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In most cases, an angry or frustrated parent or caregiver shakes the baby to punish or quiet the child. Such shaking usually takes place when the infant is crying inconsolably and the frustrated caregiver loses control. Many times the caregiver did not intend to harm the baby. Still, it is a form of child abuse (NIH, 2009).
Injuries are most likely to happen when the baby is shaken and then the baby's head hits something. Even hitting a soft object, such as a mattress or pillow, may be enough to injure newborns and small infants. Such injuries can occur because infants’ brains are softer, their neck muscles and ligaments are weak, and their heads are large and heavy in proportion to their bodies (NIH, 2009).
In addition to inconsolable crying, other triggering events include toilet training difficulties and feeding problems (NCSBS, nd).
AHT does not result from gentle bouncing, playful swinging or tossing the child in the air, or jogging with the child. It also is very unlikely to occur from accidents such as falling off chairs or down stairs, or accidentally being dropped from a caregiver's arms. Short falls may cause other types of head injuries, although these are often minor (NIH, 2009). It is estimated that the incidence of death from a short fall (<4 feet) is probably at most 1 in a million. When this does occur, the brain injuries tend to be recognizable as contact injuries and different from those seen in fatal abusive head trauma (Case & NCSBS, nd).
Episodes of shaking can occur chronically. In one study (Adamsbaum, et al, 2010), 55% of perpetrators repeated violent shaking episodes, on a daily basis over several weeks or months. The estimated number of episodes ranged from 10 to 30 episodes of shaking. Perpetrators cited repetitive shaking as an effective means of getting the child to go to sleep (62.5%). Exhaustion may be considered an immediate symptom and a result of hypoxic-ischemic injuries in some of the children (Adamsbaum, et al., 2010).
Continue on to Risk Factors for Abusive Head Trauma
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