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Shaken Baby Syndrome: The 5-Second Tragedy

It was the kind of phone call that makes a mother's heart stop. Soon after arriving at work one April day two years ago, Andrea Mitchell called home to check on her kids: Jake, 9, Isaac, 2, and twins Alex and Aiden, 4 months. The Mansfield, Ohio, single mom had no reason to suspect anything was amiss. The babies, and their older brothers, were all smiles when she left the house. But she'd only recently gone back to work, and with a new sitter still settling in, she called home regularly.

This time she got the sitter's husband, who was out of breath when he answered the phone. "Alex has quit breathing!" he told her, panicked.

The next hours were a blur. The sitter rushed Alex to the hospital. Mitchell raced there and waited for test results that might explain why her baby, perfectly healthy an hour and a half before, was now having seizures and struggling to breathe. The news, when it finally came, was unimaginable: Alex had massive bleeding in his brain and hemorrhages in both eyes; he was in a coma and on a ventilator, and it wasn't yet clear that he'd survive.

Such injuries, the ER doctor explained, can be caused by only one thing: violent shaking. The police were called, and Mitchell wasn't allowed to go home to take care of her other children until after a full investigation. "I was living a nightmare," she says.

Five days later, she learned the truth: The babysitter had left her unemployed husband alone -- briefly -- with the three younger children while she took Jake and their own two kids to school. Investigators eventually concluded that during that time, he'd shaken the infant so ferociously that Alex, now 2, was left with permanent injuries: partial blindness, cerebral palsy, epilepsy, and impaired swallowing.

The sitter's husband pleaded guilty to assault charges and was sentenced to seven years in prison. But Alex will live with this tragedy for the rest of his life. Most likely, he'll always need a caregiver, and, when he becomes an adult, a legal guardian as well.

Irreparable harm

When a baby is held by her arms -- or under her arms -- and shaken, her brain bounces violently back and forth against the inside of her skull. The force of the impact can damage the retinas of the eyes and tear open the veins that attach the brain to the inside of the head. Blood begins to pool inside the skull. Injured brain cells swell as they die; the swelling crowds out surviving cells, and they, too, begin to die. These injuries can cause a baby to stop breathing; the oxygen deprivation causes further brain damage. It happens in the blink of an eye  -- 5 to 15 seconds, on average.

These kinds of brain injuries simply don't occur when a baby falls off a bed or a changing table. Nor do they happen in games when she's swung by the arms or bounced on a knee. Baby joggers, backpacks, and infant swings are similarly safe.

The name given to this set of injuries is shaken baby syndrome (SBS). But with enough force, anyone -- a toddler, an older child, even an adult -- can be shaken hard enough to cause severe injury or death. That's why medical researchers prefer such terms as "inflicted traumatic brain injury" or simply "abusive head trauma."

Still, of the estimated 1,300 cases diagnosed each year, 1,200 happen to infants under a year old. A baby's head makes up roughly 25 percent of her body weight, compared with only 10 percent of an adult's, and her undeveloped neck muscles are far less able to hold her head steady. Plus, her still-developing brain is much softer, and thus more easily injured, than an adult's.

Another reason babies are especially vulnerable to SBS is that, unlike other forms of child abuse, it's most often triggered by incessant crying. Anyone who's ever tried to shush a colicky baby knows that violent thoughts can cross your mind. Mark Dias, M.D., chief of pediatric neurosurgery at the Milton S. Hershey Medical Center, in Hershey, Pennsylvania, was shocked to discover this when he was up late at night with his own crying infant: "I remember holding him in my arms and thinking, 'My God, I could lose it right here.'"

To a person already under stress, an infant's high-pitched cry is particularly nerve-racking. A baby who can't be consoled can trigger desperate feelings of incompetence ("I'm a bad parent"), rejection ("My baby doesn't like me"), and hopeless-ness ("She's never going to stop"). SBS happens when people simply snap, says Rachel Berger, M.D., of the Child Advocacy Center at Children's Hospital of Pittsburgh. "They may never have been violent before, and afterward they can't believe what they've done."

Peggy Whalen of Poughkeepsie, New York, lost her 11-month-old son, Skipper Lithco, when he was shaken to death by his sitter, a grandmother herself, who ran a small private daycare from her home. The sitter was depressed and going through a divorce. On that winter day, she was stuck in the house with her 2-year-old grandson and a 1-year-old baby (both of whom had colds), and Skipper, who was cutting teeth. When he spit up his food while she was feeding him, she picked him up out of the high chair and shook him, hard. Skipper was declared brain-dead three days later.

Anyone can snap under pressure, even experienced caregivers. But often it's a man. In one study, the biological father was the shaker in 37 percent of cases, the mother's boyfriend in another 21 percent.

Gina Wells, of Fort Worth, Texas, may never know what caused her husband of 15 years to snap. He'd lost his job, so was home caring for their autistic son, who was 4 years old, and 19-month-old Joseph, also a special-needs child, while she went out looking for work. She came home around 5:00 to find Joseph in his crib, struggling to breathe. Her husband told her the older boy had been jumping in his crib and landed on the toddler. But that's not what had happened.

The ER doctors recognized the signs of SBS and barred Wells from her son's side until police investigated. By then he was brain-dead. "When I finally saw Joseph, he was hooked up to all these machines, and that's when reality hit me: My husband had killed my son," she says. Wells's husband (now her ex) never confessed, but a Texas jury found him guilty and sent him to jail.

When the hurt is hidden

Not all babies who are shaken show the classic signs of trauma, even when they're examined in the ER. They may have been shaken for less time or less violently, and may develop symptoms like vomiting or lethargy, which are far more likely to be caused by a virus than SBS, so doctors don't call for a brain scan. One study found that doctors only spotted one out of five cases of less catastrophic abusive head trauma if there were no visible injuries -- and SBS rarely leaves a wound."Right now, we're only diagnosing the tip of the iceberg," says Dr. Berger. These "milder" cases can still result in long-term brain damage, ranging from ADHD to profound disability, as Mary Calderone of Haverhill, Massachusetts, discovered.

When her daughter Deena was 2 months old, Calderone took her to the ER because she was vomiting, lethargic, and crying inconsolably. The same thing happened two months later. Each time, she was told that Deena, who was born premature, was a case of "failure to thrive." For years Calderone would tell her pediatrician, "There's something wrong with my child," only to have her worries dismissed. Deena was a beautiful, normal-looking little girl, but she was slow to learn and prone to self-destructive rages. Most heartbreakingly, she couldn't make friends. "It took me two years to teach her to play hide-and-seek," says her mom, "and by the time she could do it, the other kids had moved on to something else."

When Deena was 8, someone confessed to shaking her twice -- at 2 and 4 months -- to get her to be quiet. Her mom realized that the person had suffered enough, and didn't press charges.

Today, Deena, 18, has ADHD, oppositional defiant disorder, sensory integration disorder, and bipolar disorder. Her doctors told her mom that SBS was a probable trigger.

A diagnostic breakthrough

A shaken baby, stunned from a brain injury, often does stop crying. And that can encourage a perpetrator to repeat the abuse another time. In one study, doctors found that a third of the babies who died of SBS had been brought to the ER with milder symptoms of brain injury before. Dale Franklin of Montgomery, Alabama, took her 15-month-old daughter, Dowe, to the pediatrician when she seemed dazed after being at a sitter's, only to be told she had a mild ear infection. Two weeks later, Dowe was shaken to death by the same sitter.

Soon doctors may have a diagnostic tool that can identify SBS babies before they can be shaken again. Dr. Berger and her colleagues have developed a simple blood test to detect brain injury. They're now testing it under a federal grant. The goal: A doctor could give it to a baby who's vomiting or lethargic, and know whether to give that baby a diagnostic head scan to detect SBS.

Catching milder cases offers another piece of hope: rehabilitation. While a baby's brain is more vulnerable to injury than an adult's, it's also better able to rebound. In the fall of 2003, Wendy Cochran's 4-month-old daughter, Madilynn, was shaken by her father and sustained serious damage to her brain and eyes. With intensive therapy, however, her recovery is nearly complete. She wears an eye patch for several hours a day to help her damaged eye get stronger. But she looks and behaves like any other 2-year-old.

"Madilynn passed her last developmental evaluation with flying colors," says the grateful Medford, Oregon, mom. She's no longer married to the father, who served time and is barred from seeing Madilynn.

More SBS children could escape permanent handicaps if they get treated right away, say researchers. That's why any mom who even suspects the possibility of SBS owes it to her child to make sure she gets a full medical evaluation.

Raising awareness

Even more important than improving diagnosis, though, is keeping babies safe in the first place. In 1997 a national poster campaign, "Rock, Don't Shake," got people's attention, but SBS continues to destroy lives. "Just telling people 'Don't shake your baby' doesn't work," says Robert Block, M.D., chairman of the American Academy of Pediatrics's Committee on Child Abuse and Neglect. "Everybody knows that, but they forget what they know as soon as they lose their temper."

The new focus: teaching parents that it's normal to be frustrated with a baby -- one study found that 58 percent of parents reported some fantasy of harming their child -- so they can plan what to do before they reach the boiling point. That's the thinking behind Portrait of Promise, a program developed seven years ago by Dr. Dias. It requires parents of newborns, while they're still in the hospital, to read a brochure, watch a video, and sign a commitment statement affirming that they've seen and understood the materials. In the seven years since the program was launched in an eight-county region in upstate New York, diagnosed SBS cases have dropped nearly 50 percent. The program has expanded into nine more New York counties and is now being implemented throughout Pennsylvania.

Shortly after their son's death in 2000, Peggy Whalen and her husband, George Lithco, started The Skipper Initiative, handing out brochures about SBS and speaking to civic groups, daycare centers, and schools. Since the Portrait of Promise program began in their county, they've seen a big difference in people's attitudes. "People used to say, 'No, thanks; I don't need that,'" says Whalen. "But now parents say, 'Oh, yeah, I saw that video in the hospital!' It's made people less secretive. They know it's normal to get frustrated and that it's okay to work out ways to get help."

Small programs elsewhere are also reaching out. The National Center on Shaken Baby Syndrome has materials for high school programs and Dads 101 for new fathers but lacks the funds to reach all but a few people. Neither the federal government nor major medical groups are using these effective new tools to help prevent this entirely preventable syndrome. Yet all it takes is a moment of restraint to save a baby's life.