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From the Department of Pediatrics and the Children's Hospital of Eastern Ontario Research Institute, University of Ottawa (King and Sirnick) and Plan-it-Safe, Children's Hospital of Eastern Ontario Research Institute (MacKay), Ottawa, Ont. Members of the Canadian Shaken Baby Study Group are listed at the end of the article.Canadian Shaken Baby Study Group: Dr. Robert Morris, Dr. Charles A. Janeway Child Health Centre, St. John's, Nfld.; Dr. John Anderson, IWK Grace Health Centre, Halifax, NS; Dr. Gilles Fortin, Hôpital Sainte-Justine, Montréal, Que.; Dr. Laurel Chauvin-Kimoff, Montreal Children's Hospital, Montréal, Que.; Dr. Susan Bennett, Children's Hospital of Eastern Ontario, Ottawa, Ont.; Dr. Marcellina Mian, Hospital for Sick Children, Toronto, Ont.; Dr. Harriet MacMillan, McMaster Children's Hospital, Hamilton, Ont.; Dr. Deborah Lindsay, Children's Hospital, Winnipeg, Man.; Dr. Anne McKenna, Royal University Hospital, Saskatoon, Sask.; Ms. Linda Anderson, Alberta Children's Hospital, Calgary, Alta.; and Dr. Jean Hlady, BC Children's Hospital, Vancouver, BC.
Correspondence to: Dr. W. James King, Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Rd., Ottawa ON K1H 8L1
Background: Shaken baby syndrome is an extremely serious form of abusive head trauma, the extent of which is unknown in Canada. Our objective was to describe, from a national perspective, the clinical characteristics and outcome of children admitted to hospital with shaken baby syndrome.
Methods: We performed a retrospective chart review, for the years 1988–1998, of the cases of shaken baby syndrome that were reported to the child protection teams of 11 pediatric tertiary care hospitals in Canada. Shaken baby syndrome was defined as any case reported at each institution of intracranial, intraocular or cervical spine injury resulting from a substantiated or suspected shaking, with or without impact, in children aged less than 5 years.
Results: The median age of subjects was 4.6 months (range 7 days to 58 months), and 56% were boys. Presenting complaints for the 364 children identified as having shaken baby syndrome were nonspecific (seizure-like episode [45%], decreased level of consciousness [43%] and respiratory difficulty [34%]), though bruising was noted on examination in 46%. A history and/or clinical evidence of previous maltreatment was noted in 220 children (60%), and 80 families (22%) had had previous involvement with child welfare authorities. As a direct result of the shaking, 69 children died (19%) and, of those who survived, 162 (55%) had ongoing neurological injury and 192 (65%) had visual impairment. Only 65 (22%) of those who survived were considered to show no signs of health or developmental impairment at the time of discharge.
Interpretation: Shaken baby syndrome results in an extremely high degree of mortality and morbidity. Ongoing care of these children places a substantial burden on the medical system, caregivers and society.
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