The most common trigger for shaking a baby is a baby's crying. Shaken baby injuries often occur when a parent or caregiver gets frustrated, angry or upset because they are unable to console their crying baby and they temporarily lose control and violently shake the baby.

You will find useful resources and strategies below to support you when your baby's crying causes feelings of frustration or overwhelm you.

What is shaken baby syndrome?

Shaken baby syndrome (SBS) is the name given to the assortment of signs and symptoms of brain injury resulting from violently shaking an infant, with or without impact to the head. SBS is also known as Traumatic Head Injury due to Child Maltreatment (THI-CM) in Canada & Abusive Head Trauma (AHT) in the USA.

Why is shaking a baby so dangerous?

Shaking a baby is dangerous because they have fragile, under-developed brains. Their heads are heavy and large compared to the rest of the body and their neck muscles are not strong enough to support the weight of their head. During shaking, an infant's head moves back and forth in a figure eight motion. This rapid acceleration-deceleration causes the brain and skull to move at different speeds in different locations. This may result in permanent brain damage, physical disabilities or death. Even minor injuries to a baby's brain can cause lifelong problems.

It is never okay to shake a baby or child. Approximately 25 percent of babies who are shaken die and as many as 80 percent have permanent brain damage.

Shaking injuries do not occur during regular interactions. For example, gently bouncing an infant on your knee, sudden stops in a car, or going over bumps in a stroller does not cause SBS.

What damage can shaking a baby cause?

Shaking a baby can cause:

• Seizures
• Permanent brain damage
• Speech and learning difficulties
• Blindness and deafness
• Paralysis
• Behaviour problems
• Death

How can I protect my baby from SBS?

If your baby's crying is frustrating or making you angry, take a break. Gently place your baby in a safe place, such as the crib, and leave the room. Take 10 to 15 minutes to give yourself a chance to calm down. It is more important to calm yourself before you try to calm your baby. If you feel unable to cope, call someone for help once you have put your baby in a safe place or call Healthlink BC at 8-1-1. Never pick up a baby when you are angry or overwhelmed by the crying.

Talk to others who care for your baby such as babysitters, relatives and friends about how to safely care for your baby. Make sure they understand that it is more important for the caregiver to be calm than to stop your baby from crying. Let them know that you will be happy to come and get the baby if the crying is too much for them. Do not leave your baby in the care of someone who has problems controlling their anger. Use great caution when letting inexperienced caregivers or those with any resentment towards the baby look after the baby, even for a short time.

Why do babies cry?

All babies cry - sometimes it is easy to figure out why a baby is crying; sometimes it is not so easy. Developmentally, it is normal for babies to cry more and for longer periods of time starting at about 2 weeks of age and continuing until about 3 to 4 months. This period of crying is referred to as the Period of PURPLE Crying^®. Some babies are more resistant to soothing and can cry for hours but are still healthy. For more information visit www.dontshake.ca and www.dontshake.ca/purple.

Not being able to soothe your baby or stop their crying does not mean that you are a bad parent. Crying is an annoying sound; it is supposed to be. If it were a pleasant sound, crying would be easy to ignore, and the baby's needs would not be met. Listening to your baby cry can be heart-wrenching. Remember that a period of more intense crying in the early months is a normal developmental stage that most babies go through.

If your baby's crying is constant or louder than usual, or your baby is feeding poorly, has difficulty breathing, a fever or is vomiting, or you have concerns that something is wrong, call your doctor or 8-1-1, or take your baby to the hospital or health clinic.

The most important thing to remember is that you and your baby will get through this increased crying stage and more smiles and laughter will come.

What can you do when your baby won't stop crying?

There is no magic answer that works all the time with every baby. You may find that what works today may not work tomorrow. Sometimes nothing you do will stop the crying and that doesn't mean you're doing something wrong as a parent.

Here are some suggestions that may help comfort your baby:

• Snuggle your baby close to your chest; your heartbeat may comfort your baby, skin-to-skin contact is favourable
• Follow your baby's cues for hunger such as bringing their hands to their mouth, rooting or moving their head, opening their mouth, licking their lips and sucking their hand. For the first few months of life, babies usually feed at least every 2 to 3 hours. Your baby may want to feed more frequently during growth spurts. Burp your baby after feeding
• Check your baby's diaper. Keep your baby clean and dry
• Wrap your baby in a soft blanket
  • Keep your baby warm and comfortable – but not too hot
  • Do not put your baby in a crib or bassinette when wrapped in a blanket. For a safe sleeping resource for parents and caregivers see Safer sleep for my baby
• Provide some soft music or other relaxing sounds
  • Try humming or singing a lullaby
  • Sometimes white noise such as the sound of the vacuum cleaner, clothes dryer, fish tank filter or dishwasher helps calm a baby. White noise apps can also be found on a smart phone
• Offer a favourite blanket or soft toy while cuddling the baby
• Provide gentle motion or change your baby's position
  • Walk with or rock your baby. You may want to put your baby in an infant carrier if you have one and walk around the house
  • Try an age-appropriate baby swing, rocker or bouncer if you have one
  • Take your baby for a walk outside in an infant carrier or stroller
  • Some babies like to go for a car ride. Be sure your baby is safely secured in an infant car seat

Sometimes these suggestions work and sometimes they don't. It is worth trying these suggestions but try not to blame yourself or get frustrated with your baby if they do not work. Remember that the Period of PURPLE Crying® is a normal stage that will come to an end.

What else can you do if comforting your baby doesn't stop them from crying?

If it's too frustrating, it is OK to walk away. Put your baby in a safe place, likea crib, and take a few minutes to calm yourself. Relax by doing self-comforting activities such as reading, having a cup of tea, or taking a shower, then go back and check on your baby.

Find someone to help you. Call a friend or relative you can trust. It is important to distance yourself from your baby if you think you might lose control. It is just as important to be sure that your baby will be safe while you are gone. Remember that it's okay to ask for help. Remind caregivers that crying is normal. The following people may be able to help:

• Family and friends
• Parent groups
• Your child's health care provider
• Your public health nurse

You can also call 8-1-1 to speak with a registered nurse 24 hours a day, 7 days a week or you can call your local hospital or health clinic for other contacts in your community.

Remember – NEVER shake a baby!

Put your baby in a safe place and take a break.

For more information

For more information on ways to comfort your baby, review the Period of PURPLE Crying® program materials that you received at the hospital. For mothers that did not give birth at a hospital in British Columbia, you can receive the mobile app/booklet package from your public health centre or nurse. To find your local public health authority unit use www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/partners/health-authorities/regional-health-authorities.

For more tips and resources online, visit www.dontshake.ca or the Period of PURPLE Crying® at www.dontshake.ca/purple.