February 2, 2017


What is abusive head trauma – and how is it different from shaken baby syndrome?

Abusive head trauma (AHT) and shaken baby syndrome usually refer to the same thing. When a parent or other caregiver shakes and injures a child, it's sometimes called shaken baby syndrome.

Shaking a baby is the most common form of AHT. It occurs most frequently in babies younger than 1 – typically when an adult is overwhelmed by a crying baby and tries to get him to stop. It can happen when an adult is frustrated with a toddler or preschooler, too.

AHT is also the term doctors use to describe a serious brain injury that results from blunt force. Receiving a blow to the head and being thrown or dropped cause similar injuries to violently shaking a child, so doctors refer to all such injuries as AHT.

When a child's head is shaken back and forth, his brain bumps against the skull, causing bruising, swelling, pressure, and bleeding in and around the brain. The impact often causes bleeding in the retina – the light-sensitive portion of the eye that transmits images to the brain.

A child with AHT may also have a damaged spinal cord or neck as well as bone fractures. The extent of the damage depends on how long and hard the child is shaken or how severe the blow to the head is. But in just seconds, a child can suffer severe, permanent damage or even death.

Could abusive head trauma happen accidentally while I'm playing with my child?

The normal ways that most parents interact with their children don't cause AHT. Bouncing a baby on your leg, swinging him in his swing, jiggling a child in your arms, or tossing him gently in the air won't cause AHT. An accidental fall is also extremely unlikely to cause the condition.

AHT results from a deliberately violent back-and-forth motion. Unfortunately, an angry adult can quickly unleash that degree of violence on a baby or a small child.

Does abusive head trauma only happen to babies?

Most abusive head injuries happen to babies younger than 1 year old (and most to infants younger than 4 months). But sometimes kids as old as 5 get AHT.

Babies and young children are especially vulnerable to this kind of injury because their head is proportionally larger than the rest of their body, and their neck muscles are relatively weak, making it harder to support their large head.

A baby's immature skull is thinner, and his blood vessels are more susceptible to tearing than those of older children and adults. Babies younger than 1 also have a flatter skull, which allows for more sheering force when a baby is shaken.

How common is abusive head trauma?

An estimated two to three babies out of 10,000 are victims of AHT each year. About one in five of these babies dies, and only about a third will survive without severe disabilities.

Boys are shaken more often than girls, and it's usually a parent or parent's partner who does the shaking. Most often a father, stepfather, or boyfriend abuses the child.

February 1, 2017


It's not always easy to know whether your child's caregiver is doing her job. To make sure, you may have to do some sleuthing. Some parents who suspect something's amiss rent nanny surveillance equipment. But it's often possible to tell whether something's wrong without going to that extreme.

You may have trouble on your hands if:

- Your child seems afraid of the nanny or babysitter and has become anxious and withdrawn.

Many times, kids need an adjustment period to get used to a new caregiver. They may cry, pout, or throw a tantrum at first. That's normal. But if your child seems fearful or continues to be unhappy, it's worth looking into.

A regular caregiver can never replace Mom or Dad, but a child needs to feel comfortable with his nanny or babysitter. Perhaps your child and caregiver haven't bonded, or the nanny or babysitter just isn't providing the kind of warmth and comfort your child needs. As in every human relationship, having the right chemistry is important. (If you suspect something more serious is wrong, educate yourself about the signs of child abuse.)

-Your nanny or babysitter seems secretive about the daily routine.

How your child and her caregiver spend their time shouldn't be a secret. When you come home, you're probably eager to hear about your child's day. If your caregiver isn't forthcoming about it, either she's not good at communicating with you or she has something to hide. Even a caregiver with limited English should be able to convey the ups and downs of your child's day and will understand why you want to know.

-Your child has been in one too many easily avoidable accidents.

A nanny must keep her eye on your child, and know what he's doing at all times to prevent injury. She may be leaving your child unattended as he plays.

-You notice she isn't following your requests.

Both of you are working together to care for your child, so a caregiver shouldn't act as if she knows more about raising your child than you do.

-She seems critical of your parenting.

Again, you're supposed to be a team. And you should welcome constructive suggestions from your child's caregiver, especially if she spends a lot of time with your ever-changing child. But if you get the sense that the two of you just aren't on the same page when it comes to basic issues like nutrition, sleep, and safety, the relationship might not work out in the long run.

-Your nanny or babysitter often shows up late.

An undependable caregiver will leave you in a lurch time and time again. Find someone who you know is committed to the job and considerate of your needs. Tardiness and unexplained absences may mean she's unreliable in other ways as well.

-Your child often looks unusually unkempt and dirty.

Kids are going to get messy when they play, but if your child consistently has jelly on his fingers from lunch at the end of the day or always needs changing when you pick him up, that's a problem. If your little one's caregiver can't take care of the basics, it may be a sign that she's not on the ball when it comes to meeting your child's needs.

-Her stories don't add up.

Never tolerate someone who steals, lies, or deceives you in any way. You have to be able to trust your caregiver for the relationship to work.

-Your child is consistently hungry and tired.

If your child eats like she hasn't had a bite all day or is so exhausted she can't keep her eyes open, that's a red flag. The caregiver may not be following regular mealtimes or nap times.

-You simply get a bad feeling about the caregiver.

When in doubt, trust your gut. Your intuition is likely to be on target, so if a caregiver doesn't feel right to you, find another one.