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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.


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