Shaken baby syndrome is different from gently tossing a baby playfully into the air or bouncing a baby on your knee. Though their brains and necks are fragile, babies are also unlikely to get shaken injuries by falling off furniture or making sudden stops in a car.

Shaken Baby Syndrome Symptoms

Being shaken affects babies in many different ways. Symptoms include:

• Vomiting
• Bluish skin
• Tremors or shakes
• Breathing issues
• Drowsiness
• Less interest in eating
• Trouble sucking
• No more smiling or talking

You may notice bruises on the arms or chest in the places the baby has been grabbed. Other physical signs include:

• A larger than usual head or forehead
• Different-sized pupils
• Not being able to focus
• Favoring one arm or leg over another

Babies with shaken baby syndrome may also have symptoms you can’t see, such as:

• Broken ribs or other bones
• Spinal cord or neck injury
• Bleeding in the brain

In mild cases, behavior, health, or learning issues show up later on.

Causes of Shaken Baby Syndrome

It takes infants a while to hold their heads up. That’s because their neck muscles start out weak and get stronger as they grow. The same goes for their brains, which still need time to develop.

When a baby is shaken, its brain can bounce between the front and back of its skull. This causes it to bleed, bruise, and swell. It only takes a few seconds of aggressive shaking for this to happen.

Risk factors that lead to shaken baby syndrome

Babies bring a lot of joy, but there can also be moments of frustration if you feel like you can’t console their crying. Most caregivers handle those times just fine. But if those feelings boil over, it can cross a line. Certain things can increase your risk of crossing that line, including:

• Alcohol or substance abuse
• Unstable family situations
• Depression

Shaken Baby Syndrome Diagnosis

Because shaken baby syndrome can affect so many different parts of a child’s health, there may be more than one doctor or specialist involved in the diagnosis. Depending on the child’s level of injury, the tests may be done in doctor’s offices or a pediatric intensive care unit.

To check the brain, doctors may use a CT scan to look for injuries that need immediate attention. MRI scans also show doctors detailed areas of the brain.

X-rays of other body parts, like the arms, legs, spine, and skull, show fractures and whether they were created by force or accident.

To check for eye injuries and bleeding, doctors may do an eye exam.

Some disorders can mimic the symptoms of shaken baby syndrome. To rule those out, doctors may order blood tests.

Shaken Baby Syndrome Treatment and Prevention

Treatment for shaken baby syndrome depends on the injury. Surgery may be needed in an emergency. Some children will need care for the rest of their lives.

Shaken baby syndrome is 100% preventable. It starts with making sure all the baby’s caregivers — parents, grandparents, baby sitters, nannies, etc. — understand two things:

1. The dangers of shaking a baby, even for a few seconds.
2. That babies cry a lot at first. The National Center for shaken baby syndrome calls it PURPLE crying:

• Peak pattern: At 2-3 months old, babies cry the most.
• Unpredictable: Crying starts and stops without reason.
• Resistant to soothing: Nothing stops the crying.
• Pain-like look on face: When babies cry, they look like they’re in pain, even if they’re not.
• Long bouts of crying: Babies can cry for hours at a time.
• Evening crying: Some babies cry more in the afternoon and evening.

Sometimes you can stop the crying by rubbing the baby’s back, singing, using “white noise” from an app or the sound of running water, taking a walk, or using a pacifier. Sometimes nothing seems to work. That’s when you especially need to manage your feelings.

Have a plan in place. If you feel pushed beyond your limit, put the baby on their back in a safe place — or inside your home in a car seat with the baby strapped in on the floor (never leave your little one alone in the car!) — and step away for a moment. Call someone you trust — even your neighbor — who’ll listen to your frustrations. As you talk, check on the baby every 5 or 10 minutes. You could also ask someone to watch your baby for half an hour while you take a walk and collect yourself.

If you notice your caregiver or another parent struggling, be supportive and suggest a safe place they can take the baby when they need a break. Like babies, sometimes parents and caregivers just need to cry and be comforted.

Shaken Baby Syndrome Complications

Forcibly shaking a baby, even briefly, can cause permanent brain damage. The results can be serious and long-lasting, and include:

• Partial or total blindness
• Delays in development, learning problems, or behavior issues
• Intellectual disabilities
• Seizure disorders
• Cerebral palsy

Most of these complications require lifelong care.