Traumatic Head Injury – Child Maltreatment (THI-CM) (formally Shaken Baby Syndrome (SBS)) can result from blunt force impact, compression or crushing force, penetrating force and/or inertial forces, such as those that occur with shaking or whiplash. It is broadly defined as injury to the head (skull and/or brain and/or intracranial structures, which may also be accompanied by injury to the face, scalp, eye, neck or spine. Traumatic Head Injury due to Child Maltreatment [THI-CM) is believed to reflect the current language used by health professionals and separates the diagnosis and opinion of child injury (PHAC,2020]. According to the Joint Statement on Traumatic Head Injury due to Child Maltreatment it is recommended that THI-CM replaces Shaken Baby Syndrome.
For more information visit the Joint Statement on Traumatic Head Injury due to Child Maltreatment (THI-CM): An update to the Joint Statement on Shaken Baby Syndrome.
AHS Provincial Injury Prevention (PIP) will continue to use both THI-CM and SBS as SBS is the more commonly known term. (PHAC, 2020)
- THI-CM is relatively uncommon in Canada and is present in a small proportion of cases of child maltreatment. However, it accounts for significant morbidity and mortality.
- The recognition of THI-CM is often challenging. These cases are frequently not recognized or are misdiagnosed as conditions other than head injury. Statistics on the frequency of THI-CM likely underestimate the scope of the problem.
- THI-CM is most commonly diagnosed in infants less than 1 year of age, but can also be seen in older children” (PHAC, 2020)
- The determination of and use of the term, THI-CM, as a final opinion in an individual case should be made based on consideration of the combined information from the medical, child welfare and/or legal sectors.
There are rarely any signs of external head trauma but children could display outward signs of TBI. Even a few seconds of shaking can cause permanent brain damage or death. The Injuries to the head, eye, neck can occur due to TBI-CM. Severe outcomes can include long-term disability or death.
Research suggests that most child TBI-CM cases result when a parent or caregiver is unable to cope with persistent infant crying. AHS Provincial Injury Prevention takes an approach that focuses on addressing infant crying.
Key Messages
- All babies cry. A baby may cry because they’re hungry, thirsty, needs a diaper change, needs to be cuddled, doesn’t feel well, or is sleepy. Advise parents/caregivers that a more intense crying period typically begins to increase around 2 weeks, peaks around 2 months of age, and then gradually decreases around 3 to 4 months. However, peak times may differ between one infant and another. Encourage parents/caregivers to complete a Crying Plan.
- Stay calm. Advise parents/caregivers that it is more important to stay calm than to stop the crying. If your client is feeling angry or frustrated because their baby cannot stop crying, advise them to put their baby in a safe place (like a crib) and let their baby cry for a few minutes. This is not harmful. When your client is feeling calmer, they can try to soothe their baby.
- Take a break, don't shake. Advise parents/caregivers to NEVER SHAKE A BABY. Even a few seconds of shaking can cause a baby permanent brain damage or death. Encourage parents/caregivers to think about what they will do if the crying gets to be too much, such as listening to music, going for a walk with their baby, or calling a friend or neighbor for help. Encourage parents/caregivers to utilize their Crying Plan.
- It's OK to ask for help. Remind parents/caregivers they can call Health Link to get advice from a registered nurse.
Additional Resources
Provider Resources
- Joint Statement on Traumatic Head Injury due to Child Maltreatment (THI-CM): An update to the Joint Statement on Shaken Baby Syndrome (downloadable format)
