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even believe that after he survived the first two days he was going to live and then be very shocked when he eventually bled to death. Or they might understand that the bouncing of the wagon over the rough terrain was not only painful but also dangerous for someone in his condition. The train may be halted for the three days he lived or several wagons might stay behind to tend to him while the rest of the column moved on.

What Happens to a Baby that Is Shaken to Death?

Q: If a baby were shaken to death, what would the symptoms be? What would the cause of death be?

A: This situation is called Shaken Baby Syndrome. Babies are forcefully shaken as part of an overt child abuse situation or as the result of an angry, uninformed adult. Whether intentional or accidental, it is a form of child abuse. It is neither new nor rare. It was first reported by Dr. John Caffey in 1972, and as many as 50,000 cases are reported each year.

Infants have large heavy heads and weak, undeveloped neck muscles. Also, the developing brain is smaller than it will be when the child is grown. This means that infants have more space between the brain and the skull, which allows more movement of the brain within the skull whenever a violent force is applied. These anatomical realities set the stage for severe injury and death when a baby is subjected to violent shaking.

The brain sits within the skull and is surrounded by several layers of fibrous tissue, the most important being the dura mater. Cerebrospinal fluid flows around the brain and the dura and also serves to protect the brain. Thus, the brain is not “fixed” within the skull, but can “move” somewhat.

In acceleration-deceleration injuries, such as in falls, automobile accidents, and violent shaking, the brain can literally “bounce” against the skull. If a driver’s head hits the steering wheel, the skull stops instantly, but the brain will continue its forward motion until it strikes the skull. This is called a “coup” injury. The brain will then bounce off the frontal skull and bang against the back of the skull. This type of injury is called a “contrecoup” injury. Shaking is simply the rapid repetition of these movements. The brain is bounced back and forth between the front and the back of the skull.

As the brain bangs against the skull, it may be bruised or blood vessels may be damaged and result in bleeding within (intracerebral bleed) or around (subdural bleed) the brain. This is particularly true for infants because the smaller brain has more “play,” more room to move, so that the impacts against the skull are more powerful.

These types of brain injuries may lead to death, seizures, paralysis, loss of hearing, cerebral palsy, sucking and feeding disorders, a form of autism, behavioral problems, cognitive dysfunction, coma, a permanent vegetative state (prolonged, unresponsive coma), mental retardation, blindness, and a host of other problems. The blindness may result from bleeding into the retina of the eyes or may be what is termed “cortical blindness.” The outermost layer of the brain is called the cortex. The area of the cortex responsible for vision is the rear (occipital) region. If this area is damaged by the coup-contrecoup injuries, blindness may result.

The infant’s neck is very weak, and the bones are fragile. The violent whipping action produced by the shaking causes a whiplash-type injury. The neck bones may fracture or the spinal cord may be traumatized. Paralysis or death may result.

If the infant is grasped by the arms during the shaking, the arms may be broken or the shoulders may be damaged or dislocated. If gripped by the chest or abdomen, internal organs, such as the heart, lungs, liver, kidneys, spleen, or stomach, may be damaged or ribs might be fractured.

The most likely causes of death would be “subdural hematoma secondary to coup-contrecoup injury resulting from traumatic shaking,” or “spinal cord injury secondary to hyperflexion and hyperextension injuries resulting from traumatic shaking.”

D. P. Lyle is the Macavity Award-winning and Edgar, Agatha, Scribe, and USA Best Book Award-nominated author of many nonfiction books as well as numerous fiction, including the Samantha Cody and the Dub Walker thriller series, and the Royal Pains media tie-in novels. He has worked with many novelists and writers of popular television shows. Dr. Lyle is a practicing Cardiologist in Orange County, California. See his website at www.dplylemd.com or his blog at http://writersforensicsblog.wordpress.com. These Q&As are republished with the author’s permission.

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