AAP Report on Shaken Baby Syndrome

The Committee on Child Abuse and Neglect of the American Academy of Pediatrics (AAP) has issued a technical report on rotational cranial injuries in shaken baby syndrome. This report is intended to assist physicians in identifying, evaluating, and treating victims of this form of child abuse. The AAP report appears in the July 2001 issue of Pediatrics.

According to the AAP, mortality rates of 15 to 38 percent and a high rate of morbidity are associated with shaken baby syndrome. Physicians should be especially alert to nonspecific signs associated with nonlethal episodes that are often missed or attributed to a variety of other causes (e.g., colic, viral illness). Ocular or cerebral injury may be mild, and extreme care should be taken during the assessment because milder signs of abuse may resolve with the true cause of injuries remaining undiagnosed.

The committee considers computed tomography (CT) to be the initial test of choice in suspected cases of shaken baby syndrome, with magnetic resonance imaging studies of adjunctive value, to be obtained two to three days following CT scan. Radiographs should be obtained as soon as possible to assess fractures, and in certain cases, should be repeated after two weeks to detect new fractures that may go undetected until they begin to heal.

The committee recommends that physicians become educated about all clinical aspects of shaken baby syndrome, report injuries, provide pertinent information to the proper agencies, support child abuse prevention programs, and provide referrals and resources to parents and caretakers as indicated.

Statement on Use of Infant Walkers

The Committee on Injury and Poison Prevention of the American Academy of Pediatrics (AAP) has issued a policy statement on injuries associated with the use of infant walkers and recommends a ban on their use. The statement appears in the September 2001 issue of Pediatrics.

Surveillance data from the U.S. Consumer Product Safety Commission (CPSC) indicate that 8,800 infants under 15 months of age were treated in emergency departments for injuries related to the use of infant walkers during 1999. Population-based surveys suggest that 10 times as many minor injuries may occur and be unreported (e.g., infants treated in physician offices or not requiring any medical attention).

According to the AAP statement, reported injuries associated with the use of infant walkers predominantly include head injuries, with at least 75 percent related to falls on stairs that result in the most severe injuries. Other injuries include pinch injuries to fingers and toes, burns, and poisonings—the latter two can be attributed to the increased mobility of the infant while in the walker. While more rare, fatalities from submersion and suffocation have been reported.

While many parents believe that walkers help their infants learn to walk earlier, data from one study demonstrated that infants who use walkers sat, crawled, and walked later than those who did not. According to the AAP, no documented benefit could be found to outweigh the risk of injury associated with walker use.

Some of the AAP recommendations are listed below.

• A ban on the manufacture and sale of mobile infant walkers is recommended.

• If parents insist on their infants using walkers, the walkers should meet the standards of the American Society for Testing and Materials (ASTM F977–96).

• Physicians should educate parents about the hazards of infant walkers, particularly in households with stairs.

• Hospitals and agencies that license childcare facilities should not permit the use of infant walkers.

• As an alternative to infant walkers, stationary activity centers may be suggested.

• The CPSC should monitor compliance of infant walker manufacturers and continue to collect surveillance data on walker-related injuries.