Shaken Baby Syndrome (Abusive Head Trauma)

Abusive Head Trauma is a serious brain injury in a baby or young child. It happens when a caregiver violently shakes a child, hits the head, throws the child, or uses both shaking and impact together. The baby’s head moves back and forth very fast. The baby’s neck is weak and cannot control this strong motion. The brain moves inside the skull. Fine blood vessels can tear. This can cause bleeding around the brain, swelling of the brain, less oxygen to the brain, and sometimes bleeding in the eyes. There can also be fractures and injuries in other body parts. Sometimes there is little or no bruise on the outside, so the injury can be missed if we do not look carefully. Doctors today prefer the name Abusive Head Trauma (AHT) because it includes shaking, impact, or both, and it clearly says the injury is from abuse. CDCNCBIMayo Clinic

Shaken Baby Syndrome (Abusive Head Trauma) is a severe brain injury caused when a baby or young child is forcefully shaken, sometimes also struck against a surface. A baby’s head is heavy and the neck muscles are weak. When a baby is shaken, the brain moves back and forth inside the skull. This can tear small blood vessels, cause bleeding over the brain (often subdural hemorrhage), damage the brain tissue itself, and cause retinal hemorrhages in the eyes. Children who survive may have seizures, developmental delays, vision or hearing loss, learning and behavior problems, and physical disabilities. AHT is commonest under 1 year, and it is preventable through caregiver support, crying-plan education, and safe coping strategies. CDCThe Royal College of Ophthalmologists

A baby’s head is large compared to the body. The neck muscles are weak. The skull bones are softer than in older children. The brain has more water and is more delicate. When a baby is shaken, the head snaps forward and backward. The brain shifts, stretches, and shears. This can tear the small veins between the brain and its coverings and can damage nerve fibers. These forces are stronger than what happens in normal handling or gentle play. This is why even a very short episode of violent shaking can cause severe harm. NCBI

Types

Using simple categories helps people understand that AHT can look different from case to case. These aren’t official “stages,” but they reflect common real-world patterns clinicians see.

1. Shaking-only AHT
   The main force is violent shaking without a clear head impact. The brain injury is due to fast acceleration and deceleration. Bleeding around the brain and in the eyes may happen. External bruises may be absent. CDC

2. Shaking-with-impact AHT (shaken–impact)
   The child is shaken and the head hits a surface. This adds direct impact to the brain and skull. Skull fractures or scalp swelling may appear. Internal brain injury can be worse. NCBI

3. Acute single-episode AHT
   There is one severe event. The child may suddenly become very ill with seizures, breathing trouble, or coma. CT scans often show fresh bleeding. Mayo Clinic

4. Repetitive or chronic AHT
   There are injuries at different times. Old and new bleeding can appear together. Skeletal survey may show fractures in different stages of healing. Symptoms may have been mild earlier and then suddenly become severe. NCBI

5. Hypoxic-predominant AHT
   Shaking causes brain swelling and apnea (stopping breathing). The brain is hurt mainly by lack of oxygen. MRI often shows patterns of low oxygen injury. Mayo Clinic

6. AHT with spinal involvement
   There can be injury to the neck ligaments or bleeding along the spine. MRI of the spine shows these better, and spinal subdural blood is more often seen with abuse than with simple accidents. ACSearch

7. AHT with multi-system trauma
   The head injury comes with other injuries such as rib fractures, abdominal injury, or patterned bruises. This pattern points strongly to abuse and needs a full body work-up. NCBI

Causes

Important note in simple words: The true cause is the abusive action (shaking and/or impact). The list below explains risk factors and common trigger situations that raise the chance of abuse happening. These do not excuse abuse. They help us focus on prevention and early support.

1. Long, hard-to-soothe crying
   Persistent crying (often peaking at 6–8 weeks) can trigger frustration in a caregiver who does not know how to cope safely. NCBI

2. Infant colic
   Colic adds to crying and stress. A tired caregiver may lose control and shake. NCBI

3. Young or inexperienced parents
   New caregivers may not understand normal baby behavior and may react dangerously under stress. NCBI

4. Low social support
   A caregiver with no family or community help is more likely to feel overwhelmed. NCBI

5. Unrealistic expectations of a baby
   Expecting a baby to sleep through the night or stop crying on command can lead to anger and violence. NCBI

6. Caregiver mental health problems
   Untreated depression, anxiety, or other conditions can lower coping ability. NCBI

7. Substance or alcohol misuse
   Being intoxicated reduces judgment and control. NCBI

8. Domestic violence in the home
   An environment with violence raises risk to the child. NCBI

9. Poverty and high stress
   Financial stress and crowded living conditions can increase caregiver strain. NCBI

10. Single-caregiver households
    One person doing all care, day and night, may burn out faster. NCBI

11. Presence of an unrelated adult male caregiver
    This is a known risk pattern in population data. NCBI

12. Lack of knowledge about safe soothing
    If a caregiver thinks shaking is harmless, risk is higher. CDC

13. Past involvement with child protective services
    This can signal continuing risk in the home. NCBI

14. Previous “sentinel” injuries
    Unexplained bruises or mouth injuries in a young baby can be early warning signs before a major event. NCBI

15. Prematurity or medical complexity in the baby
    Extra care needs can increase caregiver stress and fatigue. NCBI

16. Multiple births (twins/triplets)
    Crying and care demands multiply, raising stress. NCBI

17. Unplanned pregnancy
    Some caregivers may feel less prepared or supported. NCBI

18. Poor impulse control
    Some caregivers have trouble managing anger or frustration safely. NCBI

19. Lack of access to supportive services
    No easy access to parenting help, respite, or counseling increases risk. NCBI

20. Misinterpretation of normal behaviors
    Spitting up, waking at night, or brief pauses in breathing can be normal; misunderstanding them can lead to panic and harm. NCBI

Symptoms

Each symptom below is written in simple terms. A child may have a few or many. Some signs can be very subtle at first.

1. Unusual sleepiness or hard-to-wake behavior
   The baby is very drowsy or unresponsive because the brain is injured or swollen. NCBI

2. Irritability and constant crying
   The baby is fussy and cannot be soothed because the brain hurts or pressure is high. NCBI

3. Vomiting without diarrhea
   Vomiting can be from brain pressure, not a stomach infection. NCBI

4. Poor feeding or refusing feeds
   The baby may be too weak or too sleepy to suck and swallow well. NCBI

5. Breathing problems or pauses (apnea)
   Brain injury can disturb the breathing center and cause dangerous pauses. NCBI

6. Seizures (shaking, staring, or stiffening spells)
   Electrical storms in the brain can cause visible or subtle seizures. NCBI

7. Pale or blue color (poor oxygen)
   When breathing is poor, the skin or lips can turn blue. NCBI

8. Bulging or tense soft spot (fontanelle)
   Rising brain pressure can push outward on the soft spot. NCBI

9. Head seems bigger than before
   Rapidly increasing head size can suggest bleeding or fluid build-up. NCBI

10. Unequal pupils or poor reaction to light
    This can signal pressure on the brain or nerve pathways. NCBI

11. Bruises, especially in unusual places
    Bruises on the torso, ears, neck, or inside the mouth are red flags in babies who do not yet walk. NCBI

12. Scalp swelling or skull tenderness
    Impact injuries can cause swelling or fractures. NCBI

13. Eye findings
    Doctors may see bleeding inside the eyes (retinal hemorrhages), sometimes with a split layer called retinoschisis. These are very important clues. American Academy of OphthalmologyPMC

14. Stiffness or floppiness
    Muscle tone can be abnormally high (stiff) or low (floppy) after brain injury. NCBI

15. Coma
    In the most severe cases, the child may not respond at all. This is life-threatening. Mayo Clinic

Diagnostic tests

Below are 20 tests, grouped into Physical Exam (4), Manual tests (4), Lab/Pathological (6), Electrodiagnostic (2), and Imaging (4). Each entry explains what the test is and why it helps.

A) Physical Exam

1. Primary survey and vital signs
   Doctors first protect airway, breathing, and circulation. They check heart rate, breathing rate, oxygen level, blood pressure, and temperature. Life-saving support comes first because brain injury can quickly worsen if oxygen is low or pressure is unstable. NCBI

2. Full head-to-toe skin exam
   The clinician looks for bruises, especially in non-walking infants, and checks the torso, ears, and neck. The TEN-4-FACESp rule helps spot abusive bruising patterns. Finding bruises in unusual places guides further testing for hidden injuries. NCBI

3. Neurologic exam
   The doctor checks alertness, tone, reflexes, and any signs of seizures. Changes here can point to increased pressure, bleeding, or oxygen lack. NCBI

4. Head and fontanelle check with head-size measurement
   A bulging soft spot or a fast increase in head size can signal bleeding or fluid build-up and prompts urgent brain imaging. NCBI

B) Manual tests

5. Pupil light reflex
   A small light is shined into each eye to see if pupils react equally. Poor or unequal reactions can suggest pressure on the brain or nerve damage and need urgent imaging. NCBI

6. Bedside fundoscopy (ophthalmoscopy) by an experienced clinician
   Looking inside the eyes can show retinal hemorrhages and, sometimes, retinoschisis. These patterns are common in AHT and help support the diagnosis when matched with the whole clinical picture. Wide-field retinal photos can document the findings. American Academy of OphthalmologyPMC

7. Infant Glasgow Coma Scale (GCS) scoring
   This standard bedside score rates eye opening, best movement, and sound responses. A lower score means more severe brain injury and guides urgent steps. NCBI

8. Oral exam and gentle skeletal palpation
   The clinician checks the mouth for frenulum tears and feels along ribs and limbs for tenderness or step-offs. These can signal hidden fractures or squeezing injuries. NCBI

C) Lab and Pathological tests

9. Complete blood count (CBC)
   This looks at hemoglobin and platelets. It can show anemia from bleeding and platelet issues that affect clotting. It also helps screen for other illnesses in the differential. NCBI

10. Coagulation studies (PT, aPTT, INR, fibrinogen ± D-dimer)
    These tests help rule out bleeding disorders that might mimic abuse. Normal results make accidental spontaneous bleeding less likely and strengthen concern for trauma. NCBI

11. Comprehensive metabolic panel and liver enzymes (AST/ALT)
    High liver enzymes, especially ALT/AST ≥80 IU/L, can suggest hidden abdominal injury from squeezing or impact and prompt abdominal imaging. NCBI

12. Urinalysis
    Blood in the urine can point to kidney or bladder injury. This helps decide if abdominal imaging is needed. NCBI

13. Toxicology screen (as indicated)
    This checks for drugs or alcohol exposure, which can change symptoms and may be part of neglect or harm. NCBI

14. Targeted metabolic or genetic testing when red flags exist
    For unusual presentations, doctors may test for rare disorders (for example, glutaric acidemia type I) that can mimic bleeding or brain injury. Correct diagnosis protects the child and ensures the right care. NCBI

D) Electrodiagnostic tests

15. Electroencephalogram (EEG)
    EEG measures brain waves. It helps detect seizures that may be subtle and helps gauge brain function after injury. It can guide treatment for ongoing seizures. NCBI

16. Evoked potentials (as needed in severe cases)
    These tests measure brain pathway responses to sound or touch. They can support prognosis when the child is very ill and the exam is limited. NCBI

E) Imaging tests

17. Head CT scan (non-contrast) — the usual first brain image in emergencies
    CT is fast and shows fresh bleeding and swelling. It is the right first test for a very sick child in the emergency setting because it can be done quickly and safely. PubMed

18. Brain MRI (often 1–3 days after stabilization)
    MRI shows more detail about brain injury, oxygen lack, and small shearing injuries. It helps “date” injuries and can reveal damage that CT can miss. MRI of brain and sometimes MR venography can be used as part of a complete work-up. Mayo Clinic

19. Skeletal survey (with a follow-up survey in ~2 weeks)
    A complete set of X-rays looks for fractures in the ribs, arms, legs, hands, feet, and spine. A repeat survey helps show healing lines and catch injuries that were not visible at first. PubMed

20. Spine MRI when indicated
    This looks for neck ligament injury or bleeding along the spine. Spinal subdural bleeding is more often seen with abuse than with simple accidental falls. MRI of the whole spine is reserved for selected cases where it will change understanding or management. ACSearch

Non-pharmacological (non-drug) treatments and supports

(therapies & other measures; what they do, why they’re used, how they work)

These are hospital-led measures. Families should not try to treat suspected AHT at home.

1. Airway, breathing, circulation (ABC) stabilization.
   What: Emergency teams secure the airway, give oxygen, and support blood pressure.
   Why: The injured brain is very sensitive to low oxygen or poor blood flow.
   How it works: Rapid support limits secondary brain injury while definitive care begins. (Standard trauma care framework)

2. Head and neck protection.
   What: Keep the neck in a neutral position, stabilize the cervical spine until cleared.
   Why: Infants with AHT can also have high-cervical injuries; movement can worsen damage.
   How: Rigid collars, careful handling, and imaging before clearance. The Royal College of Ophthalmologists

3. Head-of-bed elevation to ~30°.
   What: Raise the head of the bed unless contraindicated.
   Why: Helps brain venous blood drain and can lower intracranial pressure (ICP).
   How: Simple positioning reduces pressure in the skull. Texas Children’s

4. Continuous brain monitoring and frequent neuro checks.
   What: Watch for changes in pupil size, movement, level of alertness.
   Why: Early detection of deterioration allows prompt interventions.
   How: Standard neuro ICU protocols, sometimes plus invasive monitors. Brain Trauma Foundation

5. Intracranial pressure (ICP)–directed care.
   What: Treat ICP if it rises above thresholds (commonly >20 mm Hg).
   Why: High ICP reduces brain blood flow and can cause herniation.
   How: Protocols combine positioning, osmotic therapy, CSF drainage, and (if needed) surgery. Brain Trauma Foundation

6. Temperature management (avoid fever; normothermia).
   What: Keep temperature normal; specific hypothermia is not used to improve outcomes.
   Why: Fever worsens brain injury; prophylactic hypothermia doesn’t improve results.
   How: Antipyretic strategies and cooling for ICP control only when indicated. Brain Trauma Foundation

7. Ventilation optimization (avoid severe hyperventilation early).
   What: Provide enough oxygen; avoid very low CO₂ early after injury.
   Why: Severe early hyperventilation can reduce brain blood flow.
   How: Ventilator settings target safe oxygen and CO₂ ranges. Brain Trauma Foundation

8. Early enteral nutrition.
   What: Start tube feeding within 72 hours when safe.
   Why: Early nutrition lowers complications and improves outcomes; “immune-modulating” specialty formulas are not recommended.
   How: Nasogastric/feeding tubes with standard pediatric formula per dietitian. Brain Trauma Foundation

9. Seizure monitoring (EEG) and precautions.
   What: Continuous or spot EEG and seizure protocol.
   Why: Seizures are common; untreated seizures worsen brain injury.
   How: EEG detects subtle seizures; teams treat per guidelines. Brain Trauma Foundation

10. External ventricular drain (EVD) for CSF drainage (if indicated).
    What: A small catheter drains cerebrospinal fluid to reduce pressure.
    Why: EVD is a recommended first-tier ICP therapy in pediatric severe TBI pathways.
    How: Neurosurgeons place an EVD; bedside titration lowers ICP. Brain Trauma Foundationdev.tbiguidelines.com

11. Imaging-guided evaluation (CT/MRI; skeletal survey; ophthalmic exam).
    What: Brain and eye imaging, full abuse work-up.
    Why: Confirms hemorrhages, brain swelling, fractures, and retinal findings.
    How: CT for acute bleeds, MRI for finer detail, standardized eye exam within 48 h. The Royal College of Ophthalmologists

12. Multidisciplinary safeguarding & social support.
    What: Hospital child-protection team coordinates safety planning and mandatory reporting.
    Why: AHT is abuse; safety and legal protections are essential.
    How: Social work, pediatrics, law enforcement, and child-protection agencies collaborate. CDC

13. Pain control and comfort measures (non-drug components).
    What: Quiet environment, gentle handling, day-night cues.
    Why: Reduces stress and metabolic demand on the injured brain.
    How: ICU environmental controls plus nursing strategies. (Standard ICU care)

14. Vision and hearing rehabilitation planning.
    What: Early involvement of ophthalmology and audiology with rehab.
    Why: Retinal hemorrhages and neural injury can impair vision; hearing loss can occur.
    How: Exams, counseling, and early therapy planning. HealthyChildren.org

15. Swallowing and feeding therapy.
    What: Speech-language pathologists assess swallow safety.
    Why: Prevents aspiration; supports safe nutrition.
    How: Structured assessments; texture adjustments; feeding strategies. (Standard pediatric rehab)

16. Physical and occupational therapy.
    What: Gentle, developmentally appropriate exercises and positioning.
    Why: Prevents contractures, supports motor recovery and daily function.
    How: Individual therapy plans started as soon as medically safe. (Standard pediatric rehab)

17. Cognitive and behavioral therapy (long-term).
    What: Child psychologists and neuropsychologists guide recovery of attention, learning, and behavior as the child grows.
    Why: AHT often causes long-lasting cognitive and behavioral challenges.
    How: Assessments and therapy blocks matched to age and school needs. CDC

18. Caregiver education and respite planning.
    What: Teach gentle soothing strategies and give caregivers support time.
    Why: Stress and crying are common triggers for shaking; support prevents recurrence.
    How: Crying-plan education, helplines, and family supports. CDC

19. Case management and community linkage.
    What: Connect families to home nursing, early intervention, special education.
    Why: Recovery is a long journey; coordinated services improve function.
    How: Hospital case managers create and track a care plan. (Standard pediatric practice)

20. Legal and advocacy processes.
    What: Documentation and testimony, when required, to protect the child and others.
    Why: Ensures safety and accountability; prevents future harm.
    How: Following local child-protection laws and medical documentation standards. The Royal College of Ophthalmologists

---

Drug treatments

(class, purpose, how they work, typical timing, key cautions; dosing is individualized by clinicians)

Important: Exact pediatric dosing varies by age, weight, and condition. In AHT/TBI, medicines are only started and titrated by the hospital team. Where specific dose ranges are recommended by pediatric head-injury guidelines, they are noted.

1. Hypertonic saline (3% HTS) — osmotic agent to lower ICP
   Purpose/Timing: First-line for high ICP episodes.
   Mechanism: Pulls fluid out of swollen brain tissue via osmotic gradient.
   Guideline dosing (examples): 3% HTS bolus 2–5 mL/kg over 10–20 min; continuous infusion 0.1–1.0 mL/kg/h on a sliding scale; 23.4% HTS 0.5 mL/kg (max 30 mL) for refractory crises; avoid sustained very high serum sodium. Side effects: High sodium, fluid shifts, thrombocytopenia/anemia with prolonged severe hypernatremia; DVT risk with very high sodium. Brain Trauma Foundation

2. Mannitol — osmotic agent for ICP
   Purpose/Timing: Alternative for raised ICP when appropriate.
   Mechanism: Osmotic diuretic reduces brain water.
   Note: Widely used, but pediatric evidence is weaker than for HTS in guidelines; clinicians choose case-by-case. Side effects: Dehydration, kidney strain, electrolyte shifts. Brain Trauma Foundation

3. Antiepileptic drugs (e.g., levetiracetam, phenytoin/ fosphenytoin) — prevent/treat seizures
   Purpose/Timing: Prevent early post-traumatic seizures (first 7 days) and treat clinical/subclinical seizures.
   Mechanism: Stabilize neuronal activity.
   Note: Guidelines suggest prophylaxis but do not favor one agent over another based on outcomes; dosing and choice are individualized. Side effects: Sedation, behavioral effects (levetiracetam), arrhythmias/hypotension with rapid phenytoin. Brain Trauma Foundation

4. Sedation/analgesia (e.g., fentanyl, midazolam) — comfort and ICP control
   Purpose/Timing: Reduce agitation, pain, and metabolic demand; avoid bolus dosing during ICP crises.
   Mechanism: Lowers stress response and prevents spikes in ICP.
   Side effects: Respiratory depression, hypotension; careful ICU monitoring required. Brain Trauma Foundation

5. Barbiturates (e.g., pentobarbital) — for refractory ICP
   Purpose/Timing: Used when ICP remains dangerously high despite other measures, in hemodynamically stable children.
   Mechanism: Deeply reduces cerebral metabolism and ICP.
   Side effects: Profound blood pressure drops; needs arterial line and vasopressors. Brain Trauma Foundation

6. Antipyretics (e.g., acetaminophen) — fever control
   Purpose/Timing: Keep temperature normal.
   Mechanism: Lowers hypothalamic set-point.
   Side effects: Liver toxicity with overdose; doses are weight-based and clinician-directed. Brain Trauma Foundation

7. Vasoactive agents (e.g., norepinephrine as needed) — maintain cerebral perfusion
   Purpose/Timing: Support blood pressure to keep cerebral perfusion pressure in safe ranges (often ≥40–50 mm Hg, age-adjusted).
   Mechanism: Increases vascular tone/cardiac output to secure brain blood flow.
   Side effects: Arrhythmias, limb ischemia at high doses; ICU monitoring essential. Brain Trauma Foundation

8. Antiemetics (e.g., ondansetron) — reduce vomiting/aspiration risk
   Purpose/Timing: Symptom control, especially during feeds or procedures.
   Mechanism: 5-HT3 receptor blockade reduces nausea pathways.
   Side effects: QT prolongation in rare cases; clinician-directed monitoring. (Supportive standard)

9. Antibiotics (only if indicated) — infection treatment
   Purpose/Timing: Treat proven infections (e.g., open skull injury, CSF infection).
   Mechanism: Pathogen-specific.
   Side effects: Drug-specific; used only when clearly needed. (Standard pediatric practice)

10. Avoidance of corticosteroids for ICP/outcomes
    Purpose/Timing: Not used to improve outcome or reduce ICP in pediatric severe TBI/AHT.
    Mechanism: —
    Rationale: Guidelines do not suggest corticosteroids to improve outcomes; they are reserved only for specific replacement needs. Brain Trauma Foundation

---

Dietary molecular supplements

There is no supplement that treats SBS/AHT. Pediatric head-injury guidelines do not recommend immune-modulating formulas. The only nutrition with proven value is early, adequate enteral nutrition chosen by clinicians and dietitians. Never give supplements to infants unless your pediatrician prescribes them. Brain Trauma Foundation

Below are common clinical nutrition considerations for brain-injured children, not cures for AHT. Doses are age/weight-specific and set by the child’s medical team:

1. Adequate energy and protein – Supports growth and healing; delivered via breastmilk/formula or tube feeds; prevents catabolism after injury. (Dietitian-directed) Brain Trauma Foundation

2. Vitamin D (medical supervision only) – Supports bone and immune health; infants typically require medical-guided supplementation even without TBI.

3. Iron (only if deficiency) – Correcting anemia improves oxygen delivery; over-supplementation is harmful.

4. Zinc (if deficient) – Important for wound healing and immunity; excess causes GI upset and copper deficiency.

5. Iodine/Thyroid sufficiency – Necessary for brain development; managed through standard infant nutrition or formula.

6. Choline (via diet/formula) – Membrane and neurotransmitter precursor; no AHT-specific outcome evidence.

7. DHA/omega-3s (via breastmilk/formula) – Structural brain lipids; evidence for TBI recovery in children is limited; not a stand-alone therapy.

8. Folate/B-vitamins (adequate intake) – Support cell metabolism; deficiency is managed by clinicians.

9. Magnesium (correct deficiency only) – Vital for many enzymes; routine high-dose supplements are not advised.

10. Hydration and electrolytes – Matched to ICU goals (especially sodium when receiving HTS); strict medical oversight to avoid dangerous imbalances. Brain Trauma Foundation

---

Regenerative / stem-cell drugs

Bottom line: There are no approved “immunity boosters,” regenerative drugs, or stem-cell therapies for SBS/AHT. These are experimental or not recommended outside carefully designed clinical trials. For safety and accuracy, doses are not provided here. Please discuss clinical trials with a pediatric neurologist or neurosurgeon.

1. Erythropoietin (EPO): Studied as a neuroprotective agent in TBI; evidence in infants/children is insufficient for routine use.

2. Amantadine: Used in some pediatric disorders of consciousness; evidence is mixed and individualized.

3. Citicoline (CDP-choline): Large adult trial (COBRIT) was negative; not recommended as routine neurorestorative therapy in children.

4. Progesterone and related agents: Failed to improve outcomes in large adult TBI trials; not used in children.

5. Cell-based therapies (bone-marrow/mesenchymal stem cells): Early-phase research only; no established benefit or approval in pediatric AHT.

6. “Immune boosters” (commercial products): No evidence they help brain injury; may be harmful in infants. (Consensus across pediatric trauma guidelines) Brain Trauma Foundation

---

Surgeries

1. External Ventricular Drain (EVD) placement
   Procedure: A neurosurgeon places a thin catheter into a brain ventricle to drain cerebrospinal fluid.
   Why: Lower ICP quickly; allows pressure monitoring and CSF sampling.
   Evidence/guidance: Supported as a treatment option on pediatric severe TBI pathways. Brain Trauma Foundationdev.tbiguidelines.com

2. Decompressive craniectomy (DC)
   Procedure: Temporarily remove a section of skull to give the swollen brain room.
   Why: Rescue therapy for life-threatening brain swelling or herniation when medical care fails.
   Evidence/guidance: Suggested for refractory intracranial hypertension; evidence is evolving. Brain Trauma FoundationPMCCochrane Library

3. Craniotomy with hematoma evacuation
   Procedure: Open the skull to remove a large clot pressing on the brain.
   Why: Quickly relieves mass effect and prevents herniation when a focal bleed is identified.
   Note: Decision is imaging- and exam-driven in the ICU. (Neurosurgical standard; supported by TBI pathways)

4. Subdural drainage or shunting for chronic collections of infancy
   Procedure: Drain or shunt persistent subdural fluid collections that cause symptoms or recurrent pressure issues.
   Why: Improves pressure and development in selected infants after AHT-related subdural collections.
   Evidence: Clinical pathways describe approaches for chronic subdural hematoma of infancy. Lippincott Journals

5. Gastrostomy (feeding tube) and/or tracheostomy (airway) in prolonged recovery
   Procedure: Place long-term feeding or airway support devices when needed.
   Why: Ensures safe nutrition and breathing during extended rehabilitation when swallow or airway protection is unsafe.
   How: Chosen only after multidisciplinary evaluation. (Standard pediatric rehab practice)

---

Prevention strategies

1. Know that crying peaks early and passes. Crying often increases over the first months and then improves; crying is normal—not a sign of failure. CDC

2. Have a “crying plan.” If overwhelmed, put the baby safely in the crib and walk away for 5–10 minutes to cool down; call a trusted person or a helpline. CDC

3. Never shake, hit, throw, or slam a baby. Not ever—no matter how frustrated you feel. HealthyChildren.org

4. Share the plan with everyone who cares for the baby. Babysitters, relatives, partners should all know what to do when the baby cries. CDC

5. Choose caregivers carefully. Prefer licensed childcare with multiple adults; observe how they handle crying. HealthyChildren.org

6. Address postpartum mood changes. Seek help for depression, anxiety, or anger; resources exist 24/7. CDC

7. Use safe soothing techniques. Swaddling, gentle rocking, white noise, pacifier, stroller walk, or car ride can help some infants. CDC

8. Watch for early signs of abuse. Bruising in a non-mobile infant is a warning sign; get medical help. HealthyChildren.org

9. Support new parents. Offer breaks, meals, and encouragement; community support prevents harm. CDC

10. Know trusted resources. Pediatrician, local hotlines, and evidence-based crying education programs (e.g., Period of PURPLE Crying). CDC

---

When to see a doctor

Immediately call emergency services or go to the emergency department if a baby or child has: unusual sleepiness or won’t wake, repeated vomiting, seizures, trouble breathing, limpness, poor feeding, extreme irritability, bulging soft spot, unequal pupils, or any unexplained bruise—especially if the child is not yet walking. If you are worried a child may have been shaken, seek help now; do not wait. HealthyChildren.org

---

What to eat / what to avoid” during recovery

Infants with suspected AHT must be fed as the hospital and pediatric dietitian instruct. Do not start or change feeds, formulas, or supplements without guidance.

1. Eat: Age-appropriate breastmilk or standard formula as prescribed; Avoid: switching formulas repeatedly without medical advice. Brain Trauma Foundation

2. Eat: Early enteral feeds (if hospitalized) started by the care team; Avoid: delaying feeds without a medical reason. Brain Trauma Foundation

3. Eat: Adequate protein and calories set by the dietitian; Avoid: “immune” or specialty formulas unless the team orders them. Brain Trauma Foundation

4. Eat: Safe, developmentally appropriate textures; Avoid: foods/liquids that raise choking risk until swallow is cleared. (SLP-guided)

5. Eat: Hydration targets matched to sodium goals (especially on HTS); Avoid: extra water or salt without orders. Brain Trauma Foundation

6. Eat: Standard vitamin D per pediatric guidance; Avoid: over-the-counter supplement stacks.

7. Eat: Iron only if prescribed for documented deficiency; Avoid: giving iron “just in case.”

8. Eat: DHA via breastmilk or approved formulas; Avoid: fish-oil capsules for infants unless specifically prescribed.

9. Eat: As solids begin (later), emphasize iron-rich purees if recommended; Avoid: honey before 12 months and choking hazards at any time.

10. Eat: Caregiver nutrition and hydration (for breastfeeding parent) to support supply; Avoid: alcohol or sedating meds while caring for the baby unless cleared by a clinician.

---

Frequently asked questions

1. Is “shaken baby syndrome” real?
   Yes. The medical community recognizes AHT as a well-established diagnosis caused by violent shaking and/or impact. Major organizations including the AAP, CDC, WHO, and neurosurgical societies support this. American Academy of Pediatrics

2. Why is shaking so dangerous?
   A baby’s heavy head and weak neck let the brain whip back and forth in the skull, tearing vessels and injuring delicate tissue. Bleeding and swelling follow. CDC

3. What are the classic signs?
   Subdural bleeding and brain injury on imaging, and retinal hemorrhages on eye exam are common patterns, but doctors consider the whole picture. The Royal College of Ophthalmologists

4. Can normal play or gentle bouncing cause this?
   No. Evidence does not support normal handling or playful bouncing as causes of the AHT pattern of injuries. The Royal College of Ophthalmologists

5. How often do children die from AHT?
   Up to 1 in 4 babies with AHT die; many survivors have serious, lifelong disabilities. CDC

6. Can AHT be caused only by impact (without shaking)?
   AHT includes shaking and/or blunt impact; patterns vary. Doctors evaluate all mechanisms. American Academy of Pediatrics

7. Is there a single “eye finding” that proves abuse?
   No single eye finding is pathognomonic, but numerous, bilateral, multilayer retinal hemorrhages with folds/retinoschisis are highly suggestive in context. The Royal College of Ophthalmologists

8. What is the first treatment in the hospital?
   Stabilize airway, breathing, and circulation; control ICP; treat seizures; start early nutrition; involve ophthalmology and neurosurgery as needed. Brain Trauma Foundation

9. Do steroids help?
   No—pediatric TBI guidelines do not suggest steroids to improve outcomes or reduce ICP. Brain Trauma Foundation

10. Which osmotic therapy is preferred?
    Guidelines recommend 3% hypertonic saline bolus (2–5 mL/kg over 10–20 min) for intracranial hypertension; mannitol is used selectively. Brain Trauma Foundation

11. Should we give special “immune” formulas?
    No. Immune-modulating diets are not recommended; standard early enteral feeding is suggested. Brain Trauma Foundation

12. Are there medicines to prevent all complications?
    No single drug “fixes” AHT. Care is supportive, guided by ICU protocols, neurosurgery, and rehab specialists. Brain Trauma Foundation

13. Is surgery always needed?
    No. Surgery (EVD, decompressive craniectomy, hematoma evacuation, chronic subdural drainage) is used only when clearly indicated. Brain Trauma FoundationPMC

14. How can families cope with crying safely?
    Have a crying plan: place the baby safely in the crib, step away, breathe, call for help, and check back in 5–10 minutes. Never shake. CDC

15. Where can I read more from trusted sources?
    CDC overview, AAP resources for clinicians and families, and the Royal College ophthalmology guidance on eye findings are excellent starting points. CDCAmerican Academy of PediatricsThe Royal College of Ophthalmologists

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: August 24, 2025.