BRAIN INJURY : SHAKEN BABY

Baby Susan was just 3 months old when her mother brought her to see the doctor. She said the baby would not stop crying. Mum left Susan with a babysitter while she was at work, and the babysitter called to say there was something wrong with her.

On examining the baby, the doctor could not find anything wrong except an abnormal, continuous cry. There was not any evidence of illness, and not a mark on the child. The doctor observed the baby, and over the course of hours, the soft spot on the front of the baby’s head called the anterior fontanelle was bulging. By that time, the baby’s spontaneous movements looked obviously abnormal, and the baby started having seizures. A neurologist called in was able to draw blood out of the fontanelle. There was also blood in the back of the baby’s eyes.

X-rays of the baby’s long bones did not show any old fractures. However, it was clear to the treating doctors that the baby had been shaken. A small baby, shaken vigorously, can have diffuse bleeding into the brain, without a mark to be seen at first. The small brain gets bounced back and forth inside the skull, suffering severe trauma.

Police and social services were called. It was up to the authorities to decide who was responsible for the baby’s injuries. The doctors had to try and treat her. They removed as much blood as they could from the fontanelle, and gave the baby anti-seizure medicine. CT scan showed tremendous, diffuse bleeding in the brain and a large subdural hematoma. In babies, the subdural space is accessible through the soft spot, which is how the doctors were able to drain it.

While at first it appeared that the TBI might kill baby Susan, it did not. The person who shook her, who turned out to be the babysitter’s boyfriend, had grabbed her by the abdomen tightly when he shook her, “just to stop her from crying.” In doing so, he had also injured multiple organs in the abdomen. Susan’s bowel had holes in it, her liver was injured, as well as other organs. Although surgeons repaired everything they could, Susan died of her injuries.

The neurologist said that had Susan survived, she would have been blind, deaf, and unable to walk as a result of her TBI. Babies that survive being shaken are often left with terrible neurologic deficits. They also often do not have a stable home to return to.

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