nervous system—the basal ganglia, the cerebellum and the inner ear (fluid in the eustachian tubes of the ears maintains a consistent level for balance to effectively occur). Damage to any of these areas may result in poor balance. When a balance problem primarily stems from the inner ear, masking agents—such as a device that produces “white noise”—can assist in maintaining balance and coordination.
Physical and occupational therapy can help correct deficits in a child’s balance. These deficits may cause a child to have difficulty standing or walking in an uncontrolled way. Coordination therapies and strengthening therapies can allow for smoother mobility.
BLINDNESS
Many types of visual deficits may develop as a result of SBS. Retinal hemorrhaging may resolve without any lasting ill effects, but may also leave permanent scarring with partial or complete blindness.
Cortical blindness relates to injuries in the cortex of the brain. Cortical trauma results from any type of brain injury, including contusion, edema or hemorrhage. The eye and optic nerves are functional, yet the brain’s cortex is unable to effectively process visual information. There are several types of visual deficits that may result from cortical injury, such as gaze disorder (strabismus), visual field defects or total blindness.
Cortical injury usually results in severe loss of vision. Any injury to the occipital region of the brain may threaten vision, because this is the area that controls that function. Visual deficits may also occur in conjunction with other disabilities, such as cerebral palsy (CP), wherein a child is more likely to experience optic atrophy, lazy eye (amblyopia) or eye jerks (nystagmus).
Children affected by visual disability or blindness caused by SBS will benefit from regular visits to an ophthalmologist who is experienced in the area of ocular injuries resulting from child abuse.
CEREBRAL PALSY (CP)
This condition identifies a group of disorders that affect a child’s motor skills, such as the ability to perform and control normal movements. Poor balance, weakness, stiffness and lack of coordination are all aspects of CP.
A child may be affected on different sides or various parts of his or her body. Hemiplegia is CP that affects an arm and leg on one side of the body, diplegia affects both legs and quadriplegia affects all four limbs. These are all considered “pyramidal” (spastic) CP as the pyramidal tract of the brain is often affected. Muscle control may be spastic (rigid movement), hypotonic (floppy movement) or ataxic (poor balance and coordination).
Extrapyramidal CP occurs when there is damage to the basal ganglia section of the brain. Muscle control will be athetoid (no control) where the limbs move in an abrupt and involuntary fashion. The majority of children diagnosed with extrapyramidal CP have a concurrent diagnosis of being mentally handicapped.
CP in infants and toddlers is diagnosed after certain developmental milestones fail to be met and there is abnormal muscle tone and abnormal movement. There is no exact measurement that can predict the eventual severity of the effects of CP, though by age two a child can be diagnosed as hemiplegic, diplegic or quadriplegic.
Parents and other caregivers are encouraged to allow the infant or toddler to socialize with other children, especially other children with disabilities, because this will emotionally support the child’s instinctual need for independence from within a largely dependent body.
DEAFNESS
Children who are shaken may suffer damage to the eighth cranial nerve, which controls hearing. Damage may also affect the bones of the inner ear and the cochlea, which converts sounds from mechanical impulses to chemical and electrical impulses sent to the brain.
Children’s hearing may be tested with an audiology follow-up. Deficits in hearing range from a mild impairment to profound deafness. Children may be left with some residual hearing that may be amplified with the assistance of a hearing aid.
Regular visits to an audiologist and speech therapist will help these children who are deafened from shaking to make the most of this particular disability.
DEATH
Death in SBS most commonly occurs as a result of cerebral edema and/or hemorrhaging with resulting uncontrolled increase of intracranial pressure. Children under the age of six months have a greater risk of dying as a result of being shaken and overall, infants and young children have a 20 to 25 percent chance of dying after a shaking incident.
There are also children who suffer a “late death.” These are children who have suffered massive brain injury and die years later, such as a child with only brain stem function which ceases. Or a child who succumbs to increased intracranial pressure and a shunt that can no longer support her neurological changes. Or the child who dies from pneumonia after living with devastating neurological damage for twelve years from being shaken at five months. The outcome for shaken infants is something that can never be predicted. There are children who are expected to live, expected to die, make recoveries that are called “miracles” and others whose young bodies cannot take the trauma of living with their injuries. Providing a hopeful, loving environment is the best any caregiver can give, no matter the days, months or years.
EMOTIONAL PROBLEMS
A subtle complication of SBS is a child who experiences subsequent emotional problems. This is subtle because of the fact that it is one category where a shaking incident may never be discovered or diagnosed. There are children who are shaken, become unconscious, may experience lethargy or vomiting and then recover. Years later, subtle complications will be present without parents or caregivers knowing the basis for such complications. Emotional problems might range from explosive anger to self-injurious behavior to depression. Later in life, a child who has been shaken may develop an attachment disorder. Psychiatric evaluation and treatment may be needed as a shaken child grows.
The harmful effects of abuse can be lessened. Loving family members offer structure and guidance to a child whose basic trust issues were dramatically altered. Parents and caregivers should watch for changes in their children. Therapists and other mental health professionals can help with understanding emotional problems and guide with treatment options.
A Behavioral Issue
My son was three months old and suffered subdural hematomas, seizures, retinal hemorrhages and buckle fractures in both legs. He was misdiagnosed with spinal meningitis for two days before he was transferred to a hospital in Springfield, Illinois. There, he underwent a full body scan and MRI, which showed bleeding in his brain and behind his eyes. I wasn’t given this information at the first hospital. I told the nurses that he wasn’t looking at me and I was told that it was because of the medication.
I found out at the Springfield hospital that he was blind, because of the bleeding behind his eyes. The next day the Department of Children and Family Services (DCFS) arrived with the Springfield police, accusing me of hurting my baby. Alone and scared and being threatened with having my baby taken away was the worst feeling ever, because I knew I didn’t hurt my child. He spent two weeks in the hospital.
I figured out a male friend of mine was responsible for the abuse of my baby. I had to take a lie detector test to prove I had nothing to do with the abuse. The DCFS worker did a home visit and after getting my results I was cleared. She went to the state police to get something done. She fought to have the person responsible brought to justice and we were finally close to an arrest. But that was only the beginning.
I moved nearer to my family, where there were people I knew I could trust. My son had a neurologist, an ophthalmologist and physical and speech therapy, so we were busy. At five months, he had to have surgery to relieve pressure on his brain due to “slow bleeders” from being shaken two months earlier. Then he spent another two weeks in the ICU with more therapy and weekly CT scans in Chicago (two hours away).
My son made great strides, but there were developmental delays which led to special education classes beginning in preschool. He also had sensory and behavioral issues, which resulted in