2019 Conference

Children mildbraininjuries.pdf

Mild brain injuries (concussions) are physical injuries to the brain. They are common in childhood and may be the result of a fall or a blow to the head. A mild brain injury might also happen if the head hits an object, like in a car or bicycle accident. There may be a brief loss of consciousness (your child passes out) or  a dazed/confused feeling.

Bicycle Safety  PDF file: 2002 Fact sheet bike safety

Fact and safety advice about bicycles and brain injury


Scooter Safety PDF file: 2002.Fact.Sheet.scooter.pdf

Prevention and statistical information about scooters


Sports and Recreation PDF file: 2002 fact sheet – sports and recreation

Safety information on boxing, soccer, football, skiing, baseball, skating and horseback riding


Youth Violence school.violence.pdf

Incidence and prevention information on youth and  violence


Shaken Baby  PDF file: 2002 fact sheet sbs

What is Shaken Baby Syndrome?

Shaken Baby Syndrome is caused by vigorous shaking of an infant or young child by the arms, legs, chest or shoulders. Forceful shaking can result in brain damage leading to mental retardation, speech and learning disabilities, paralysis, seizures, hearing loss and even death.

When a baby is vigorously shaken, the head moves back and forth. This sudden whiplash motion can cause bleeding inside the head and increased pressure on the brain, causing the brain to pull apart and resulting in injury to the baby. This is known as Shaken Baby Syndrome, and is one of the leading forms of fatal child abuse. A baby's head and neck are susceptible to head trauma because his or her muscles are not fully developed and the brain tissue is exceptionally fragile. Head trauma is the leading cause of disability among abused infants and children.

Shaken Baby Syndrome occurs most frequently in infants younger than six months old, yet can occur up to the age of three. Often there are no obvious outward signs if inside injury, particularly in the head or behind the eyes. In reality, shaking a baby, if only for a few seconds, can injure the baby for life. These injuries can include brain swelling and damage; cerebral palsy; mental retardation; developmental delays; blindness; hearing loss; paralysis and death. When a child is shaken in anger and frustration, the force is multiplied five or 10 times than it would be if the child had simply tripped and fallen.

Scope of the Problem

An estimated 50,000 cases occur each year in the United States.

One shaken baby in four dies as a result of this abuse.

Head trauma is the most frequent cause of permanent damage or death among abused infants and children, and shaking accounts for a significant number of those cases.

The sudden shaking motion causes the baby's fragile brain to slam against the skull wall often resulting in cerebral hemorrhage, contusion and edema, bleeding within the brain or tears in brain tissue. The potential outcome is generally severe brain damage or death.

Approximately 75 to 90 percent of the cases have retinal hemorrhages - a symptom almost never seen with accidental head injuries.

A baby's brain, along with the blood vessels connecting the skull to the brain, are fragile and underdeveloped. Therefore, when a baby is shaken, the brain ricochets about the skull, causing the blood vessels to tear away and blood to pool inside the skull.

 Who, What, When & Why

Often frustrated parents or other persons responsible for a child's care feel that shaking a baby is a harmless way to make a child stop crying. The number one reason a baby is shaken is because of inconsolable crying. Almost 25 percent of all babies with Shaken Baby Syndrome die. It is estimated that 25-50 percent of parents and caretakers aren't aware of the effects of shaking a baby.

Males tend to predominate as perpetrators. They are involved in 65 to 90 percent of the shaken baby cases.

Females who injure babies by shaking them are more likely to be baby-sitters or child care providers.

Shaken baby syndrome can have disastrous consequences for the family, the victim and society. If the child survives, medical bills can be enormous. The victim may require lifelong medical care for brain injuries such as mental retardation or cerebral palsy. The child may even require institutionalization or other types of long term care.

The number one reason a baby is shaken is because of inconsolable crying.

More than 60 percent of victims of Shaken Baby Syndrome are male.

What can you do to prevent a tragedy?
If you or someone else shakes a baby, either accidentally or on purpose, call 911 or take the child to the emergency room immediately. Bleeding in side the brain can be treated. Immediate medical attention will save your baby many future problems . . . and possible the baby's life.

Other Suggestions for Parents

Never throw or shake a baby

Always provide support for the baby's head and neck

Place the baby in a crib, leave the room for a few minutes

Sit down, close your eyes and count to 20

Take the baby for a stroller ride

Play music, or sing to the baby

Ask a friend to "take over" for a while

Don't pick the baby up until you feel calm

Make sure the baby is fed, burped and dry

Gently rock or walk the baby

Check for discomfort  of diaper rash, teething or fever

Call the doctor if you think the baby is sick

Make sure clothing is not too tight

Give the baby a pacifier

Offer a noisy toy or rattle

Hug and cuddle the baby gently


Can SBS Be Prevented?
It is 100% preventable.

A key aspect of prevention of the syndrome is increasing awareness of the potential dangers of shaking. Some hospital-based programs have helped new parents identify and prevent shaking injuries and understand how to respond when infants cry.

Finding ways to alleviate the parent or caregiver's stress at the critical moments when a baby is crying can significantly reduce the risk to the child. One method that may help is author Dr. Harvey Karp's "five S's":

·        Shushing (using "white noise," or rhythmic sounds that mimic the constant whir of noise in the womb, with things like vacuum cleaners, hair dryers, clothes dryers, a running tub, or a white noise CD)

·        Side/stomach positioning (placing the baby on the left side - to help digestion - or on the belly while holding him or her, then putting the sleeping baby in the crib or bassinet on his or her back)

·        Sucking (letting the baby breastfeed or bottle-feed, or giving the baby a pacifier or finger to suck on)

·        Swaddling (wrapping the baby up snugly in a blanket to help him or her feel more secure)

·        Swinging gently (rocking in a chair, using an infant swing, or taking a car ride to help duplicate the constant motion the baby felt in the womb)

If a baby in your care won't stop crying, you an also try the following:

·        Make sure the baby's basic needs are met (for example, he or she isn't hungry and doesn't need to be changed).

·        Check for signs of illness, like fever or swollen gums.

·        Rock or walk with the baby.

·        Sing or talk to the baby.

·        Offer the baby a pacifier or a noisy toy.

·        Take the baby for a ride in a stroller or strapped into a child safety seat in the car.

·        Hold the baby close against your body and breathe calmly and slowly.

·        Call a friend or relative for support or to take care of the baby while you take a break.

·        If nothing else works, put the baby on his or her back in the crib, close the door, and check on the baby in 10 minutes.

·        Call your child's doctor if nothing seems to be helping your infant, in case there is a medical reason for the fussiness.

To prevent potential SBS, parents and caregivers of infants need help with responding to their own stress. It's important to talk to anyone caring for your baby about the dangers of shaking and how it can be prevented.

Prevention of Shaken Baby Syndrome

If you are afraid you might hurt your child, follow these three simple steps:

Stop: Put the child in a safe place and leave the room for a few minutes.

Calm Down: Call a friend or a neighbor, take ten deep breaths, than take ten more, do something for yourself, change your activity, or sit down, close your eyes, think of a pleasant place in your memory.

Try Again: Go back to your child and try again to deal with the problems at hand.


In any SBS case, the duration and force of the shaking, the number of episodes, and whether impact is involved all affect the severity of the infant's injuries. In the most violent cases, children may arrive at the emergency room unconscious, suffering seizures, or in shock. But, in many cases, infants may never be brought to medical attention if they don't exhibit such severe symptoms.

In less severe cases, a baby who has been shaken may experience:

·        Extreme irritability

·        Decreased appetite or feeding problems

·        Poor sucking or swallowing

·        Vomiting

·        Lethargy/poor muscle tone

·        Inability to follow movements

·        No smiling or vocalization

·        Rigidity

·        Seizures/convulsions

·        Difficulty breathing

·        Comatose

Even in milder cases, in which babies looks normal immediately after the shaking, they may eventually develop one or more of these problems. Sometimes the first sign of a problem isn't noticed until the child enters the school system and exhibits behavioral problems or learning difficulties. But by that time, it's more difficult to link these problems to a shaking incident from several years before.


Many cases of SBS are brought in for medical care as "silent injuries." In other words, parents or caregivers don't often provide a history that the child has had abusive head trauma or a shaking injury, so doctors don't know to look for subtle or physical signs. This "silent epidemic" can result in children having injuries that aren't identified in the medical system.

And again, in many cases, babies who don't have severe symptoms may never be brought to a doctor.

Unfortunately, unless a doctor has reason to suspect SBS, mild cases (in which the infant seems lethargic, fussy, or perhaps isn't feeding well) are often misdiagnosed as a viral illness or colic. Without a diagnosis of shaken baby syndrome and any resulting intervention with the parents or caregivers, these children may be shaken again, worsening any brain injury or damage.

If shaken baby syndrome is suspected, doctors may look for:

·        Retinal hemorrhage (usually bilateral)

·        Subdural hemorrhage

·        Cerebral edema (brain swelling)

·        Subarachnoid hemorrhage

·        Rib fractures

·        Long bone fractures

·        Grasp bruises around ribs, neck, or head

·        Cerebral infarction


·        Partial or total blindness

·        Developmental delays

·        Seizures

·        Cerebral palsy

·        Paralysis

·        Impaired intellect

·        Hearing loss

·        Speech difficulties

·        Learning difficulties

The Child's Development and Education
What makes SBS so devastating is that it usually involves a total brain injury. Because the infant's immature brain has little stored information and few developed capacities to make up for the deficit, the brain's adaptive abilities are substantially impaired. For example, a child whose vision is severely impaired won't be able to learn through observation, which decreases the child's overall ability to learn.

The development of language, vision, balance, and motor coordination, all of which occur to varying degrees after birth, are particularly likely to be affected in any child who has SBS.

Such impairment can require rigorous physical and occupational therapy to help the child acquire skills that would have developed on their own had the brain injury not occurred. Therapists do this by providing a sensory-rich environment, which forces the child to be attentive.

Therapists often work one on one with a child, concentrating on building the child's ability to pay attention. They use sound and other stimuli to increase the child's interest in objects, such as repeatedly squeaking a toy near the child's ear. As they get older, kids who were shaken as babies may require special education and continued therapy to help with language development and daily living skills, such as dressing themselves.

Before age 3, a child can receive speech or physical therapy through the Department of Public Health. Federal law requires that each state provide these services for children who have developmental disabilities as a result of being shaken as babies.

Some schools are also increasingly providing information and developmental assessments for children under the age of 3. Parents can turn to a variety of rehabilitation and other therapists for early intervention services for children after abusive head trauma. Developmental assessments can assist in improving education outcomes as well as the overall well being of the child.

After a child who's been diagnosed with SBS turns 3, it's your school district's responsibility to provide additional special educational services.

Effects of TBI on Students


What areas may be affected? What might that look like? What may help?


Complaints of difficulty seeing words, either on the board or on paper

Inability to stay on the line when writing or when reading (this may not be a vision problem)

Sensitivity to bright or fluorescent lighting

Hand-held magnifiers

Preferential seating

Reproduction of written material – enlarged &/or bold print

Paper with heavy lines

Colored acetate sheets over textbook pages

CCTV with magnification abilities

Lighting alterations (bright vs. dim; fluorescent vs. incandescent)

Hearing Off-task behavior

Difficulty following directions

Lack of response to requests for attention

Preferential seating – close to teacher, outside row with hearing impaired ear toward wall, away from sources of noise (hallway, air conditioner

Teacher’s notes/outlines for student to follow &/or a copy of another student’s notes to compare with own

FM amplification system

Speech Inaccurate articulation (slurred, strained, "garbled") Speech therapy

Augmented/alternative communication

picture book with snapshots of objects & people

one-message recording device (e.g., Yak-Back)

slate and stylus

electronic communication device (e.g., MessageMate, Chatbox, AlphaTalker, Dubby, DynaMyte)

Balance Inability to balance body in chair

Bumping into walls when ambulating

Falling with unusual frequency

Adaptive Physical Education

Physical Therapy

Occupational Therapy

Support for walking (e.g., handrails, cane)

Muscle tone Difficulty sitting in upright position

Uncontrolled drooling

Very rigid or very loose muscles

Inability to place head/hands/arms/legs with intent

Adaptive Physical Education

Physical Therapy

Occupational Therapy

Speech Therapy

Positioning Chairs

Headaches Verbal complaints of headache

Inability to complete cognitively demanding tasks



Adherence to medication schedules

Part-time attendance &/or frequent breaks (scheduled or requested)

Fatigue Appearance of being sleepy

Deterioration of quality of work throughout the day, or even by the end of an assignment

Consultation with parents regarding physician’s reports & medication schedules

part-time attendance and/or frequent breaks (scheduled or requested)


What areas may be affected? What might that look like? What may help?
Attention or concentration Off-task behavior

Distraction caused by neighbor, extraneous noises and/or activity that can be seen through windows and doors

Signal between student and teacher/peer helper to bring the individual back to the task at hand

Seating away from sources of distraction

Shortened assignments

Memory Difficulty following directions Frequent breaking of rules

Forgetting to complete or turn in assignments

Denial of bad behavior while being punished

Inability to recall former actions

Peer companion to aid student to stay within rules and boundaries

Structured environment with consistent expectations

Simplified planners

Visual schedules

New learning Inability to recall information at a later time, even if the student appeared to master the material at the time of instruction Frequent review of materials, even after initial mastery

Cueing system (e.g., cards, notes, mnemonic devices, or peer cueing)

Errorless learning (high rates of success)

Immediate, non-judgmental, corrective feedback

Well-organized presentation of material

Learning rate Inconsistent speed of learning – one concept may require only a few repetitions, while another takes many repetitions Repetition of material provided as needed
Initiation Difficulty beginning work assignments

No initiation of interactions with peers

Lack of motivation

Passive approach to most or all expected activities

Watch/timer alarm to cue student to initiate

Use a script for student – "What should I be doing now?"

Organization Writing assignments that "wander"

Inability to adjust to any changes in schedules, school activities, lessons, etc.

Activity/daily planner

Consistent schedule

Visual organizers, outlines, and note cards to organize writing assignment.

Sequencing Difficulty putting items in order

Does not complete work assignments in a logical order

Adaptive physical therapy

Occupational therapy

Speech therapy

Checklists/picture schedules for multi-step tasks

Involvement of the whole body in activities

Generalization Difficulty transferring skills learned in resource room or therapy to general classroom functioning Written or pictorial step-by-step directions

Instruction provided in natural/multiple settings

Planning Difficulty planning for play and work activities

Begins activities in haphazard fashion

Activity/daily planner with routine for scheduling day

Consistent schedule

Thought flexibility Difficulty coping with changes in routine

Perseveration – getting "stuck" on one thought or behavior

Inability to generate more than one possible solution

Preparation for changes in routine in language consistent with the cognitive level of the student

Redirection from inappropriate or incorrect behavior

Abstract thought Inability to determine thoughts behind casual comments

Feelings hurt by cynicism or sarcasm

Difficulty understanding figures of speech, or concepts beyond the concrete "here and now"

Group therapy with cognitive rehabilitation activities

"Script" for student to get clarification of speaker’s intent

Reasoning Difficulty with drawing conclusions

Inability to figure out and apply rules in problem solving activities

Difficulty with production and fluency of thought

Group therapy with cognitive rehabilitation activities
Problem Solving Difficulty with identifying the problem, understanding need for help, generating possible solutions, &/or selecting best solution

Inability to learn from trial and error

Group therapy with cognitive rehabilitation activities

Training to identify breakdowns in problem solving

Information processing Delayed responses to teacher’s questions

Considerable time required to complete assignments

Adequate time for student to answer questions and complete assignments
Judgment Bad decisions about friends, behavior, etc Group therapy with decision-making activities

Scripts and routines for negotiating difficult situations

Confabulation Exaggeration

Tells stories not necessarily based in fact

Group cognitive therapy

Peer counseling

Journal documenting past activities to guide student’s recollection of facts

Fatigue "Shutting down" following cognitively demanding tasks

Inability to focus as day progresses

Complaints of being tired

Consultation with parents regarding physician’s reports & medication schedule

Part-time attendance and/or frequent breaks (scheduled or requested)


What areas may be affected What might that look like? What may help?
Perception, evaluation, and use of social cues Violation of others’ personal space

Unable to ‘read’ body language and social cues in interpersonal activities

Social Skills Therapy to address deficits

Contextualized (i.e., at lunch, during art activity) cueing to assist student during interactions

Coping with over-stimulating environment Difficulty functioning in the lunchroom or in gym – may demonstrate with behavioral outburst Avoidance of over stimulation

Therapy to address deficits

Routine for identifying anxiety and "escaping" stressful situation before outbursts

Frustration tolerance Easily upset by failure

Refusal to complete difficult work

Group Therapy to address deficits

Routine for "waiting"

Presentation of easy, previously mastered tasks before beginning difficult work to promote positive feelings of success

Emotional control / stability Sudden changes in emotional state

Emotional reactions (anger, sadness, etc.) out of proportion to the situation

Irritability in classroom and during class activities

Group/Individual Therapy to address deficits

Prevention of emotional reactions through management of environment

Routine for "escaping" stressful situations and/or reducing agitation

Self Esteem Repeated and emphasized statements indicating feelings of worthlessness, stupidity, etc. Group/Individual Therapy and counseling to address difficulties

Provision of frequent opportunities for success

Awareness of deficits


Limited insight into own abilities and behavior

Denial of problems and need for help

Group/Individual Therapy to address deficits

Education about strengths and weaknesses in a supportive environment

Analysis and discussion of performance on difficult tasks by student and teacher

Counseling for cases of psychological denial

Emotional adjustment to injury Demonstrates social and physical withdrawal, depression or emotional disturbance Group/Individual Therapy and counseling to address deficits

Provision of frequent opportunities for success

Maturity Immature behavior Group Therapy to address deficits

Peer modeling of age-appropriate behavior

Discussion of performance in supportive environment

Relating to others Egocentric behavior

Focus solely on self with little concern about needs of others

Inappropriate affection towards others

Isolation of self

Group Therapy to address deficits

Cueing for consideration of others’ feelings

"Scripts" for interacting with others

Self-control / Inhibition Verbal or physical aggression


Inability to inhibit offensive behaviors

Sexual acting-out


Group/Individual Therapy to address deficits

Consistent and clearly-defined expectations

Prevent aggression by eliminating triggers in the environment

Peer modeling

Pre-existing behavior or learning disabilities Learning and behavioral difficulties present before the injury become more significant areas of difficulty Group/Individual Therapy to address needs

Peer counseling/support

One-to-one tutoring in difficult subject areas

Assorted computer programs that address areas of need

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