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  DFCS Online Policies & Procedures

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Handbook 3: Assessment Guides
3-12 Assessment of Shaken Infant Syndrome
Assessment Guides
3-12 Assessment of Shaken Infant Syndrome
Reference Points
Overview
Assessing for Shaken Baby Syndrome
When there is Suspicion of Shaken Baby Syndrome


Reference Points
Effective Date: 03/01/2006
Last Updated: 12/30/2005
 Non CWS/CMS Forms:
pdf Service Documentaion Log (SC 909)
 CWS/CMS Forms:
bullet Contact Notebook
bullet Case Plan


Overview  

Shaken Infant Syndrome, also known as Shaken Baby Syndrome or Whiplash Shaken Infant Syndrome, is the most common cause of child fatality due to abuse by violent shaking. Although most common in very young infants, it can occur in children up to age four. In general, of those children who are shaken, about one third die or become permanently disabled, one third are permanently impaired, and one third appear to make a complete or almost complete recovery. A majority of severe shaking is inflicted by young male caregivers (usually the father of the child or the mother’s boyfriend in the father’s role). Female babysitters, and then the mother, cause the next highest percentage. Lowest on the list is a grandparent of either sex.

Most often, there is no visible evidence of trauma, although, occasionally, there will be some bruising, especially along the chest. As this Syndrome is diagnosed by medical findings of intra-cranial, intra-ocular and/or skeletal injuries, a thorough medical examination must be completed, including, but not limited to, Computerized Axial Topography (CAT), Magnetic Resonance Imaging (MRI), ophthalmology consult, skeletal survey/bone scan and bleeding studies.

The child usually presents with a variety of symptoms such as decreased feeding, poor sucking/swallowing, vomiting, failure to thrive, lethargy or rigidity, irritability, seizures, convulsions rapid heart beat, shock, difficulty breathing, or coma. Other common symptoms include poor muscle tone, inability to follow movements and no smiling or vocalizations. Examination of the eyes shows retinal hemorrhages in about 80% of cases. A head Computerized Axial Topography (CAT) scan will show brain swelling and subdural hemorrhage. Later, a Magnetic Resonance Imaging (MRI) might identify further damage, such as skeletal fractures.

Studies have shown that these types of injuries rarely occur as a result of short accidental falls from furniture or down steps. In addition, cardiopulmonary resuscitation (CPR) is unlikely to cause retinal hemorrhages or rib fractures. However, there are some situations which can result in a similar cluster of symptoms, such as birth trauma, certain types of accidents (e.g., car, falls from significant heights), meningitis, vascular malformations/ aneurysms, bleeding disorders or sepsis (generalized infection).

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Assessing for Shaken Baby Syndrome  
  1. Identify risk factors for infants. Consider:
    • Does the child have ongoing difficult behaviors or special health care needs, such as developmental or multiple medical problems?
    • Is the child described as crying frequently?
    • Does the child have colic or any other feeding problems?
    • Is the child prone to tantrums?
    • Is the child in toilet training?
  2.  
  3. Document any pertinent information in the Contact Notebook.  

  4. Identify risk factors for parents/caregivers. Consider:
    • Is this a single-parent home?
    • Are there several children under age five?
    • Is the parent/caregiver socially isolated?
    • Is parent/caregiver involved with drug/alcohol abuse?
    • Is there domestic violence in the home? Does the parent/caregiver have psychological problems?
    • Is the family currently experiencing any stress-causing events e.g., moving, eviction, divorce, death, and unemployment?
    • Is there the presence of a parent substitute (boyfriend, girlfriend, babysitter)?
     
  5. Document any pertinent information in the Contact Notebook.
 
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When there is Suspicion for Shaken Baby  
  1. Conduct a detailed and thorough interview of the parent and/or caregiver according to established procedures.

  2. Differentiate between accidental versus abusive  causes, reasonable versus unreasonable explanations. 
    • Obtain an accurate history of when the infant last appeared normal.
     

    NOTE: If the child is brought to the hospital immediately following the severe damage, the injury probably occurred just after the child was last observed to be well. In these cases, it is usually the last person who was with the child when the child was well who caused the injuries. In cases where there is a delay in bringing the child for treatment (usually with less severe injuries), it often becomes impossible to prove who did the shaking.

  3. Consult with the Public Health Nurse according to established procedures.
    • Provide any identified risk factors.
    • Request assistance with a face-to-face home visit.
    • Request informational resources on Shaken Infant Syndrome for distribution to caregivers, if appropriate.
    • Seek help in identifying any special medical needs of the infant to assist in discharge planning/placement. 
    • Request assistance with resources/referrals for follow-up of special medical needs of the child including any special training needs for the caregiver.
    • Ask for input on the development of the Health/Medical component of the Case Plan, if appropriate.
     

    NOTE: It is critical that consultation occurs between the SW, Public Health Nurse and medical provider to obtain a complete medical history to assist in formulating an accurate assessment. Only medical personnel may provide the diagnosis of Shaken Infant Syndrome.

  4.  
  5. Follow established procedures regarding disposition of allegations and detention of minors.

  6. Document all information accumulated during the assessment in Contact Notebook and SC 909's.
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