Sunday, July 16, 2006

Shaken

I'm used to seeing young mothers with lots of children, but even I was taken aback when I went to the delivery of a mother having a scheduled repeat Caesarean section. At the age of twenty years, she was having her fourth C-section. I could only sigh.

Mom said she was putting this baby up for adoption, as she had her other three children, but she wanted the baby to stay in her room until she went home. This is not that unusual. It turned out, though, that her other three children were removed from her home by Protective Services because of abuse. Apparently mom had shaken one or more of her babies.

Many of you have probably heard of shaken baby syndrome. It occurs when someone holds an infant in front of them and shakes them to and fro, causing their head to flip repeatedly and rapidly from front to back. That shaking alone can cause bleeding into the baby's brain, in some cases causing significant brain damage. The baby's head doesn't have to hit anything, so there may be absolutely no external signs of abuse. A tell-tale sign, though, is the presence of retinal hemorrhages - patches of bleeding in the back of the eye that can be seen when a doctor examines the eye with an ophthalmoscope, that really bright light we shine into people's eyes.

Because of the Protective Services involvement, we kept the baby in our special care nursery until P.S. could check out the home again and determine whether this baby could go home with mom. The mother has been faithfully visiting her baby and feeding her. She acts like she really loves this baby, and I believe she does. I think she probably loves her other children too, even the one or more she shook. It's a bit paradoxical, but I think a lot of child abusers love the kids they abuse. They just can't help themselves, though, or their temper gets the best of them, and they harm their children anyway. They're not monsters - in fact, they are very much like you and me. They just get out of control sometimes.

It's sad to see kids taken away from parents who love them, but it is absolutely necessary in cases of abuse. It's too bad we haven't figured out a way to make that love all encompassing, so it overrides any fits of anger and abuse. I guess it's just another example of the imperfect world in which we live.

8 Comments:

Blogger SmartBlkWoman said...

This story makes me think of an article that I read somewhere about women that want to be pregnant but they don't want the babies (maybe their boyfriends or someone else close to them doesn't want them to have a child) so they end up getting repeated abortions. It's a cycle they keep themselves in: the enjoyment of being pregnant and wanting to have this baby followed by an abortion to get rid of the baby they know they can't/or won't be able to care for.

Life is full of contraditions.

11:29 PM  
Anonymous Anonymous said...

Before I had kids, an experienced parent friend warned me:

"You'll want to shake your baby at some point. You might also want to hit it. You WON'T, because you're you--but prepare yourself now to be ready to deal with those feelings."

He was right.

9:13 AM  
Blogger WendyLou said...

For me, this is a "but for the grace of God, there go I" things. I don't think ANYONE is immune to the frustrations of a parent with a child who won't stop crying. My nine week old balled all weekend, I am very grateful that my mom and sisters were around to help. If you think you are immune from this, there is a problem there.

I am a strong believer that support systems prevent this sort of snapping abuse. My friend, who is a CPS investigator called me while I was on bed rest, and begged me to watch her 6 month old. She said I was the first one to answer my phone, and she needed a break now. Her baby came over and stayed with me for 6 hours while she went grocery shopping, had a nap, and had a manicure. She was afraid she would so something she would regret, so she got her baby somewhere safe. Even if she had not been able to have someone watch him, I don't think she would have shaken him, because she was aware she was tempted to harm him, and hence she could prevent it.

The parents who shake, in my experience either are very immature, have unrealistic expectations for parenting, or have no support systems which are really supportive. (or all three.) These parents don't seem to be the ones that just don't care about their children, I see them as usually loving and caring for these children, the parents just have no means to cope with the responsibilities of parenting.

11:31 AM  
Blogger Kelly said...

I firmly beleive that your thoughts on parents of shaken babies is often correct.

I, too, have been exhausted and stressed out with a colicky baby. And if it weren't for all the publicity around the Nanny trial back in 1997, I would've shaken that child out of frustration. Not because I was mean or terrible, but because that feeling of helplessness is very real and very overwhelming. You just want the screaming to stop!

I also know someone who once told me that they understood how some women kill their kids. This woman had a child that was severly colicky for 12 months, and she was losing her mind. If it weren't for a support group, she doesn't know what she would've done. She's one of the best mother's I've ever known. But that situation was dire at that point in her life.

In your patient's mother's case, it was probably immaturity, yet it could've been an almost "natural" human response. It's taken information and knowledge to let people know how much that can hurt a child, and now people push aside that impulsive response. But years ago, how many people shook their screaming baby, not knowing the consequenses?

(I'm not saying everyone who's ever shaken a child is a saint otherwise, but I do beleive that some are innocent of malice)

12:36 PM  
Blogger Fat Doctor said...

I don't mind admitting that I've been tempted to shake my child until his neck snaps, but I don't. I put him in a safe place and walk away and curse my animal instincts.

4:26 PM  
Anonymous Anonymous said...

Having been engaged in shaken baby education since our son was shaken in 2000, the comments on your post reflect the reality I hear everytime I talk to parents, child care providers or students. As the social support system becomes more tenuous and we have less experience with children growing up than generations before, I think we are more prone to unrealistic expections. Having imagined the Gerber baby for nine months, I think many new parents are shocked by their response to the 'baby from hell' and the mind-numbness of the first year. Many parents tell us anecdotes about anger and frustration, then admit they've never told anyone else because the anger made them feel like they were bad parents. It's no coincidence that books about babies and sleep are among the perennial top 250 on Amazon.
Last year, two articles published in Pediatrics reported on bad news - good news.
Bad: UNC researchers found that 2.6% of parents self-report that a child under age 2 in their household was shaken (on a national scale, that's 52,000 shaking events a year). Good: a program developed by Mark Dias has been educating new parents in the Buffalo NY area about the danger of shaking young children for six years. In that time, the incidence of inflicted head injuries dropped by 47%. So education does make a difference. It's also much better to tell parents what to do, not just what not to do. It can be as simple as having a coping plan.
Changing the frame is critical. Ask a parent if they want to learn how to keep their child safe from shaking injuries. Or tell them they should never, ever shake their baby.
Want to guess which parent (or which nurse educator) wants to listen to you?
Just never assume that someone taking care of your child know the danger of shaking...
George Lithco
For more info, www.SkipperVigil.com or www.shakenbaby.com

12:43 AM  
Blogger neonataldoc said...

Thanks all. I agree, we probably all get very frustrated at times with a our crying babies. Smartblkwoman, what a sad story you describe. George, excellent comment about the value of education.

8:28 PM  
Anonymous Anonymous said...

I am the mother of a child who sufferes from SBS. While I do know that being a parent, a young parent is hard sometimes; I would never shake my child and not just because I now live with it every day but because no matter how upset and frustrated you become with your children your undying love for them keeps you from harming them.

I don't, won't and can't have more children because having a child with SBS is very hard work and I don't have time to have more children.

People who shake children are selfish and inhumane period..I have no respect for anyone that shakes a child, a mature and truly loving parent would put the baby down and just walk to another room until they cooled off. Clearly in this situation age and ignorance played a factor.

9:30 AM  

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