Bruce2

Shaken Impact Syndrome

Citation:

Bruce DA, Zimmerman RA: Shaken impact syndrome. Pediatric Annals 18:482-494, August 1989.

Notes:

Severe accidental head trauma is not common in young children less than 2 years of age.
80% or more of deaths from head trauma for such children are the result of child abuse.
The shaking is often a single event. There may be no external signs of injury. There is frequently no intent to harm the child.
"A history of minor trauma in a small baby with significantly altered consciousness should trigger an immediate alarm, as should a history of unwitnessed trauma." (p. 482)
It may be difficult to tell the difference between normal sleepiness and pathologic stupor.
There can be significant brain injury without a fracture.
An infant with no history of seizures but presenting with their sudden onset was likely injured by an abuser.
Meningitis or metabolic disturbances may cause irritability, involuntary motor movements, and sleepiness.
30% of children who have been shaken die, 30% are disabled, and about 30% recover.
"The shaking is usually an isolated event that results from custodian frustration and loss of control." (p. 494)
The authors assert that in the majority of cases with severe injury, unconscious occurs immediately.
Seizures and apnea results as the brain swells.