Q&A

Kathleen Lillis is medical director of emergency medicine at Children's Hospital and director of the 5th annual Childhood Violence Symposium held earlier this week.

What is shaken-baby syndrome?

Shaken-baby syndrome is the medical term used to describe the violent shaking and resulting injuries sustained from shaking. Often, there are no obvious outward signs of injury to a baby or young child's body, but there is injury inside, particularly in the head or behind the eyes. Vigorous shaking causes the brain to be repeatedly hit around within the skull. These sudden motions can cause some parts of the brain to pull away, tearing brain cells and blood vessels in the process. When a child is shaken in anger and frustration, the force is multiplied five to 10 times more than it would be if the child had simply tripped and fallen.

How prevalent is this problem?

There are approximately five to eight known cases of shaken-baby syndrome each year in Western New York. There are probably more that are not detected.

What are the short- and long-term effects?

Short-term effects include extreme irritability, vomiting, lethargy/poor muscle tone, inability to follow movements, seizures/convulsions and coma. Long-term effects include partial or total blindness, developmental delays, seizures, cerebral palsy, paralysis, hearing loss and speech and learning difficulties.

Does it affect only babies? Is there an age when children are no longer affected?

Violent shaking is especially dangerous to infants and young children because their neck muscles are undeveloped and their brain tissue is exceptionally fragile. Their small size further adds to the risk of injury. Vigorous shaking repeatedly pitches the brain in different directions. Children under age 2 are most at risk.

Is shaken-baby syndrome a "new" problem or a new name for an "old" problem? It seems to be a phenomenon of the 1990s.

Despite the fact that there is a common belief that this is a relatively "new" disorder, its ancestry can be traced back more than 400 years, from the first description of the subdural hematoma that was sustained by Henri II of France in 1559, to John Caffey's. It is clear that much of our present understanding of the shaken-baby syndrome relies on information gathered from generations of shaken infants.

When you hear of the syndrome, you think of children who are deliberately and maliciously abused, but can't it also occur as the result of "innocent" play?

Most of the time, shaken-baby syndrome occurs because a parent or caretaker is frustrated or angry with a child. Other times, children become victims when a parent or caretaker, not realizing how seriously this behavior can harm, throws a small child into the air vigorously, plays too roughly or hits an infant too hard on the back. Anyone who takes care of a baby or small child-parents, older siblings, baby-sitters, child-care professionals and other-should be reminded to never shake babies or small children.

How do you prevent shaken-baby syndrome?

The key to prevention is education. Anyone who cares for an infant or young child should be taught the dangers of shaking an infant. It is important to teach families that babies cry for many reasons and that it can be very frustrating when you cannot get the baby to stop. Individuals caring for a baby should be taught alternative ways of dealing with their anger and frustration. They should ask for help. Call a friend or relative to take over. If these measures are not possible, gently place the baby in the crib on his or her side and take a short break. The baby is safer in its crib then in the arms of an angry, frustrated person.

What resources are there locally for dealing with the syndrome?

There are not a lot of resources locally or nationally. Most of the medical community's involvement occurs once a child has been shaken. It is only recently that the medical community has recognized the importance of prevention. We will hear from representatives from the medical community, the legislature, from the schools and community groups, including Parents Anonymous, about current efforts. One of the goals of the symposium was to work together as a community to increase resources available to prevent shaken-baby syndrome.

How is the "Buffalo experience" with the syndrome different than that elsewhere or nationally?

The Buffalo experience is very similar to what is happening elsewhere. In Western New York, there has been an increase in the number of cases seen during the past few years.