Babies or young people with possible inflicted head or brain injuries

This page refers to the internal head injuries a baby or young child sustains from being violently shaken or thrown (previously known as 'shaken baby syndrome').

Terminology

Various terms are in use to describe babies or young children with a possible inflicted head or brain injury. These include:

  • Shaken Baby Syndrome
  • Inflicted Traumatic Brain Injury
  • Battered Child Syndrome
  • Non Accidental Head Injury
  • Inflicted Head Trauma
  • Shaken Impact Syndrome
  • Shaking Injury
  • Whiplash Infant Syndrome
  • Whiplash-shaking injury

The above terms refer to the internal head injuries a baby or young child sustains from being violently shaken or thrown. This can cause a range of serious injuries to a baby or small child, which are often fatal. These injuries are mainly to the head but there may also be injuries to the body.

From a medical, social care and judicial perspective, the main interest is the consequence of any non-accidental injuries in terms of treatment, investigation, identifying who may be responsible and safeguarding the child and any siblings from further harm.

Initial Possible Signs

The child is in a collapsed state and presenting some or a combination of the following:

  • Lethargy
  • Irritability
  • Abnormal movements or seizures
  • Drowsiness
  • Increased or decreased muscle tone
  • Vomiting
  • Poor feeding
  • Irregular breathing
  • Apnoea (stopping breathing)

Child Protection Considerations for Hospital Staff

  • A history/explanation should be sought from the parents/carers
  • The history/explanation given by the parents/carers should be assessed for consistency with the injuries.
  • If there is any doubt a Paediatric opinion should be sought.
  • When injuries follow genuine accidents, the child is normally presented promptly and there is a clear history of an accident.
  • When injuries are non-accidental, there may be delay in seeking medical advice (although on occasion a delay may follow an accident where the parents had initially thought the infant was alright).
  • When injuries are non-accidental, the history may be vague or unwitnessed.

Account should also be taken of associated risk factors, which include:

  • Child or siblings subject to a Child Protection Plan
  • Previous history of sudden infant death or apparent life threatening events in the family
  • Very young parents
  • Parents suffering from addictive behaviour
  • Parents showing odd behaviour, for example, very aggressive
  • A history of domestic violence
  • If the child appears to be failing to thrive.

If required, consultation should take place with the Named Doctor for Child Protection.

If at any point during the course of admission, examination, treatment or tests etc., there is reason to suspect that the injuries to the child are non-accidental, an immediate referral is to be made to children’s social care, irrespective of the time or day.

The referral should be followed in writing to children’s social care within 48 hours.

Children’s Social Care and Police

On receipt of a referral indicating that an infant or child is suffering from possible traumatic brain injury which appears to have a non-accidental cause, there must be immediate liaison between children’s social care and the Police Child Abuse Investigation Unit.

This is to be followed by a Strategy Meeting/Discussion which should include as a minimum:

  • Children’s social care Team Manager/Emergency Duty Team
  • Consultant Paediatrician/Consultant Community Paediatrician
  • Child Abuse Investigation Police Officers/Duty Inspector

Other relevant professionals should be involved as appropriate.

The referrer’s information should be available for the Strategy Meeting.

Where abuse is suspected, children’s social care and the Police will work jointly, with children’s social care undertaking a child protection enquiry (s47 enquiry) and the Police undertaking an investigation.

During the Strategy Meeting there is to be joint planning in relation to the children’s social care enquiry and the Police investigation. It is imperative that the immediate safety and welfare needs of any siblings or other children involved are also considered.

The Police will work to the ACPO guidelines.