Abusive Head Trauma (AHT) has many victims and causes the death of about a dozen babies every year in Switzerland. An awareness campaign was launched this spring (2023) to prevent AHT and its serious consequences. The key is to reduce the drama around crying and better understand why infants do it.
It is when everything piles up: the piercing, never-ending cries, a numbing fatigue caused by practically sleepless nights, a neighbour who rings to complain about the noise, and so on. With one’s nerves on edge, it only takes a few seconds to commit the irreversible. In Switzerland, Shaken Baby Syndrome is the leading cause of death in children under the age of two who are victims of abuse. Repeated shaking is an extremely brutal act that causes the infant’s head to rock violently forward and backward. It can cause the veins in the brain to tear, which leads to intracranial bleeding. The back-and-forth movement causes retinal haemorrhages, and the brain damage leads to neurological disability. These days, medical staff prefer the term Abusive Head Trauma (AHT) to refer to the injury rather than the act.
“Shaken Baby Syndrome does not happen by accident, during play or rocking,” says Sarah Depallens, paediatrician and head of the Child Abuse and Neglect (CAN) Team, a unit at the CHUV specialising in child abuse. “It’s an extremely violent act.” One in ten babies die from the shock. Two out of three children are severely disabled, both physically and mentally. As for the rest, the after-effects are more difficult to assess. Psychological and cognitive delays may be mild and only show up later, for example at school, in language difficulties or learning disorders.
Often, the crying in the first few months can be unbearable for drained, exhausted parents, and they lose control. In some situations, the lack of awareness of the dangers is also to blame. In 60% of cases, the child’s father or the mother’s partner is the culprit. “Men are less educated about a baby’s crying,” the paediatrician says. “Furthermore, due to family schedules and lack of social support, few fathers are present during discussions with the midwife or paediatric nurse, or on visits to the paediatrician, which means that they are less informed about the baby’s needs and receive less educational guidance.” In 10% of the cases, mothers are responsible, and in 30% of the situations, it is child care givers, au pairs or babysitters.
The average age of the victims is 5 months, “a period when babies cry the most, especially due to the infant’s episodes of colic and irregular sleep patterns”. Some 10 cases are reported in Switzerland every year, but that figure could in fact be higher because only serious and symptomatic cases are detected. “Statistics on child abuse are always lower than the reality because a large proportion of it remains invisible,” Sarah Depallens says.
Early detection to avoid further shaking episodes is vital. Most symptoms of a shaken baby are non-specific: irritability, vomiting, lethargy, even convulsions or disturbances in consciousness. Healthcare professionals are now trained to identify these clinical situations and spot signs of abuse as early as possible.
A study conducted by Sarah Depallens estimates that more than 60% of babies examined for suspected AHT had brain damage that occurred at different ages, and 70% of those babies had already seen a paediatrician a few weeks earlier for non-specific symptoms that could be indicative of an earlier abusive episode. “It is therefore essential to identify them as soon as possible to prevent violence from reoccurring for the baby and the baby’s siblings.” If a baby is identified as a victim of abuse, close coordination with the civil and criminal justice systems is established to identify the person responsible for the abuse and avoid a recurrence.
“Crying can exhaust parents,” says Sarah Depallens. “When the situation becomes too intense, it’s better to leave the room, ask for help, and take time to breathe. A baby is never in danger lying on his or her back in a cot.” Sarah Depallens has teamed up with Professor Tony Fracasso, forensic doctor and deputy director of the Centre for Forensic Medicine in French-speaking Switzerland to create a prevention campaign in the region. Launched this spring (2023), the campaign will include videos and a website with advice for young parents. “We need to reduce the drama around crying, to take the pressure off parents. They may take a baby’s crying as a sign of their incompetence,” explains Tony Fracasso. “Crying is normal. Infants sometimes remain inconsolable despite parents’ efforts. Frustration is therefore understandable. And by realising that, you learn what is dangerous, such as shaking a baby. And once someone is informed, they usually pass on the information to those around them.” Initially launched in Lausanne and Geneva, the campaign is being relayed by healthcare professionals, particularly midwives. “The trigger is identified: crying,” he says. “Caregivers generally do not want to harm the child. They regret their action. But with greater awareness, these tragedies are avoidable.” /