Abusive head trauma factsheet


Abusive head trauma is a head, neck or brain injury that happens when a baby is shaken or hit on purpose. Shaken baby syndrome is a type of abusive head trauma.

Babies have heads that are bigger and heavier than the rest of their body. Their neck muscles are not strong enough to hold their head up, which means their head and neck are floppy and move around a lot. Babies need help from caregivers to support their necks as they grow.

When a baby is purposefully shaken or hit, their head can forcefully move back and forth quickly. This can cause nerves and blood vessels around the brain to tear and bleed.

The brain can also move back and forth, hitting the skull and causing bruising and bleeding.

These injuries can cause the brain to swell inside the skull, causing high-pressure levels. Pressure in the skull means that blood cannot properly carry oxygen and nutrients to the brain, causing serious damage.

Abusive head trauma is severe and is the most common type of abuse that causes death and long-term disability in children younger than 12 months old.

 Signs and symptoms

After abusive head trauma, a baby may not be awake or may have a seizure. Other signs that a baby has had an abusive head trauma include:

  • vomiting
  • trouble with feeding, sucking or swallowing
  • feeling stiff
  • having seizures
  • having trouble breathing
  • blue colour to the skin
  • being unable to move or lift their head
  • having trouble following movement with their eyes
  • moving less and being more quiet
  • being upset and hard to settle.

Abusive head trauma is very serious and can cause death and long-term disability. If your baby shows any of these signs or has experienced abusive head trauma, call Triple Zero (000) for an ambulance or go to the nearest emergency department.


Abusive head trauma can be diagnosed by examining the baby’s head and body.

The doctor will:

  • look for bleeding in the eyes
  • order scans to check for:
    • brain swelling and brain bleeding
    • broken or healing bones in the head, body and limbs
  • check vital signs like blood pressure, temperature, pulse and breathing
  • do a blood test.


Treatment of abusive head trauma will depend on how severe the injury is and what signs and symptoms are showing.

Medical issues, like bleeding and broken bones, are treated first. The doctor will then check for any old or hidden injuries.

Abusive head trauma is serious and can cause death or life-long issues, including:

  • breathing difficulties
  • bruising
  • brain damage
  • loss of vision
  • loss of hearing
  • seizures
  • developmental delays
  • learning difficulties
  • memory and attention problems
  • severe intellectual and physical disability, including cerebral palsy.

Your baby will see a treatment team to manage their abusive head trauma. Depending on the signs, symptoms and seriousness of the abusive head trauma, this team may include:

  • specialist doctors
  • nurses
  • social workers
  • child abuse specialists.


How abusive head trauma happens

Abusive head trauma can happen when children experience physical abuse. Physical abuse can include being shaken or hit on purpose.

Shaken baby syndrome can happen when a parent or caregiver becomes frustrated, angry, or distressed in response to a baby crying. 

When caregivers are faced with stress, frustration, and other issues, they may be unable to manage their response to the baby's crying.

It's important to know that shaking or using any force on a baby is unsafe, regardless of the amount. For example, throwing a baby into the air or onto a bed or playmat can cause serious injury. To keep your baby safe, it's best to avoid any activity that could put them at risk.

Abusive head trauma, like shaken baby syndrome, does not happen by accident or during gentle play.

If you think your baby has abusive head trauma, call Triple Zero (000) for an ambulance or go to the nearest emergency department.

If you are having trouble coping with your crying baby or think something is wrong, call your local doctor as soon as possible.

Reasons why babies cry

Babies need parents and caregivers to help them with their needs like:

  • safety
  • comfort
  • love
  • hunger
  • hygiene.

Babies communicate their needs by crying since they cannot talk yet. It's normal for some babies to cry more than others, up to 2-3 hours a day. They may cry at certain times or when away from their caregiver. This is normal.

It is not always easy to figure out what your baby is trying to tell you. They might cry because they are:

  • hungry
  • uncomfortable
  • too hot or too cold
  • upset, scared or startled
  • teething, gassy or otherwise unwell
  • feeling lonely and wanting to be close to their caregiver
  • in pain
  • over tired.

How to cope with a crying baby

Sometimes, a baby will cry even when their obvious needs, like feeding and nappy changes, are taken care of.

Try the following strategies when your baby is unsettled:

  • try another feed by putting baby to the breast or offering a small amount of milk or formula in a bottle
  • use your baby’s sucking reflex to calm them by offering the breast or a dummy
  • hold your baby and offer them a comfort object like a blanket, cloth or toy
  • try skin to skin contact, also called kangaroo care, so your baby can feel warmth and your heartbeat
  • sing, read or talk gently to your baby
  • try gentle massage with a baby-safe moisturiser or oil
  • give your baby a warm bath
  • take your baby outside for a walk in the pram or carrier
  • swaddle your baby
  • settle your baby in a dark, quiet place
  • try playing gentle white noise or lullabies.

Babies need to experience cuddling, playing, and doing everything that makes them feel secure and loved. It is also important for parents and caregivers to enjoy time with their baby.

If you are finding it difficult to cope, need more information on settling or think there is something wrong with your baby, there is help available. Speak to your local doctor or maternal child and family health nurse. Reach out to friends and family if you can and contact the services below for support.

Last updated Tuesday 27th February 2024


This factsheet is provided for general information only. It does not constitute health advice and should not be used to diagnose or treat any health condition.

Please consult with your doctor or other health professional to make sure this information is right for you and/or your child.

The Sydney Children’s Hospitals Network does not accept responsibility for inaccuracies or omissions, the interpretation of the information, or for success or appropriateness of any treatment described in the factsheet.

© Sydney Children’s Hospitals Network 2024