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  • Information about the current Coronavirus (COVID-19) outbreak has been moved to a new, separate area. Information provided by DCDEE related to COVID-19 and child care providers, settings and health precautions can now be found on the Coronavirus Information for Child Care page.



Be On The Safe Side: Prevention of Shaken Baby Syndrome

In September 2016 the Child Care Commission adopted rules in response to federal child care requirement changes, outlined in the Child Care Development Block Grant. One of the rules was in regard to the prevention of Shaken Baby Syndrome and Abusive Head Trauma.

North Carolina Child Care Rules 10A NCAC 09 .0608 (center) and .1726 (FCCH) require that all facilities that serve children up to five years of age must develop and adopt policies to prevent shaken baby syndrome and abusive head trauma. The rule outlines six areas that must be addressed in each facility's policy, requirements for adopting and sharing the policy with staff and families, as well as what to do if changes to the policy are made.

So you may be wondering, what is Shaken Baby Syndrome (SBS) and Abusive Head Trauma (AHT)? DCDEE has chosen to use this terminology in its rule-making, but you may also hear other names such as "inflicted traumatic brain injury" and "shaken impact syndrome". Regardless of which name you hear, all the phrases mean one thing, a brain injury that is a result of child abuse.

DCDEE has adopted the North Carolina Child Care Health and Safety Resource Center definition of Shaken Baby Syndrome (SBS) and Abusive Head Trauma (AHT). SBS or AHT is the name given to a form of physical child abuse that occurs when an infant or small child is violently shaken and/or there is trauma to the head. Shaking may only last a few seconds, but it can result in severe injury or even death.


While the average age of SBS/AHT victims is between three and eight months old, and the highest rate of cases occur in infants six to eight weeks old, trauma can happen to any child up to five years of age. In addition, this type of injury does not have to occur over a period of time, it can be inflicted from one single incident.

According to the National Center on Shaken Baby Syndrome, SBS is the leading cause of physical child abuse deaths in the US. More than eighty percent of surviving victims of SBS/AHT suffer lifelong disabilities.

So, let's take a closer look at why SBS happens? Shaking any age child can cause an injury, but the brains of children under the age of five are still rapidly developing; therefore, they are more susceptible to injury and sadly, death. These young children have underdeveloped brains and weak neck muscles. Their heads are often heavier, in proportion, than their bodies, which increases their risk for injury. In many SBS/AHT cases, a caregiver is frustrated because they cannot get a baby to stop crying, so they shake them.

There is a big difference between violently shaking a child and playing with a child. Simply bouncing a child on your knee, or a child falling out of a chair, are not causes of SBS/AHT. Caregivers should always be aware, and they should never, under any circumstance, shake a young child.

It is important to educate yourself on ways to prevent SBS/AHT, to be aware of signs of SBS/AHT, and to be able to respond to and report suspected instances of SBS/AHT. Some of the signs of AHT include but are not limited to: irritability, high pitched crying, difficulty breathing and/or staying awake, lethargy or loss of concentration, inability to lift head, vomiting, bruising, an absence of smiling or vocalization, inability of the eyes to track, poor feeding/sucking, and/or decreased muscle tone. As you research and prepare to draft your "Prevention of Shaken Baby Syndrome and Abusive Head Trauma Policy" please take a moment to review the following websites. If you have additional questions, please contact your child care consultant.

There is a lot to learn about Shaken Baby Syndrome and Abusive Head Trauma. Please take time to educate yourself, your staff, and your families. Together we can ensure the health and safety of children.




2201 Mail Service Center | Raleigh, NC 27699-2200
919-814-6300 | 1-800-859-0829 (In State Only)
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