Case Briefs
Case One
A five-year-old girl, who was in her father's custody, became the oldest child in the house when her father remarried.
Both the girl’s father and the stepmother beat and shook her. On the day of her death the girl was
struck forcibly in the head as punishment. It is also believed that she was shaken, though no one confessed to
this action. The autopsy description of the injuries was extensive at over 1,600 words. The brain of this battered
child was coated with a thick layer of blood (subdural hematoma), and there were retinal hemorrhages
and diffuse brain injury. Due to the severe abuse that the child suffered, both parents were convicted in court
and are serving jail time.
Case Two
A 2½ year old girl with normal development was shaken not once, but twice, on two different occasions in
March and April of 2002, leaving her struggling for her life. She had to be resuscitated on both occasions after
she was shaken. However, as a result of the “second shaking”, she had seizures, two subdural hematomas on
the left side, swelling around the brain, paralysis on the entire right side of her body and became blind. After
the shaking, she could no longer function as she once had; she couldn’t see anything, couldn’t sit up, hold her
head up, hold a cup, walk or crawl. She was incapacitated by the abuse and didn’t smile, talk or show signs of
the happy child she once was. After numerous therapists, neurologists, vision specialists, seizure clinics, medications
and special provisions, she has slowly regained some of her functions and has begun to cope with her
disabilities. To date, she has 50% of her vision and is considered legally blind. She must continue therapy to
help with the paralysis, loss of vision and other handicaps.
Shaken Baby Syndrome Deaths 2003-2007
Victim Characteristics
Between 2003 and 2007, there were 26 deaths classified as shaken baby syndrome (SBS). Of these 26 deaths,
four were shaken as infants and died later due to complications from their injuries; three were older than 2
years of age and died from being shaken and hit. The crude 5-year death rate for all deaths during this time period
was 0.35 per 100,000 children younger than 15 years of age.
Children 4 years of age or under
accounted for all but 2
deaths, for a 5-year crude death
rate of 1 per 100,000 population.
Children less than one
year of age represented the majority
of SBS cases with more
than 60% of SBS deaths occurring
in this age group. The
crude 5-year death rate for infants
under one year was 3.12
per 100,000 population.
Almost 70% of SBS victims
were male. Males had a death
rate two times that of females.
Victims of SBS were mostly
Non-Hispanic white (42%) and
Non-Hispanic black (42% ).
Virginia Injury Update Page 2
0 10 20 30 40 50 60 70 80
5-14
1-4
<1
Other
Hispanic
Black
White
Female
Male
Age Group Race/Ethnicity Gender
Percent
Figure 1
. Demographic Characteristic of Shaken Baby Syndrome Deaths 2003-2007Source: Virginia Department of Health, OCME
Crude death rates were highest for non-Hispanic Black children, followed by Hispanic children and non-
Hispanic whites. However the number of deaths were insufficient to produce stable rate estimates.
Perpetrator Characteristics
In 18 of the 26 cases (69%), the abuser was reported to be male. Females were identified as the abuser in 6
cases and gender was not reported for 2 cases. The child’s parent/guardian was identified as the abuser in more
than half of the cases. In 42% of the cases, the father was identified as the abuser. The boyfriend of the child’s
parent/guardian (23%), a female baby sitter (11%) and female parent (7.7%) were also commonly identified.
Shaken Baby Syndrome Hospitalizations 2004-2008
Between 2004-2008, 98 children age 4 and younger were hospitalized with a diagnosis of shaken baby syndrome
(SBS). The 5-year crude hospitalization rate was 3.83 per 100,000 population.
Virginia Injury Update Page 3
0 10 20 30 40 50 60 70 80
Grandparent
Babysitter/Caregiver
Parent Significant
Other
Parent or Gaurdian
Females
Males
Type of Caregiver Gender
Percent
Figure 2.
Perpetrator Demographics for SBS Deaths, 2003-2007Source: Virginia Department of Health, OCME
0 5
10
15
20
25
30
2004 2005 2006 2007 2008
Year
Count Rate
Source: Virginia Health Information, Inc.
Figure 3.
SBS Hospitalizations by Year, 2004-2008Virginia Injury Update Page 4
Children under the age of 1-year accounted for 84% of the SBS hospitalizations, for a 5-year crude rate of
15.9 per 100,000 population. While more than half of the children hospitalized for SBS were white, non-
Hispanic, the 5-year rates for NH, whites, NH, blacks and Hispanics were comparable.
In 63% of hospitalizations there was a valid e-code accompanying the SBS diagnosis. Of these, one-third
were classified as maltreatment by the child’s father or stepfather. Assault not elsewhere classifiable (NEC)
or not otherwise specified (NOS) was the next most frequently reported cause of injury. Maltreatment by a
non-related caregiver was listed for four cases and in two cases the child’s mother or stepmother was identified
as the abuser.
0 10 20 30 40 50 60 70 80 90
Female
Male
Hispanic
Black, NH
White, NH
1-4
<1
Gender
Race/
Ethnicity
Age
Group
Source: Virginia Health Information, Inc.
PercentFigure 4.
SBS Hospitalizations by Demographic Variables, 2004-2008E-code Description Count Percent
Battering/maltreatment by father or stepfather 21 33.87
Assault NEC/NOS 18 29.03
Battering/maltreatment, NOS 13 20.97
Battering/maltreatment by non-related caregiver 4 6.45
Battering/maltreatment by mother or stepmother 2 3.23
Battering/maltreatment by other relative 1 1.61
Fall from bed 1 1.61
Struck by falling object 1 1.61
Unarmed fight or brawl 1 1.61
Valid E-code Total 62 100
Missing E-code 36 36.73
TOTAL 98 100
Table 1.
Source: Virginia Health Information, Inc.
SBS Hospitalizations by E-code Description, 2004-2008RISK:
While crying is the most common trigger for SBS, other activities such as toilet training and feeding, may also cause the
person caring for the baby to become frustrated or angry.
Factors that can increase a caregiver’s risk for harming a child include:
Shaking most often results in response to a crying baby/toddler when a caregiver becomes frustrated or angry.REMEMBER:
infants usually cry to signal unmet needs, there are times when they will cry for no obvious reason.
Crying, including long bouts of inconsolable crying, is normal developmental behavior in infants. WhileRECOMMENDATIONS to prevent Shaken Baby Syndrome:
1. Parent’s and caregivers need to understand the frustration they may feel as a result of crying in normal infants. The
National Center on Shaken Baby Syndrome refers to this as the period of
PURPLE Crying.P
eak Pattern– crying peaks around 2 months and then decreasesU
npredictable– crying for long periods can come and go for no reasonR
esistant to soothing– the baby may keep crying for long periodsP
ain-like Look on FaceL
ong Bouts of Crying– crying can go on for hoursE
2. Try to soothe a crying baby using methods such as skin-to-skin contact or calming white noise.
3. If the infant will not stop crying and is fed and changed, it is okay to place him or her in a safe spot, such as a crib,
and leave the baby to cry while you take a break. It is more important to stay calm than it is to soothe the baby. Allow
5-10 minutes for the frustration to pass, then go back and try to soothe the baby.
4. Parents and caregivers should be encouraged to ask for help when feeling overwhelmed.
vening Crying– baby cries more in the afternoon and eveningP
REVENTION TIPSVirginia Injury Update Page 5
Young parental age
Unstable family environment
Rigid attitudes and impulsivity
Feelings of inadequacy
Being a victim or witness to intimate partner violence
Being tired
Limited anger management or coping skills
Limited social support
Low socioeconomic status
child-rearing
Unrealistic expectations about child development and
abuse
Negative childhood experiences, including neglect orThe problem is not the baby’s crying; it’s how caregivers respond to it. Picking up a baby and shaking,
throwing, hitting, or hurting him/her is never an appropriate response.
http://www.dontshake.org/
National Center on Shaken Baby Syndrome
http://www.shakenbaby.com/
The Shaken Baby Alliance
http://www.aboutshakenbaby.com/
Shaken Baby Syndrome
http://www.cdc.gov/concussion/HeadsUp/sbs.html
http://www.cdc.gov/ncipc/dvp/cmp/CMP-resources.htm
Centers for Disease Control and Prevention
http://www.sbsprevention.com/
Shaken Baby Prevention
http://www.dss.virginia.gov/family/cps/shaken_baby.cgi
Virginia Department of Social ServicesR
ESOURCESR
EFERENCES1. Centers for Disease Control and Prevention. Heads Up: Prevent Shaken Baby Syndrome. http://www.cdc.gov/
concussion/HeadsUp/sbs.html
2. Centers for Disease Control and Prevention. Shaken Baby Syndrome Tips. http://www.cdc.gov/healthmarketing/
entertainment_education/tips/shaken_baby.htm
3. The Shaken Baby Alliance. Shaken Baby Facts. http://www.shakenbaby.com/
4. Virginia Department of Health. Virginia Violent Death Reporting System. http://www.vdh.state.va.us/medExam/
NVDRS.htm
5. Virginia Department of Social Services. Shaken Baby Syndrome. http://www.dss.virginia.gov/family/cps/
shaken_baby.cgi
Virginia Injury Update Page 6
The Virginia Injury Update has been prepared by the Injury, Suicide and Violence Prevention
Program, Division of Prevention and Health Promotion, Virginia Department of Health .
For more information, or to obtain additional copies, contact:
Stephanie Goodman, MPH
Data and Evaluation Coordinator
Injury, Suicide and Violence Prevention Program
Virginia Department of Health
109 Governor Street, 8
Richmond, VA 23219
Phone: (804) 864-7745
th Floorwww.vahealth.org/injury
Case Brief Sources:
Virginia Office of the Chief Medical Examiner
http://www.vdh.state.va.us/medexam/
The Shaken Baby Alliance
http://www.shakenbaby.com/<http://www.dss.virginia.gov/files/division/dfs/cps/shaken_baby_syndrome/learn_more/stats.pdf>
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