Shaken Baby Syndrome: the Local Perspective

The medical profession in 1972 first described the shaken baby syndrome (SBS). Since then, SBS has been recognized as one of the most severe types of child maltreatment and is the most common cause of death in abused children. It refers to a form of severe head injury when a young child is shaken vigorously by a grown-up. The shaking produces a shearing force to the immature brain and tears the underlying nerve fibres and blood vessels. The more characteristic signs include bleeding in the subdural space (subdural haematoma) and the retina (retinal haemorrhage). Superficial bruises and fractures may provide important clues to the abusive nature, but these features are often absent. A confession by the abuser is almost never obtained. Hence, a heightened awareness is needed to identify the child with SBS. Although suspected cases of inflicted head injury in children have been mentioned, it was only first reported in the local medical literature in 1995. Because of the increased concern by the paediatric specialty, more cases were reported in the last four years. It is clear to the medical profession that the proper recognition and diagnosis of SBS require an expertise in the area of child abuse. A review in our hospital indicates that SBS occurs at an annual incidence of 1.4 per 100 000 children under the age of 15. It accounts for 5% of the abuse cases admitted into our hospital. 30% of the cases died and the others were left with significant neurologic handicaps. Many child protection workers in the social welfare, the law enforcement, and the health care disciplinces are still unaware of or unfamiliar with the SBS. Misconceptions about childhood head injury and inexperience in handling the deceptive nature of most abusers are common among the caseworkers. The true incidence and the underlying factors predisposing to the occurrence of SBS are largely unknown. Because of the relatively uncommon occurrence of SBS in Hong Kong and the specific nature of this kind of maltreatment, individual expertise in the social welfare department, the law enforcement, and the medical discipline is required. Successful management of SBS calls for the effective collaboration among these disciplines. There is still much room for research concerning the prevention and follow-up of the SBS. Introduction: What is Shaken Baby Syndrome (SBS)?