From the NSPCC'S Library and Information Service specialists
‘Whiplash-induced’ head injuries in infants were first described in the 1970s by American paediatric radiologist John Caffey. He used the term ‘whiplash shaken infant syndrome’ to describe this form of abuse and this led to shaking becoming recognised as a cause of brain injury in infants.1
While Caffey identified shaking as the main cause of brain injuries in the cases he studied, research has since concluded that forceful contact to a baby’s head also causes the injuries associated with ‘shaken baby syndrome’.2 So, while Caffey identified that the rapid movement of ‘shaking’ a baby can cause harm, the term ‘shaken baby syndrome’ itself doesn’t prompt professionals to think about other causes of injuries, such as hitting, slamming, striking, throwing and crushing.3,3
Why shouldn’t we use ‘shaken baby syndrome’?
Using the term ‘shaken’ to describe infants experiencing head injuries is misleading. It focuses on one action and limits professional thinking around the other potential causes of a head injury in an infant.
‘Shaken baby syndrome’ also has a negative reputation from its use in the media where it became sensationalised through cases that came into the public eye.4 On a practical level, this negative media representation and the stigmas around the term can make it difficult for parents to talk about the subject with professionals. The emotive words can also be distressing and distracting for professionals and overshadow effective conversation around ensuring parents understand how vulnerable new babies are.5
What is a more helpful way for professionals to talk to each other about the subject?
Babies do have accidents that can result in injury. However, it is important for professionals to be able to identify when these injuries are a result of deliberate actions.
When babies are injured due to be being hit, shaken or thrown, the term ‘non-accidental head injury (NAHI)’ more accurately reflects the nature of the abuse experienced. The NSPCC uses the term NAHI, however other services may use ‘abusive head trauma (AHT)’. Both are widely used terms amongst professionals.6 Using ‘non-accidental head injury’ instead of ‘shaken baby syndrome’ to describe an incident of deliberate head trauma can be useful for communication between professionals and agencies. It focuses on the impact to the child by making it clear that the injury wasn’t an accident and prompts professionals to think about the potential risks posed by the adults around the child.7
Working with parents
The Child Safeguarding Practice Review Panel (the Panel) identified in their national review Safeguarding children under 1 year old from non-accidental injury,8 that some parent and carers with additional struggles, such as experiencing poor mental health, can find it harder to manage their own emotions and behaviours around their infant crying. Professionals need to recognise that the struggles parents and carers have around coping with crying can be a trigger for behaviours that may result in non-accidental head injury.9
Working with parents on handling their baby safely and managing stressors is important. It can reduce the actions or behaviours that may result in deliberate head injury to their babies.10 However, non-accidental head injury can be a really tough subject to talk about and using terms like ‘shaken baby syndrome’ or ‘NAHI’ can alienate parents and carers. Stepping away from using labels and being able to use non-judgmental language can help parents and carers to think, and open up, about the challenges they are facing and the support they need.
It is helpful to frame conversations about NAHI with parents around recognising their triggers and equipping them with the tools to cope, rather than focusing on the potential harm they could cause their baby. If parents have the tools and support to manage stress they may feel less overwhelmed and can better care for their baby.
> Learn more about NAHI with our Preventing non-accidental head injury training
References
Lazoritz, S. and Baldwin, S. (1997) The whiplash shaken infant syndrome: has Caffey’s syndrome changed or have we changed his syndrome? Child Abuse & Neglect 12(10): 1009-1014.Lazoritz, S. and Baldwin, S. (1997) The whiplash shaken infant syndrome: has Caffey’s syndrome changed or have we changed his syndrome? Child Abuse & Neglect 12(10): 1009-1014.
Spencer Greeley, S. (2015) Abusive head trauma: a review of the evidence base. American Journal of Roentgenology (AJR), 204(5): online.
Dykes, L. (1986) The whiplash shaken infant syndrome: what has been learned? Child Abuse & Neglect, 10: 211-221.
Storr, W. (2017) ‘We believe you harmed your child’: the war over shaken baby convictions. [Accessed 14/09/2023].
Crown Prosecution Service (CPS) (2021) Non accidental head injury cases (NAHI, formerly referred to as shaken baby syndrome [SBS]) - prosecution approach. [Accessed 14/09/2023].
BMJ Best Practice (2023) Abusive head trauma in infants and young children. [Accessed 14/09/2023].
Cindy, W. et al. (2009) Abusive head trauma in infants and children. American Academy of Pediatrics, 123(5): 1409–1411.
Child Safeguarding Practice Review Panel (2021) The myth of invisible men: safeguarding children under 1 from non-accidental injury caused by male carers. [Accessed 14/09/2023].
Barr, R.G. (2012) Preventing abusive head trauma resulting from a failure of normal interaction between infants and their caregivers. Proc Natl Acad Sci USA, 109(2): 17294–17301.
Barr, R.G. (2012) Preventing abusive head trauma resulting from a failure of normal interaction between infants and their caregivers. Proc Natl Acad Sci USA, 109(2): 17294–17301.