Never shake a baby.  Should be obvious, right?  I could have titled this post "non-accidental trauma", the new politically correct term for child abuse.  But I didn't think it would get your attention in quite the same way.  This post has been brewing since I was on the general pediatrics service a couple months ago, but it became necessary when I met one of my PICU patients.

Here's quick run down of the patients I have seen who were getting the non-accidental trauma workup...
1. 6 month old girl with fractured femur
2. 6 month old girl with fractured femur (yes, a second one)
3. 3 year old boy with fractured humerus
4. 6 year old boy with bloody nose
5. 3 month old boy with rib fractures, seizures, brain hemorrhages, and blindness.

Of these 5 kids, one was ruled accidental (#1), one was ruled unlikely to happen again (#4), and the other three children were taken from their parents and put in DSS custody.  The worst case of all is the last, a 3 month old infant boy, totally normal and adorable and innocent.  The story from his parents is that he was sitting on the couch, and then rolled off.  Then they noticed he seemed to not be looking at them, and was shaking a bit.  Rolled off the couch.  Seriously.

First of all, three month olds can't roll.  Secondly, when the prodigious ones DO roll at three months, and they roll off the couch, they generally don't break ribs on BOTH sides of their chest.  This child came to the ED in status epilepticus (having constant seizures), with epidural hemorrhages, subdural hemorrhages, subarachnoid bleeding, retinal hemorrhages, and diffuse axonal injury to his brain.  Yes, that is all as bad as it sounds.  When I met him, the little guy was in a drug induced coma because it was the only way to stop him from seizing.  Even with three other medications, he continued to have abnormal brain activity.  When we decided that he was not going to stop seizing, we took him out of the coma to see what he would do.  He opens his eyes occasionally, although much of that is blinking rapidly, likely seizures.  He responds to pain, but nothing else.  He doesn't look at anyone, doesn't respond to his surroundings.  He is blind.  He can breath on his own, which I almost wish wasn't the case.  He has no hope of any rewarding life.  He is incapable of enjoying any pleasures of life.  He will not ever be a boy scout or go to school or see the sunrise or eat a popsicle or learn to tie his shoes.  He won't walk.  He won't talk.  He won't swallow. 

Last week, we took him off the ventilator to see if he would breath on his own.  Our hope was that the parents would agree to let him go if he didn't.  While they don't have custody of him, they maintain parental rights, which means they have the ultimate decision in withdrawing or withholding care.  They wanted him reintubated if he could not breath.  We haven't even addressed tube feeding or tracheostomy or who will care for him.  Taking care of a baby 24/7 doesn't seem like that big a task.  But taking care of a 17 year old with all the needs of an infant is an unimaginably difficult task. 

I imagine the mother will not withhold any care.  I don't know if that comes from guilt that she didn't keep this from happening (the father is suspected of being the abuser), or from fear that they will be charged with murder when he dies, or if they don't understand the severity of his condition.  Either way, I imagine he will live... if you can call it that.

The worst part of this, of all the non-accidental trauma cases, is that they are 100% totally preventable.  Abuse is never justified, never deserved, and never excusable.  Abuse of anyone, let along a child, is inexcusable.  If you know someone who is being abused, who is abusing, or who you think needs help, please go to one of the links below for help, or call your local police to report it.  No more children need to die at the hands of the adults that are supposed to love them.

Child Help
State Child Abuse Hotlines