Associated injury patterns are generally found in victims with SBS and non-accidental head trauma. If additional injuries are present with SBS, the infant and/or child may have bruising on the scalp, torso, and extremities. Bruising may be red, bluish-purple or brown, depending on the age of the bruises. Lacerations and contusions may be found anywhere on the child’s body where areas of impact occurred against a surface. Sprains, torn ligaments and tendons in the neck, shoulders, wrists, hands, hips, legs, knees and feet may be present where joints were stressed from hyper-extension (bending back), hyper-flexion (bending forward) and stretching from forceful pulling and shaking action.
The mouth, or oral cavity, is often a focal site for signs of abuse. That’s because a primary cause of SBS is an overstressed caregiver trying to quiet a baby from crying. In an effort to quiet the baby and stop the crying, the caregiver will often jam a bottle in the baby’s mouth – causing visible damage. Oral trauma such as cuts, swelling and bruising may be present where forceful feeding or forceful insertion of a pacifier, oral infant toy, foreign object or bottle occurred in the child’s mouth. Oral trauma may also occur from slapping the face area and the sudden impact of teeth through lips or cheeks from a variety of abusive acts. Oral trauma may be found on the outside of the cheeks, inside the cheeks, upper and lower gums, under the tongue, roof of the mouth and back of the throat. If the child is older, evidence of loose or absent teeth may be present. An infant’s oral structures at the bottom of the mouth, such as under the tongue and floor of the mouth are very compliant, therefore more relative force is necessary to cause injury to an infant as compared to an adult. The presence of injuries in this area of the mouth is almost always indicative of maltreatment to the infant, whether by intent or neglect and an unsafe environment.
Neck and spinal injuries are commonly present with SBS. Evidence of neck and spinal injuries may or may not be visualized both with and without imaging studies. Bruising, swelling over the spinal area and around the neck may or may not be evident. Fracture of the bones, new and old fractures, may be present in the skull, ribs, extremities, and in the spinal column. Sometimes, while imaging studies are done for an abuse injury, other healed or partially-healed fractures of the infant’s or child’s skull, ribs or extremities may be discovered that were not previously known. These findings are evidence of prior abusive events that went undiscovered.
Sometimes the age of an old injury can be estimated, depending on the physical findings or the age of an injury may be undetermined. Often times when this happens, parents and caregivers may recall a time in the infant or child’s recent history where the child was irritable or acted to be in pain and then the behavior resolved without treatment or investigation into the discomfort or irritability. But healthcare providers don’t anticipate that accurate histories are always attainable by parents or caregivers in clinical situations that feature child abuse. So there may be no history on record of prior abuse, when in reality there was a history of child abuse that actually occurred multiple times previous to the last clinical presentation. Approximately seventy-five percent of child abuse victims have no prior history of abuse on record.
Skull fractures are indicative of blunt force trauma to the head in addition to Shaken Baby Syndrome. Skull fractures are clear evidence of impact to the skull, whether by hitting, throwing or banging the skull. There may be more than one skull fracture. And there may be fractures elsewhere on the infant or child’s body. In infants and children, the presence of previous fractures is easily ascertained.
If an infant or child has sustained bruising to the torso or chest, underlying injury patterns may be present such as, contusions to the heart, lungs, liver, spleen, stomach, intestines and pelvic structures. Nerve pathway and vascular tears may be present anywhere in the body or head. Emergency exploratory surgery may be indicated to stabilize bleeding from organs or vessels in the head, torso, chest and extremities. Neurosurgical repair may be indicated to repair and approximate nerve tracts if possible.
In some cases, there may be associated sexual abuse. Indicators of sexual abuse may include trauma to the pelvic organs and/or external genitalia, oral cavity and rectum. In females, sex abuse may not be as readily observable. The presence of blood in the vaginal vault may be discovered by a healthcare provider experienced in child sex abuse assessment. Redness and swelling in the perineum and rectal area is indicative of sex abuse. Presence of infection in these areas is evidence of prior abuse. Oral trauma may be indicative of sex abuse also. Sometimes these findings are discovered after initial assessment for head injury takes place. The infant or child may cry from the sex abuse trauma and then become a victim of violent shaking and blunt trauma. Internal organ trauma may be present with distention of the pelvic and abdominal cavity.
If you have any questions or concerns about what can be done to help babies who have been shaken due to Shaken Baby Syndrome, Child Abuse, or families of babies who have died, please call Christopher Keane and The Keane Law Firm toll-free for free consultation at (888) 592-5437 (KIDS), click on contact us here, or use the web form provided at https://www.keanelaw.com