1. Rodts, Mary Faut

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Figure. Mary Faut Ro... - Click to enlarge in new windowFigure.

Violence toward children is all around us. In the recent months, numerous examples of the horror that befriends some children on a daily basis have been seen on television and across the front pages of our newspapers: from a child being found stuffed in a trunk to a toddler found chained at the neck to his bed because he left the refrigerator door open to children who are enslaved and required to participate in activities that no child should be exposed to and to a child abandoned in a department store. Strangers did not carry out all of these actions out. These actions were perpetrated by family members or a perceived trusted individual against small children who were just being children.


Nonaccidental injuries to children are a problem here and around the world. Shaken baby syndrome is one manifestation of this crime against children. In Smith's article, Shaken Baby Syndrome, she describes this particular scenario of violence to the smallest members of our society. What is the nurse's role in trying to identify a potential problem?


A recent Canadian national study consisting of a retrospective chart review in 11 tertiary care hospitals, King et al. found that during a 10-year period, 364 children were shaken babies, 19% (69) of whom died from this ordeal. Of those children who survived, 55% (162) had neurologic injuries and 65% (192) had visual impairment. Only 65 (22%) of the 364 children who survived had no signs of continuing problems.


According to Dr. Lionel Dibden, Medical Director of Capital Health's Child and Adolescent Protection Program in Canada in response to this study, there is uncertainty whether the incidence of shaken baby syndrome has increased or if the diagnosis is being made because those at risk are beginning to be identified. He goes on to say that infants of stressed caregivers who have few resources are at greatest risk, but Dibden stresses that shaken baby syndrome can be found in all socioeconomic and ethnic populations. "Any of us is potentially at risk of shaking a baby." In Edmonton, a campaign has been started to educate women in prenatal classes, in the hospital after delivery, and during postpartum visits about shaken baby syndrome and strategies to avoid this situation.


There are those among us, such as emergency room nurses and pediatric intensive care nurses, who have obvious vantage points to recognize potential problems. However, many of us may also have a good view. School nurses, nurses in both pediatric and orthopaedic practices, and home care nurses may also be able to identify either children who are at risk or the subject of abuse.


On the other hand, some of these children were so hidden from society that they were never known to exist, not even by next-door neighbors.


As a nurse, parent, neighbor, friend and even stranger, it is our responsibility to ask the question: Is the child next door safe? In most case, there is no question that our children are safe. However, when situations present the telltale signs of child abuse, further investigation must be sought so that the tiniest person among us is protected.




King, W. J., MacKay, M., Sirnick, A. The Canadian Shaken Baby Study Group. (2003). Shaken baby syndrome in Canada: Clinical characteristics and outcomes of hospital cases. Canadian Medical Association Journal, 168( 2), 155-159.