Shaken Baby Syndrome

[RegenerativeNurse, ASN, LPN, RN]

Ive never had a patient with so many diagnoses all at once but this poor child has a list.

I was just wondering if anyone has also had a patient suffering from Shaken Baby Syndrome and how you cared for them. I want to play with the patient but with the head trauma risk for seizure and increased ICP I know shouldn't really move them much. They are developmentally delayed too.

Has anyone cared for such an ill child like this before, specifically with Shaken Baby Syndrome as the cause? How'd you go about treating them?

[JustBeachyNurse, LPN]

Is this a home care patient? What does the plan of care state as far as restrictions ? Most care plans for medically complex children specify activity restrictions and care precautions. Your employer should have specific guidelines for seizure and ^ICP precautions.

I have several patients with seizure and ^ICP and hydrocephalus precautions as well as a few with VP shunts. Each is unique not only due to age, developmental stage and medical history but also medical complexity and comirbid conditions.

A child with a history of shaken baby is not necessarily treated differently than a child with a congenital or postnatal ICH, spontaneous brain hemorrhage, traumatic brain injury, hydrocephalus, epileptic condition (whether "simple" seizures or more complex like LGS) or even CP

Children like to play. Am I going to take a high risk for seizures child to swim, play soccer or ice hockey? Probably not. But a post shaken -baby client who can sit with support, I might set up a safe area (like not sit within fall distance of a table edge, perhaps a play mat or pillow) and play with a ball. Or my one kiddos likes to push cars down an incline so they crash. Laughs so hard he looks like he might stop breathing. My other toddler lives to sit supported on an incline and reach for strings of beads suspended on a bar just within reach.

Most like music in the background. Some like typical toddler tunes. Others like tween pop. Others like classical.

[Esme12, ASN, BSN, RN]

thread moved for best response

[KelRN215, BSN, RN]

It's not true at all that you "shouldn't move" a child who has a history of shaken baby syndrome. How old is this child? When was the injury? You are caring for the child at home, so presumably he or she has recovered (at least somewhat) from the initial insult. Children with shaken baby syndrome who don't die are affected for the rest of their lives but they live and they certainly move. There's no reason not to play with this child.

[CloudySue]

Have you spent time w this child yet or are you just reading up on the 485? Sometimes dx'es have been mostly resolved or controlled by the time we start caring for the child. You can certainly interact w the child w/o moving them much- sensory stimulation is great... singing, hand/foot massaging w scented lotion, etc. I cared for a child w SBS who had been injured when less than 2 months old. The child was then 10. He couldn't play too much in the way a typical child would, and he was developmentally delayed and fragile, but he loved to hug and hear people's voices (he was blind). I think these are the saddest cases, I couldn't help but continue to think how his life was wasted... there was no reason this child should not be living a completely normal life.

[KelRN215, BSN, RN]

Have you spent time w this child yet or are you just reading up on the 485? Sometimes dx'es have been mostly resolved or controlled by the time we start caring for the child. You can certainly interact w the child w/o moving them much- sensory stimulation is great... singing, hand/foot massaging w scented lotion, etc. I cared for a child w SBS who had been injured when less than 2 months old. The child was then 10. He couldn't play too much in the way a typical child would, and he was developmentally delayed and fragile, but he loved to hug and hear people's voices (he was blind). I think these are the saddest cases, I couldn't help but continue to think how his life was wasted... there was no reason this child should not be living a completely normal life.

Shaken baby cases are the worst, IMO. I worked pedi neuro/neurosurgery for years and we saw terrible, progressive illnesses- brain tumors that came out of nowhere and killed a child in 6 months, devastating degenerative diseases, etc. but nothing was worse than the shaken babies because, as you say, there is no reason for it.

[ventmommy]

Every single time I think about my son, I think that he should be playing kickball in the yard or swimming at the beach or asking for help with homework or helping me bake cookies or begging me for one more bedtime book.

But he's not.

He's dead.

And he's dead without doing a single one of those things ever.

Because his birth parents couldn't do the right thing.

There is never a reason to shake, strangle, beat, starve or hurt a baby.

[momyzarc]

I have an adopted son shaken by birth family at 4weeks old. He is now 11. He is very impaired physically...gtube, wheelchair, nonverbal, drooling, seizures, vision impaired... People would assume he is severely cognitively impaired. He just started fifth grade and he reads at an almost fourth grade level. He talks with a computer including jokes, typing out sentences, flirting with girls, being a sarcastic kid. He demands to pick out his own clothes, looks in the mirror before school, refuses to get a haircut, asks "who is in charge here" if he waits too long for the doctor at an appt. he says if he is mad, confused, scared. He listens to books on tape...age appropriate stories. He negotiated with his teacher to pat less "rent" during a business project bc he brings his own chair to class so he does not need one provided. He fishes with adaptive equipment and is a super sports fan. He has been continent since 2years 3 months though we have to lift him onto a commode. I could go on but my point is brain damage can be very different that what you might expect. It will always be sad but he has joy in his life.

I am also a nurse doing primarily rehab but also some private duty. I have done work with post-stroke aphasia patients and other kiddos with brain injury, and I have seen others make great strides in communication and interaction. Sometimes it just takes belief and hard work from caregivers to support that progress.

[meanmaryjean, DNP, RN]

God love you BOTH ventmommy and momyzarc.

[CloudySue]

Good point, there are no typical SBS victims, everybody's got their own unique crosses to bear. Like rolling the dice, you don't know what damage you'll end up with after the deed is done.