Assessment of Shaken Infant Syndrome

0070-525.10 | Revision Date: 07/01/14

Overview

This policy guide provides information on assessing for and observing, gathering and assessing evidence of Shaken Infant Syndrome.

TABLE OF CONTENTS

Policy

Assessing Shaken Infant Syndrome

Physical Symptoms

Risk Factors for Infants

Risk Factors for Parents/Caregivers

Diagnosing Shaken Infant Syndrome

Alternative Explanations for Symptoms of Shaken Infant Syndrome

Procedure

Assessing for Shaken Infant Syndrome

ER/Case-Carrying CSW Responsibilities

Investigating Shaken Baby Syndrome

ER/Case-Carrying CSW Responsibilities

Approvals

Helpful Links

Referenced Policy Guides

Version Summary

This policy guide was updated from the 09/22/10 version, as part of the Policy Redesign, in accordance with the DCFS Strategic Plan.

POLICY

Assessing Shaken Infant Syndrome

Shaken Infant Syndrome, also known as Shaken Baby Syndrome or Whiplash Shaken Infant Syndrome, is the most common cause of child fatality due to abuse by violent shaking. Although most common in infants, it can occur in children up to age four.

Physical Symptoms

Generally speaking, in cases of Shaken Infant Syndrome, there is no visible evidence of trauma other than occasional bruising, especially along the chest however the child may exhibit other symptoms which may include:

Risk Factors for Infants

As part of a comprehensive assessment, the presence of the following risk factors in infants may help in determining whether Shaken Infant Syndrome is present.

The child has:

• Ongoing difficult behaviors or special health care needs, such as developmental or multiple medical problems.

• Colic or other feeding problems

The child is:

• Prone to tantrums

• Toilet training

• Described as crying frequently

Risk Factors for Parents/Caregivers

The presence of the following risk factors in parents/caregivers may help in determining whether an infant has Shaken Infant Syndrome:

• The child has physical symptoms of Shaken Infant Syndrome but the parent/caregiver reports that the child had a short accidental fall from furniture or down steps.

• The person caring for the child when the child sustained injuries was a substitute caregiver (particularly young males, such as the mother’s boyfriend in the father’s role)

• The child lives in a single-parent home.

• There are several children under age five.

• The parent/caregiver is socially isolated.

• The parent/caregiver is involved with drug/alcohol abuse.

• There is domestic violence in the home.

• The parent/caregiver has psychological problems.

• The family is currently experiencing stress-causing events (e.g., moving, eviction, divorce, death, and unemployment).

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Diagnosing Shaken Infant Syndrome

Only medical personnel may provide the diagnosis of Shaken Infant Syndrome. Shaken Infant Syndrome is diagnosed through medical finding of intra-cranial, intra-ocular and/or skeletal injuries. A consultation must occur between the CSW, Public Health Nurse and medical provider to obtain a complete medical history and medical examination to assist in formulating an accurate assessment. 

Alternative Explanations for Symptoms of Shaken Infant Syndrome

There are some situations which can result in a similar cluster of symptoms, but are not a cause of Shaken Infant Syndrome, such as:

• Birth trauma

• Certain types of accidents (e.g., car, falls from significant heights)

• Meningitis

• Vascular malformations/ aneurysms

• Bleeding disorders

• Sepsis (generalized infection)

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PROCEDURE

Assessing for Shaken Infant Syndrome

ER/Case-Carrying CSW Responsibilities

1. Identify risk factors for infants being assessed for Shaken Infant Syndrome.

2. Identify risk factors for the parents/caregivers of infants being assessed for Shaken Infant Syndrome.

3. Document findings in the Contact Notebook.

Investigating Shaken Infant Syndrome

ER/Case-Carrying CSW Responsibilities

1. Conduct a detailed and thorough interview of the parent and/or caregiver.

2. Differentiate between accidental versus abusive causes, reasonable versus unreasonable explanations.

3. Obtain an accurate history of when the infant last appeared unharmed.

4. If the child is brought to the hospital immediately following the severe damage, the injury probably occurred just after the child was last observed to be well.  In cases where there is a delay in bringing the child for treatment (usually with less severe injuries), it often becomes impossible to prove who did the shaking.

5. Consult with the Public Health Nurse according to established procedures.

1. Provide any identified risk factors

2. Provide all known medical information

3. Request assistance with a face-to-face home visit

4. Request informational resources on Shaken Infant Syndrome for distribution to caregivers (if appropriate)

5. Seek help in identifying any special medical needs of the infant to assist in discharge planning/placement (including consultation of the Medical Case Management Section)

6. Request assistance with resources/referrals for follow-up of special medical needs of the child including any special training needs for the caregiver

7. Ask for input on the development of the Health/Medical component of the Case Plan (if appropriate)

6. If applicable, take the child to the HUB for a forensic examination.

7. Follow procedures regarding disposition of allegations and detention of children.

8. Document all information accumulated during the assessment in all appropriate Case Notebooks (Contact Notebook, Health Notebook, etc.)

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APPROVALS

None

HELPFUL LINKS

Referenced Policy Guides

0070-548.10, Disposition of Allegations and Closure of Emergency Response Referrals

Referrals

0070-548.20, Taking Children into Temporary CustodyThe removal of a child from the home of a parent or legal guardian and placement or facilitation of placement of the child in the home of a non-offending parent, relative, foster caregiver; group home or institutional setting.Temporary custody also includes: placing hospital holds on children; situations in which the CSW interrupts an established Family Law Court custody or visitation orders when the CSW believes that if the order is carried out, the child would be placed in immediate risk of abuse, neglect or exploitation and the child is allowed to remain in the home of the non-offending parent; situations in which DCFS requests that law enforcement remove a child from the home of his or her parent/legal guardian and the CSW places the child with a relative or unrelated caregiver; and situations in which the child is living with a relative or an unrelated caregiver and all of the following conditions exist: child’s parent is asking for the child to be returned home, CSW believes that the return of the child to his or her parent would place the child at risk of abuse, neglect or exploitation, CSW does not allow the child to be returned to his or her parent; and, the child remains in the home of the relative or is placed in out-of-home care.

0070-548.24, Structured Decision Making (SDM)

0070-548.25, Completing the Structured Decision Making (SDM) Safety Plan

0070-560.05, Joint Response Referral: Consulting with PHN

0400-503.10, Contact Requirements and Exceptions

0600-500.00, Medical Hubs

1000-504.10, Case Transfer Criteria and Procedures

Criteria and Transfer Procedures

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