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SHAKEN BABY SYNDROME. Bernadette J. Madrid, M.D. Executive Director Child Protection Unit Network. What is physical abuse?. Acts by a caregiver that cause actual physical harm or have the potential for harm (WHO, 2002)

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Shaken baby syndrome


Bernadette J. Madrid, M.D.

Executive Director

Child Protection Unit Network

What is physical abuse

What is physical abuse?

  • Acts by a caregiver that cause actual physical harm or have the potential for harm (WHO, 2002)

  • Physical injury includes but is not limited to lacerations, fractured bones, burns, internal injury or serious bodily harm suffered by the child (R.A. 7610)

Head trauma in child abuse

Head Trauma in Child Abuse

  • Most common cause of mortality and morbidity in physical child abuse

  • 33%-56% of brain injuries in children < 1 year of age were inflicted.

Head trauma in child abuse1

Head Trauma in Child Abuse


    Population-based study in Scotland (Barlow & co-authors, 2000):

    24.6 per 100,000

Shaken baby syndrome sbs

Shaken Baby Syndrome (SBS)

  • Violent shaking or shaking plus head impact against a hard or even soft surface

Sbs sis


  • Crying is the usual trigger to shaking

  • Infant held by chest, upper arms or neck

  • Variable duration – 4-20 seconds

  • 2-4 shakes per second

  • Head rotates in many directions on the axis of the neck

Infant brain vs adult brain

Infant Brain vs. Adult Brain

  • Infant brain has approximately 25% more water than the adult brain

  • Infant brain has little or no myelin

    Result: infant brain is much softer, more gelatinous than adult and thus more fragile

Retinal hemorrhages

Retinal Hemorrhages

  • Incidence of RHs in SBS: 50% -100%

  • Overwhelmingly more common in SBS than in accidental head injuries

Signs and symptoms of sbs sis

Signs and Symptoms of SBS/SIS

  • Variable, depending on duration and number of shakes, presence of impact

  • Continuum from decreased responsiveness, irritability, lethargy, limpness to:

    • Seizures, tachypnea, bradycardia, hypothermia

    • Coma, death

Associated injuries

Associated Injuries

  • Bruising

  • Abdominal Injuries

  • Skeletal injuries:

    • Long bones

    • Posterior rib fractures

    • Classic metaphyseal lesions (CML)

Present illness

Present Illness

  • 3 most common triggering events:

    Inability to control infant crying

    Feeding difficulties

    Toileting issues

Past history

Past History

  • Accidents

  • Previous seizure episodes

  • Previous hospitalization

Suspicious stories fatal cases

Suspicious Stories* – Fatal Cases

  • Child fell from low height

  • Child fell onto furniture, floor, object

  • Unexpectedly found dead

  • Child choked, shaken to dislodge object

  • Child turned blue, shaken to revive

  • Sudden seizure activity


Common suspicious stories

Common Suspicious Stories

  • Resuscitation efforts caused injuries

  • Traumatic event a day or so ago

  • Tripped or slipped carrying child

  • Sibling did it

  • Child left alone for short time

  • Child fell down stairs

Outcomes of sbs

Outcomes of SBS

  • Long-term morbidity high amongst survivors – 90% affected

  • Mortality rate approximately 20%

Sequelae of sbs

Sequelae of SBS

  • Tetraplegia, hemiplegia, hemiparesis

  • Mental Retardation

  • Blindness

  • Learning Disabilities

  • Cerebral Palsy

Issues when child is in the hospital

Issues when child is in the hospital

  • Protective Custody

  • Consent for procedures

  • “Bantay” in the hospital

Sec 9 irr of ra 7610

Sec. 9 IRR of RA 7610

Protective Custody. If the investigation discloses sexual abuse, serious physical injury or life-threatening neglect of the child, the duly authorized officer or social worker of the Department shall immediately remove the child from his home or the establishment where he was found and place him under protective custody ensure his safety.

Shaken baby syndrome

Patient comes to MD

Determine nature of injuries


Intentional/Neglect/Physical abuse

Child at risk

Report to LGU or DSWD field office





Crime Scene





Criminal Case filed

Involuntary commitment

Issues if the child dies

Issues if the child dies

  • Consent for autopsy

  • No Complainant

  • Can we prove who inflicted these injuries?

  • What is the charge?

Doj circular no 55 sept 11 2002

DOJ circular No. 55 (Sept. 11, 2002)

Authorizing all Provincial and City Prosecutors to make an order for the performance of an autopsy on the body of child-victims, upon the request of any interested party, and upon proper showing that the child may have died under suspicious or abuse-related circumstances, there being no external signs to readily conclude that the child died as a result of violence or crime.

Doj circular no 55 sept 11 20021

DOJ circular No. 55 (Sept. 11, 2002)

“Any interested party”

Shall include but be not limited to a law enforcement

Officer, parent or legal guardian, or authorized physicians of the UP-PGH Child Protection Unit and other government hospitals.

Common defenses

Common Defenses

  • Alibi, character and other defense witnesses

  • Medical Witnesses for the defense

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