Hidden injury to
infants is deadliest
form of abuse

Shaking can damage a child
more than a three-story fall, a
child safety official says

By Lori Tighe
Star-Bulletin

Of all the injuries Reubyne Buentipo Jr. suffered, an invisible one hurt him the most.

Doctors said the 4-year-old was shaken so hard, it caused his brain to swell. That cut off blood circulation, which killed parts of his brain. It left Reubyne in a permanent vegetative state in a nursing home.

The injury is called "shaken baby syndrome."

The lack of bruises, broken bones or blood kept the injury hidden for years from doctors, who began diagnosing it just recently.

Many parents and professionals still don't know that shaking a child can be deadly, said Marilyn Sandberg, executive director of the national Child Abuse Prevention Center in Ogden, Utah.

"Whenever a case like this one (the Kimberly Pada trial) shakes a community, the public wants information on how this could happen," Sandberg said.

Hawaii experiences 12 to 15 cases of shaken baby syndrome a year, said Chuck Braden, executive director of PREVENT Child Abuse.

One-third of the children die, another third suffer permanent damage, and the final third recover completely. Most of the cases go through Kapiolani Medical Center.

"Shaken baby syndrome is a very clear-cut diagnosis. It's when the head rapidly accelerates and deaccelerates, shaking the brain like a bowl of Jell-O running into the sides of the bowl," Braden said.

Most of the kids who die from child abuse die from head injuries caused by shaken baby syndrome, said Dr. Cynthia Tinsley, an expert at Kapiolani and Reubyne's physician.

"It's much more severe than a fall," Tinsley said. "It ruptures blood vessels in the brain, the brain swells, cutting off blood supply and causing death, vegetative state, cerebral palsy and mental retardation."

The reason shaking can kill an infant or small child but not an adult lies with the head and neck, Braden said.

Young children have a large head compared to their body, with weak, undeveloped neck muscles. An infant's head makes up 25 percent of his body; an adult's head makes up 10 percent of his body.

The description of shaken baby syndrome presents no outward signs of injury, Tinsley said.

Symptoms include: sleepiness, limp muscle tone, difficulty breathing, extreme irritability, seizures, decreased appetite or vomiting, inability to lift head, and no smiling or vocalization. Sometimes the abuser leaves bruises on the child's shoulders or neck, and the child's forehead may bulge or become spongy from brain swelling.

Braden said parents in the past have tried to cover up the cause of the injury, saying the child fell off the couch, also known as the "killer couch syndrome."

"A baby can fall out of a three-story building and not have as much damage as from shaking," Sandberg said. "Even mild shaking can cause damage.

"A parent should never, ever, ever shake a baby or small child."

Parents shake children to make them stop crying, Braden said.

"New parents get taken aback at how much a baby's cry affects them," he said.

Parents should make sure a crying baby is fed, has a clean diaper and nothing like a diaper pin is hurting the baby, Braden said. Then parents can put the baby in a crib, walk away and take a break, checking in every 15 minutes.

If parents have any questions, they can call the Parent Line at 526-1222.