargic, irritable, may vomit, develop breathing problems and have seizures.”
Pillay says: “The majority of victims are infants younger than one-year-old. The average age of victims is between three and eight months, although these injuries can be seen in children up to five.
“The perpetrators in these cases are most often parents or caregivers. Common triggers are frustration or stress when the child is crying. Unfortunately, the shaking may have the desired effect: although at first the baby cries more, he or she may stop crying as the brain is damaged.”
It is said that the perpetrators in 65 to 90 percent of cases are men – usually either the baby’s father or the mother’s boyfriend, often someone in his early twenties.
Infants with injuries of shaken baby syndrome require emergency care, including respiratory support and surgery.
Often these infants require draining of the blood around the brain to decrease the ongoing brain injuries associated with brain swelling.
Additional treatments may be required as well, including obtaining ophthalmologic and neurological evaluations.
Normal interaction with a child, like bouncing the baby on a knee, will not cause these injuries. It’s important to never shake a baby under any circumstances.
Shaken baby syndrome is almost always a result of child abuse, often perpetrated by a parent or caregiver who shakes an infant angrily in response to persistent crying. In very rare cases, the injuries associated with shaken baby syndrome may be caused by accidental actions, such as jogging with a newborn baby in a backpack. It does not result from gentle play or bouncing a child on a knee. Even in the rare accidental cases, the injuries are rarely as severe as the cases associated with non-accidental trauma from shaken baby syndrome.
* Head injury
In a contrecoup injury, the head stops abruptly and the brain collides with the inside of the skull. This is often associated with shaken baby syndrome as babies and toddlers have more space between the brain and skull to allow for brain growth and are more susceptible to this type of injury than adults.
Pillay says the shearing of neurons within the brain can lead to cognitive fallout, often only detected once the child reaches a school-going age and has learning difficulties.
It cannot be clinically proved, but may be diagnosed by a neurological specialist. Treatment is in the form therapy, occupational and otherwise.
* The line between rocking and shaking
Shaken baby syndrome is when the baby is shaken so violently that the brain moves in the skull and causes swelling, says Liz Victor of Top Tots.
Rocking a baby stimulates the vestibular system, lulling him or her to sleep.
The difference between a shaken baby and rocking is the intensity.
Don’t allow yourself to be overwhelmed by a crying baby. Here are some of Victor’s tips on how to help your baby go to sleep.
You can firmly hold the baby and rock to help him or her relax.
Swaddle or hold the baby firmly with as much body contact as possible and then rock. This stimulates the sense of touch, relaxing the infant, and the rocking stimulates the near senses, allowing them to fall asleep. Ensure you don’t overstimulate the baby before bedtime. Turn the TV off and dim the lights. Sing a specific song or play a CD that signals bedtime.
This same routine has to be repeated every night so that they start associating it with sleep. You are not looking for absolute quiet. A background hum (white noise) is what they are used to in the womb.
Daytime sleep is just as important. Try to let your baby go to sleep in the same place, his cot, for every sleep. Mom needs a break. If she is the one dealing with the crying baby every night, it will take its toll on her.
Possible reasons for the “suicide hour” parents experience with young babies, which is often diagnosed as colic:
* Overload. Newborn babies can’t regulate their environment and those who might be slightly sensitive to sounds, touch, sights and smells will experience sensory overload. They usually acquire this skill by three to five months.
* An immature digestion system, which causes painful winds.
* Reflux, which is almost like heartburn.
* Parents who smoke seems to contribute, but the reason is not clear.
* Mom’s milk supply might dip in early evening, causing irritation to the infant. Supplement with a pumped bottle.
Just one more tip: when placing a baby in his cot, put his bottom down first,then the head. This grounds the baby. Head first will activate the vestibular system; the baby registers that he is going down and wakes up. - The Mercury