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

This policy guide was updated from the 9/22/10 version, as part of the Policy Redesign, in accordance with the DCFS Strategic Plan.

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 (4).

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 (5).
• 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)

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 investigation and 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.)

Referenced Policy Guides

0070-524.10, Assessment of Failure to Thrive

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

0070-548.20, Taking Children into Temporary Custody

0070-548.24, Structured Decision Making (SDM)

0070-548.25, Structured Decision Making (SDM) Safety Plans

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