What Is Shaken Baby Syndrome?

crying baby

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Most of us are shown videos about shaken baby syndrome in the hospital after we have a baby. But while we might have a general idea about what shaken baby syndrome is, it is a topic most of us would rather not think about. After all, the idea of anyone harming a baby is unthinkable.

Although the vast majority of parents would never shake their baby, shaken baby syndrome is something that can happen out of the blue, especially when you are up all night with a screaming baby and feel overwhelmed.

And, it is not just parents who can struggle with this issue. Anyone who takes care of a baby can find themselves in this position including babysitters, nannies, and extended family.

That is why all parents need to understand what shaken baby syndrome is, how serious it is, what its symptoms look like—and most importantly, what to do if you or someone who cares for your baby might be at risk for shaking a baby out of anger or frustration. Here is what you need to know about shaken baby syndrome.

How Is Shaken Baby Syndrome Defined?

Shaken baby syndrome occurs when a child is held by the shoulders or chest—or upside down by the legs or feet—and is shaken back and forth. This action causes the head to move quickly and forcefully away from the rest of the body in a "whiplash" motion. Rocking your baby, bouncing them on your knee, putting them in a swing, and so on is not going to cause this syndrome.

Overall, shaken baby syndrome is a critical brain injury found in babies who have been violently shaken, says Ilan Shapiro, MD, medical director of health and wellness at AltaMed Health Services and fellow of the American Academy of Pediatrics. Shaken baby syndrome is a form of child abuse, and is more formally referred to as pediatric abusive head trauma (AHT).

Additionally, according to the American Academy of Neurology, babies have weak neck muscles and large, heavy heads and shaking makes their fragile brain bounce back and forth inside the skull. This action causes bruising, swelling and bleeding, which can lead to permanent, severe brain damage or death,

Another reason that babies are so susceptible to the harm of violent shaking is because of their physique. Babies' brains are softer than adult brains due to a higher water content—which makes the brain softer and more susceptible to acceleration-deceleration injuries (like those caused by shaking a child).

Shaken baby syndrome can cause extremely serious injuries—including death. The symptoms can appear within seconds to hours after the baby is shaken.

For instance, shaking a baby can cause the brain to hit the skull, which can kill brain cells and decrease the ability of oxygen to reach the brain. However, simple non-aggressive movements, such as gently bouncing your baby on your knee, do not cause shaken baby syndrome.

“Violent shaking also can cause brain bleeding, bruising, and swelling,” says Dr. Shapiro. “Brain damage can result in as little as five seconds of aggressive shaking.”

How Prevalent is Shaken Baby Syndrome?

Shaken baby syndrome is more prevalent than you might expect. In the U.S., between 1,000 and 3,000 babies experience it each year. Tragically, about 1 in 4 victims of shaken baby syndrome die from their injuries, and up to 80% of them suffer long-term damage. Anywhere from $1.2 to $16 billion is spent each year on medical care and hospitalization to treat babies suffering from shaken baby syndrome.

“The trauma to the head may be the result from either blunt trauma or injury that occurs after aggressive shaking back and forth, which causes intracranial brain and retinal hemorrhage,” says Robert Hamilton, MD, a pediatrician at Providence Saint John’s Health Center in Santa Monica, California, and host of the podcast “The Hamilton Review: Where Kids and Culture Collide."

Why Does Shaken Baby Syndrome Happen?

Usually, shaken baby syndrome happens when a parent or caretaker feels pushed to a breaking point because of a crying baby and they take out their aggression on the baby. Babies cry very frequently, especially in their first few months. Many parents aren’t prepared for this reality and don’t have the ability to cope with their own feelings about what is happening.

“Babies cry...a lot,” Dr. Shaprio says. “It's their only way to communicate. Sometimes new parents and caregivers feel overwhelmed and simply want to make the baby stop crying.”

Instead, it is important to understand that you may not be able to calm your baby and that is not your fault, nor is it your baby's. In fact, babies tend to cry much more in the first 4 months of life. The National Center for Shaken Baby Syndrome calls this period in their life as the Period of PURPLE Crying.

Period of PURPLE Crying Explained

Here is what PURPLE stands for.

  • Peak pattern: Crying peaks around 2 months and then decreases
  • Unpredictable: Crying can come and go for no reason
  • Resistant to soothing: Crying may last for long periods of time
  • Pain-like look: May have a pained look on their face
  • Long bouts of crying: Crying can go on for hours
  • Evening crying: Crying occurs more in the afternoon and evening

But shaking is never a solution when you are trying to console a baby or get them to stop crying. Shaken baby syndrome can occur when a baby is crying non-stop for hours and can’t be consoled, or has colicky symptoms, says Dr. Hamilton. Parents in these situations may feel pushed to the limit and resort to violence.

Additionally, parents under the influence of drugs or alcohol are at greater risk of shaking their baby because these substances can diminish their usual inhibitions toward violent behavior, says Dr. Hamilton. Alcohol and drugs mixed with infant care is a dangerous recipe, especially for exhausted parents.

What Are the Symptoms of Shaken Baby Syndrome?

There is a wide range of symptoms when it comes to shaken baby syndrome. Some symptoms happen immediately, and some may be slower to present and then progress to more worrying symptoms.

“Babies experiencing mild cases of shaken baby syndrome appear to be perfectly fine, but over time develop health or behavioral issues,” says Dr. Shapiro.

Symptom Overview

Some less severe symptoms of shaken baby syndrome include extreme fatigue, vomiting, poor feeding, and fussiness due to pain from the head injury and/or rib fractures suffered when the adult squeezed the child's chest while shaking them. More severe symptoms may include seizures, coma, apnea (the baby stops breathing and turns blue), and death.

It also is not uncommon to find bodily injuries like rib and bone fractures as well as bruising. Some babies will even have signs of retinal eye bleeding.

In addition to these symptoms, Dr. Shapiro says you might find babies who are experiencing body tremors—which are seizures due to the brain injury—and bluish skin—which occurs because the baby is not remembering to breathe due to the brain injury. Spinal cord injuries also can happen with shaken baby syndrome, as well as brain bleeding.

Does Shaken Baby Syndrome Cause Long-Term Damage?

Many cases of shaken baby syndrome cause immediate symptoms, often very serious in nature. Plus, babies who have experienced shaken baby syndrome may suffer the effects of what happened to them for years to come. That’s one of the most tragic aspects of the syndrome.

“The brain damage from shaken baby syndrome is irreversible and can cause learning disabilities, behavioral issues, vision loss, issues with hearing and speech, seizure disorders, cerebral palsy, or can be fatal,” says Dr. Shapiro.

According to the National Center for Biotechnology Information (NCBI), babies who were victims of severe abuse from shaken baby syndrome will experience a significant reduction in their quality of life. This can also include babies who only experienced minor injuries from it.

As NCBI notes, approximately 50% of kids ages 0 to 4 who experienced abusive head trauma will die of their injuries by the time they are 21 years old. More than 50% will experience blindness (partial or complete), and an additional 20% will need to be fed by a feeding tube.

What Are the Treatment Options?

Treatment options will vary from one baby to another, depending on symptoms, says Dr. Shapiro. Plus, there is no cure for shaken baby syndrome.

If your baby suffers from the condition, they will need treatment for their injuries as prescribed by their medical team. Severe cases of shaken baby syndrome may even involve surgery and life-long treatments. The treatment is dependent on your baby's specific injuries.

“Children with fractures, for example, would require bone setting,” says Dr. Hamilton. “Children who have sustained intracranial bleeding may require neurosurgical draining of the bleed.”

What to Do If You Think You Might Shake Your Baby

It may be hard to understand, but in the majority of cases, the perpetrators of shaken baby syndrome are the baby's parents or caretakers. Of these, 65% to 90% of offenders are male.

Although most parents don’t end up acting violently toward their babies, many of them do experience frustration, irritability, and feelings of anger as they are caring for young babies. Many of them simply aren’t prepared for the intense demands of baby care.

When you have a baby who is colicky or cries for hours on end, and can’t seem to be consoled no matter what you do, it’s understandable that you would feel on edge. You may even begin to feel intense rage or feelings of violence.

Acknowledging your feelings is an important first step. This can prevent you from acting out on your feelings. Dr. Shapiro also advises taking a breather from your baby.

Ilan Shapiro, MD

Put the baby in a safe place, like [on their back] in a crib or playpen, and take 5 minutes to yourself to relax and regroup.

— Ilan Shapiro, MD

If you need more than 5 minutes to regroup, continue to check on your baby every 5 to 10 minutes until you feel in control of your emotions. Remember, a baby crying in their crib is OK, but a shaken baby is not OK.

To help decompress, Dr. Shapiro recommends a technique called the “3x3x3 breathing technique.” This technique involves breathing in for a count of three and then breathing out for another count of three. You can repeat this exercise three times.

In addition, Dr. Shapiro recommends connecting with a family member or friend to whom you can vent your feelings. Sharing your feelings and frustrations in a safe space can really help.

“You can check on the baby every few minutes as you talk, or ask someone to watch your baby while you take some personal time to collect yourself,” Dr. Shapiro suggests.

Speaking to a healthcare provider also can help. It’s possible that you may be dealing with a postpartum mood disorder, such as postpartum depression or postpartum anxiety. There are treatments for these disorders, which can help with the feelings of anger or rage you may be feeling.

In some situations—especially if you feel out of control to the point where you might harm your baby or yourself—it makes sense to seek emergency medical assistance. Call 911, or drive yourself and your baby to the emergency room.

What To Do If You Think Someone Else Might Shake Your Baby?

Some of us find ourselves in situations where we fear that someone else might harm our baby or act violently toward them. This may be your baby’s other parent, a family member who is caring for your baby, or a hired caretaker like a babysitter or nanny. Parents need to have a zero-tolerance policy when it comes to anyone who might harm their baby, says Dr. Hamilton.

Robert Hamilton, MD

Parents should never leave a child with a relative or other caretaker who they do not completely trust.

— Robert Hamilton, MD

"Individuals who have quick tempers or have demonstrated previous violent actions—especially those who have abused children or spouses—should not be allowed to care for a child unsupervised," says Dr. Hamilton.

If you feel someone may act violently toward your baby, it is important to remove them from that person's care. If you are unable to do this alone, call 911 for help.

You should also call 911 if you think your baby has been a victim of shaken baby syndrome. Shaken baby syndrome—or any kind of abuse toward a baby or young child—is a very serious matter and should be acted upon immediately.

A Word from Verywell

Shaken baby syndrome may be something too upsetting for most of us to think about or even consider. But it’s a situation that all parents need to be educated about. Even if you are not the perpetrator of shaken baby syndrome yourself, you need to recognize that sometimes others might act violently toward them.

And while none of us wants to think of ourselves as someone who would act out in anger, some parents do find themselves on the brink of doing so. Help is out there for anyone who fears they may harm their baby.

Speak to a healthcare provider or a mental health professional if you or someone who cares for your baby is in that place. Most importantly, recognize that shaken baby syndrome is extremely serious, and any baby who is vulnerable to harm needs to be removed from that situation immediately.

5 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Center for Biotechnology Information, U.S. National Library of Medicine. Pediatric abusive head trauma. PMID:29763011

  2. National Center on Shaken Baby Syndrome. Consensus.

  3. Weill Cornell Medical College. Concussion.

  4. New York State Department of Health. Shaken baby syndrome: Facts and figures.

  5. National Shaken Baby Syndrome. The period of PURPLE crying.

Additional Reading

By Wendy Wisner
Wendy Wisner is a lactation consultant and writer covering maternal/child health, parenting, general health and wellness, and mental health. She has worked with breastfeeding parents for over a decade, and is a mom to two boys.