*Warning:  Graphic post*

“Hush little baby, don’t say a word,” a new mother sings softly to her newborn.  She gently cradles her daughter, as if made of porcelain, as if she could break.  She kisses her forehead, caresses her soft skin.  She bends her face close to her daughters, and talks in a sing-song voice.  Her newborn daughter is not a blank slate.  She recognizes her mom’s voice, and smell.  She tracks her mom’s movements with her eyes.

Inside her baby’s skull is a beautifully engineered interplay of anatomy, blood flow, synapses, and mystery.  The way the skull is built at birth allows for the bones to be flexible, so the newborn’s head can adapt while coming out of the birth canal.  Her brain floats in cerebrospinal fluid,  much like a baby floating in amniotic fluid in utero.  This fluid acts as a cushion or buffer for the brain, to protect it from sudden movements. The infant’s fontanelles, or soft spots, allow for the extremely rapid brain growth an infant experiences those first months of life.  While she is being touched, and held, and sung to, her brain cells are communicating.  The mother may not know it, but her actions of touch, sound, sight,and smell, stimulate her baby’s brain to grow and develop.  The mother’s dreams of her daughter being a concert pianist, dancer, scientist, teacher, singer, are all being nurtured by her loving actions.  They are instinctive in helping her daughter grow.  Yet, instincts can fail.  Others may never develop these maternal instincts.

The new mom leaves her newborn for a few hours with an experienced caretaker, so she can shop and decompress.  Her daughter wakes up from her nap and communicates the only way she knows how.  She cries.  Her new brain is not yet used to all the sights and sounds and stimuli of life outside the womb.  She can be hard to console and fussy.  Nothing may work to stop her crying.  The caretaker is frustrated.  She picks up the baby and shakes her back and forth and back and forth, furiously.  The infant’s head snaps violently back and forth on her neck.  She is quiet.  The caretaker lies her back down for her nap.  She tells the mom nothing.

Inside the baby’s skull her brain is being battered.  It is smashing back and forth and back and forth against the hard surface of her skull.  Her brain twists and contorts from the rush of movement.  Blood vessels sever from the force, and leak blood into the tissues of her brain.  Brain cells die from the lack of oxygen not being delivered from the severed blood vessels.  Her brain begins to swell inside her skull, further damaging her brain tissue.  Functions of the brain that allow for sight and smell and movement and emotion, and thought, are being starved, suffocated.

The new mom wonders why her baby is so sleepy, why she refuses to eat.  The experienced caretaker tells her this is normal, babies are like that.  The new mom worries.  In the middle of the night her daughter starts to have spastic movements, her lips turn blue.  She is rushed to the hospital.  The news is not good.  Her daughter has suffered  a traumatic brain injury.  Months pass.  Her newborn daughter who she had such dreams for, dreams of happiness, love and success, are gone.  Her child will be blind.  She will suffer from intractable seizures.  She will never walk or talk or smile.  She will forever be a 5 day old infant, in a toddlers, preschoolers, teenagers, adult body.  The new mom’s lofty dreams for her daughter have turned into dreams of her child one day being able to swallow, to vocalize, to recognize, to walk.  Seconds in the life of an infant can last a lifetime.

*****************************************

Head injuries are the leading cause of traumatic death and the leading cause of child abuse fatalities.  (American Academy of Pediatrics) Shaken Baby Syndrome is the result of traumatic head injury of a child, usually less than 2 years of age, but up to the age of 5.  It can cause a constellation of symptoms and disabilities in a child, with the most severe cases resulting in death.  According to the AAP:

There is a high rate of morbidity and mortality among infant victims of shaken baby syndrome. Mortality rates range from 15% to 38%, with a median of 20% to 25%. In one series, of those infants who were comatose when initially examined, 60% died or had profound mental retardation, spastic quadriplegia, or severe motor dysfunction. Other infants initially had seizures, irritability, or lethargy but had no lacerations or infarctions of brain tissue. These children did not have severely elevated intracranial pressure, subtle neurologic sequelae, or persistent seizures. When severely brain-injured children survive, they may be cortically blind; have spasticity, seizure disorders, or microcephaly; or have chronic subdural fluid collections, enlarging ventricles, cerebral atrophy, encephalomalacia, or porencephalic cysts. The outcome of shaken infants who do not receive medical attention is presently unknown but may be revealed later as learning, motor, or behavior problems of unknown cause.

There is work being done to improve the outcomes of infants and children with traumatic brain injuries.  Thanks to efforts such as  The Sarah Jane Brain Project, which states:
“The Mission of The Sarah Jane Brain Project is to create a model system for children suffering from all Pediatric Acquired Brain Injuries.”

This project was started by a father whose 5 day old daughter was violently shaken by a baby “nurse”.  (She was not actually a nurse, but a caretaker who took a two week course and was legally allowed to call herself a nurse…..Don’t get me started!) He has worked tirelessly to promote awareness on Shaken Baby Syndrome and improve care for these kids.

Of course in the best of all worlds, no one would ever shake a child.  Prevention is key.  As an OB nurse, part of our discharge instructions include not shaking your baby.  This really is not good enough.  We bombard new parents with a ton of information on how to care for a child in the 24-72 hours they are our captive audiences in the hospital.  Much of what we teach is never absorbed.

Prevention of child abuse needs to happen in the home.  It needs to happen before the woman has sex, before she gets pregnant.  Child abuse needs to be never, ever tolerated in our society.  Children need to be valued by all.  A second in the life of a child can have life long consequences.

RR