Shaken Baby Syndrome
Shaken Baby Syndrome (SBS) is a form of child abuse that can cause severe brain damage or death. It is caused when a baby is shaken violently and repeatedly and can inflict serious injuries. Shaken Baby Syndrome (SBS) is a preventable public health problem that can also be seen as a crime (Center for Disease Control [CDC], 2010). “Policy interventions are important and effective community and societal level strategies for improving the public’s health” (CDC, 2010). New York passed a bill that states that all hospitals are required to provide parents with information about the dangers of shaking an infant and that all childcare providers are to be educated and informed on the identification, diagnosis, and prevention of SBS (CDC, 2010).
Shaken Baby Syndrome
Shaken Baby Syndrome is an intentional injury inflicted onto a child, usually an infant, which is caused by violent shaking of the child. (Barr, Trent & Cross, 2006). It can involve solely shaking the child or it can involve contact with a hard surface (Barr et al., 2006). Shaking that involves hitting a child on a hard surface can cause serious head trauma that may include: “subdural hematomas, diffuse axonal injury, and retinal hemorrhages but also often fractures of the long bones or ribs” (Barr et al., 2006). When an infant is violently shaken, without the involvement of a hard surface, (shaken from the shoulders, arms or legs) it can suffer from extreme whiplash that can inflict bleeding in the brain or the eyes (CDC, 2010). Injuries caused by SBS are said to be similar to the effect of an infant or child being in repeated car crashes (CDC, 2010). The resulting consequences of SBS include: death, blindness, mental retardation or developmental delays, cerebral palsy, sever motor dysfunction, spasticity (some muscles are continuously contracted), and seizures (CDC, 2010).
There are no firm statistics on the actual incidence of Shaken Baby Syndrome, because there are no central reporting registries to collect data (Reece & Kirschner, n.d). It is difficult to determine past incidences due to the lack of reporting efforts, but there has been a large increase in the number of books and articles written about this subject in the last few decades (Reece & Kirschner, n.d.). “SBS is a leading cause of child abuse deaths in the United States” (CDC, 2010). Reece and Kirschner (n.d.) state that some reports show the incidence rate to be as low as 600 per year and other reports that show rates as high as 1400 per year. One source stated that there are about 24 children per 100,000 children under the age of one that are victims of SBS (Barlow & Minns, 2000). Shaken baby syndrome seems to be more common in urban regions and during the fall and winter months (Barlow & Minns, 2000).
New York passed bill A08314, which requires that all hospitals, childbirth centers and other medical facilities provide an educational video to new parents that informs them about Shaken Baby Syndrome. This policy is intended to prevent SBS from occurring. It states that the New York Department of Health should continue to provide ongoing information and education services on SBS to help educate the general public about the causes, consequences and injuries that can occur if one were to shake a baby. Information and education options include: print, audio, video, electronic and other forms of mass communication to the public (CDC, 2010.).. An additional part of the policy requires all childcare providers to be educated and informed on the identification, diagnosis and prevention of Shaken Baby Syndrome (CDC, 2010.). There are other states, such as Utah and Texas, who have similar policies to help prevent this syndrome.
Piaget’s Cognitive Development Theory
Piaget’s theory of cognitive development emphasizes that children develop cognitively through a series of four stages. The first stage of cognitive development is sensorimotor: children ages 0 to about 2 years begin to understand their world through sensory perceptions and motor activities (Feldman, 2005). Throughout this stage there are also sub stages, which include items such as reflexes, coordination of reactions and many other developmental successes (Feldman, 2005). Next, is the preoperational stage: children ages 2 to 7 develop language and increase symbol usage (increase in play and pretending) (Feldman, 2005). The third stage of Piaget’s cognitive development theory is called concrete operational. In this stage children ages 7 to 11 years gain a better understanding of mental operations, begin to think logically and develop reversibility (Feldman, 2005). The final stage of cognitive development is formal operational thought and is associated with people ages 12 to adulthood (Feldman, 2005). Formal operational thought consists of being able to think abstractly: having logical thought, deductive reasoning and systematic planning. Each stage of cognitive development shifts how children understand and view the world.
Cognitive Development and SBS
Compared to any other age group, infants have the largest head to body ratio, they also have neck muscles that are too weak to support the head, and the myelination in their brain has not been completed (Castiglia, 2001). These aspects of an infant’s head cause their brain to be more susceptible to injury and more sensitive to movement (Castiglia, 2001). Additionally, the central nervous system is also not fully developed and is more prone to injuries that can cause long-term effects (Castiglia, 2001). The physical effects of SBS can lead to “brain damage, seizures, blindness, paralysis, and death” (Castiglia, 2001). The portion of head injuries in infants caused by shaking varies between 20 to 50 percent of cases (Ashton, 2010). When these traumatic injuries occur, it can directly affect the infant’s cognitive development and can restrict a child from reaching all aspects of the stages of Piaget’s cognitive development theory.
According to Piaget, sensorimotor actions are the origins of intelligence and are the prerequisites for operational thought (the three stages following the sensorimotor stage) (Berninger, 1988). In order to reach a stage, the previous stage needs to be conquered first (Berninger, 1988). Infants under the age of 1 year are at the greatest risk for the poorest outcomes from a brain injury, compared to other age groups (Ashton, 2010). Brain injury resulting from Shaken Baby Syndrome can lead to sensory problems and information processing skills from their sensory actions can become impaired: for example, vision problems can arise (Ashton, 2010).
The second stage of Piaget’s cognitive development theory, preoperational, is where language development occurs and there is a substantial increase in symbol usage (Feldman, 2005). When a child has a brain injury inflicted by SBS, they can incur many problems associated with their language development, which ultimately could cause a child not to reach the stages that surpass preoperational thought (Ashton, 2010). Evidence shows that there is a strong possibility for speech production impairments. Studies have found that 2 out of 3 infants with brain injury had considerable difficulties with language (Ashton, 2010). Additionally, studies have also found that infants with Shaken Baby Syndrome did significantly worse on language tasks than their peers who did not have a brain injury (Ashton, 2010).
New York State’s policy that attempts to prevent Shaken Baby Syndrome does an adequate job at addressing a human’s needs based on Maslow’s hierarchy of needs theory. It aims to prevent the harm done to a child that is caused from shaking them by preventing the shaking from happening altogether. As stated previous, this policy requires that all hospitals, childbirth centers and other medical facilities provide an educational video to new parents that informs them about Shaken Baby Syndrome (CDC, 2010). Prevention strategies are essential for putting a stop to the problem of Shaken Baby Syndrome. If a child does not fall victim to SBS, they will not suffer from the brain injuries that are linked to SBS and will be able to reach all four stages of Piaget’s cognitive development theory.
Although the policy, New York Bill A08314, works on educating parents and childcare providers on how to prevent SBS from happening, there are features to the policy that could be added that would aid further prevention. Recent New York State Senate, William J. Larkin Jr., brought up the issue that parents who are incarcerated are not receiving the same education that non-incarcerated parents are receiving. This law seems to fail at providing the educational material to parents who are incarcerated during the child’s birth and also adults who are not related to the child who live in the home (Larkin, 2007). Parents who are able to be there with their child when they are born in the hospital are educated with various materials (videos, articles, etc.) about what happens when an infant is shaken, but parents who are in prison or in jail while this happens do not receive any education about it (CDC, 2010; Larkin, 2007). Larkin recommended and is trying to add to the law that all persons incarcerated at the time of their child’s birth, receive education on SBS in order to further prevent more SBS cases from occurring (Larkin, 2007). I agree with his recommendation entirely and think it will help reduce rates.
Another recommendation for this policy is to try to expand it nationwide. Each year roughly 1400 to 1600 children become victims of Shaken Baby Syndrome in the United States alone (Larkin, 2007), and yet few states have laws that require educational programs and information guides to new parents about it. If more states tried to implement this policy and educate the general public, it could potentially reduce these numbers significantly and allow children to reach the highest stages of Piaget’s cognitive development theory.
Additionally, New York could work on generating information about SBS to all of the general public in the state. They could reach this policy recommendation by having news stations report information on the news, have all children’s stores hand out informational flyers with customers purchases, create commercials that demonstrate the negative consequences of what happens when you shake a child and using social media to blast knowledge to the public.
Family Teaching Toolbox, an information guide written by neonatal nurses, provides basic information for caring for a newborn (National Association of Neonatal Nurses, 2008). They grant permission for health care provides to print off their guide and use it as a resource to educate their clients. If the state of New York and/or the entire United States could team up with the Family Teaching Toolbox and create a section about the dangers of shaking a baby, they could potentially reach out to more people (ones already referring to the Family Teaching Toolbox) to help aid further prevention of Shaken Baby Syndrome.
Shaken baby Syndrome is a serious but preventable problem in the United States. Many new parents do not know the severe consequences that coincide with SBS, mostly because they have not been educated on it (CDC, n.d.). When SBS happens to a child, they are not able to development in a normal developmental way and cannot reach the highest levels of Maslow’s hierarchy of needs (Snell, 2007). New York and other states have worked on implementing policies to prevent parents from harming their child by shaking them, but unfortunately it is does not reach all new parents and it is also not nationwide (Larkin, 2007).
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Ashton, R. (2010). Practitioner review: beyond shaken baby syndrome: what influences the outcomes for infants following traumatic brain injury?. The Journal of Child Psychology and Psychiatry, 51(9), 967-980.
Barlow, K., Minns, R. (2000). Annual incidence of shaken impact syndrome in young children. Lancet, 356(9241), 1571-1572.
Barr, R., Trent, R., Cross J. (2006). Age-related incidence curve of hospitalized shaken baby syndrome cases: convergent evidence for crying as a trigger to shaking. Child Abuse & Neglect, 30(1),pp. 7-16.
Berninger, V. (1988). Development of operational thought without a normal sensorimotor stage. Intelligence 12, 219-230.
Castiglia, P. (2001). Shaken baby syndrome. Journal of Pediatric Health Care, 15(2), 78-80.
Center for Disease Control and Prevention [CDC] (2010). A journalist’s Guide to shaken baby syndrome: a preventable tragedy. U.S. Department of Health and Human Services.
Feldman, D. (2005). Piaget’s stages: the unfinished symphony of cognitive development. New Ideas in Psychology 22, 175-231.
Kirschner, R., Reece, R. (n.d.). Shaken baby syndrome/ shaken impact syndrome. National Center on Shaken Baby Syndrom. Retrieved from www.dontshake.org.
Larkin, W. (2007). Larkin bill to prevent shaken baby syndrome becomes law. NY Senate Homepage. retrieved from http://www.nysenate.gov.
National Association of Neonatal Nurses. (2008). Advances in neonatal care, family teaching toolbox. The Official Journal of the National Association of Neonatal Nurses. pp. 77-79.