Forensic Nurse Helps to Detect Child Abuse


Child abuse is often under reported and a tragic event. More and more you hear on the news of a case of child abuse that is horrible, and these are just the ones that are caught and prosecuted. Fortunately not all cases of child abuse end up as tragic as this one where the child will be on a ventilator for the rest of his life with no hope of a normal life. Fortunately in this case, shaken baby syndrome was included in the physician’s differential diagnosis, and was treated as such from the beginning, and led to the conviction of the mother’s boyfriend. Violently shaking a baby just once can cause profound effects on the child for the rest of their life.

Original post:
Saturday, August 20, 2005

Forensic Nurse helps to Detect Child Abuse
Until you have witnessed a shaken baby syndrome case, either on a personal level or professional level, you cannot appreciate the devastating effects of these cases.

A 28-day-old baby was rushed to the ER with a sudden change in mental status. Mom’s boyfriend had been babysitting while mom was at work. When mom got home, her boyfriend claimed that the baby had been sleeping a lot and wasn’t acting right. Mom was unable to arouse the baby, this she brought the baby to the ER.

Upon presentation to the ER, the physician and the nurse rushed the baby to the trauma room. They realized the severity of the baby’s symptoms. The baby was lethargic and limp. His respirations were shallow, but present. The baby was intubated and stabilized medically, then prepared for transfer to NICU. The physician in charge included shaken baby syndrome in his differential. The mom and boyfriend were not allowed to be alone with the child pending further investigation.

Apparently, the mother’s boyfriend violently shook the baby when he wouldn’t quit crying. Shortly after the shaking incident, mom came home to discover that the baby wasn’t acting right.

Nearly five years later, this case went to court. The mother’s boyfriend was found guilty of first-degree murder status post shaken baby syndrome. The child lives in foster care. He will live on a ventilator for the rest of his life.

Shaking a child or a newborn can cause life-threatening injuries. The injuries are mostly internal. Head trauma is the most common. With an infant, shaking will cause the head to wobble around. The backwards and forwards movement of the brain within the casing of the cranium causes swelling, increased intracranial pressure and retinal hemorrhages. The first symptom that is seen is a change in level of consciousness. This symptom is worrisome to a parent and prompts treatment. Typically, there are not any marks on the body. If marks are discovered, usually fingerprints of the suspect will be seen on the arms or trunk. It is always best to consider child abuse and be cautious until proven otherwise. Time is of the essence for these cases.

As a forensic nurse, what would be the first symptom presenting that may alert you to Child Abuse in the form of Shaken Baby Syndrome?


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