Caring for Our Children (CFOC)

Chapter 3: Health Promotion and Protection

3.4 Health Protection in Child Care

3.4.4 Child Abuse and Neglect Preventing and Identifying Shaken Baby Syndrome/Abusive Head Trauma

Content in the STANDARD was modified on 05/30/2018.

All childcare facilities should have a policy and procedure to identify and prevent shaken baby syndrome/abusive head trauma. All caregivers/teachers who are in direct contact with children, including substitute caregivers/teachers and volunteers, should receive training on preventing shaken baby syndrome/abusive head trauma; recognizing potential signs and symptoms of shaken baby syndrome/abusive head trauma; creating strategies for coping with a crying, fussing, or distraught child; and understanding the development and vulnerabilities of the brain in infancy and early childhood.


Shaken baby syndrome/abusive head trauma is the occurrence of brain injury in newborns, infants, and children younger than 3 years caused by shaking a child. Even mild shaking can result in serious, permanent brain damage or death. The brain of the young child may bounce inside of the skull, resulting in brain damage, hemorrhaging, blindness, or other serious injuries or death. There have been several reported incidents in child care (1). 

Caregivers/teachers care for young children who may be fussy or constantly crying. It is important for caregivers/teachers to be educated about the risks of shaking and provided with strategies to cope if they are frustrated (2).  Many states have passed legislation requiring education and training for caregivers/teachers. Caregivers/teachers should check their individual state’s specific requirements (3). Staff should be knowledgeable about and be able to recognize the signs and symptoms of shaken baby syndrome/abusive head trauma in children in their care.


Victims of shaken baby syndrome/abusive head trauma may exhibit one or more of the following symptoms (4):

  1. Irritability
  2. Trouble staying awake
  3. Trouble breathing
  4. Vomiting
  5. Unable to be woken up


For more information and resources on shaken baby syndrome/abusive head trauma, contact the National Center on Shaken Baby Syndrome at

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS Recognizing and Reporting Suspected Child Abuse, Neglect, and Exploitation
  1. Araki T, Yokota H, Morita A. Pediatric traumatic brain injury: characteristic features, diagnosis, and management. Neurol Med Chir (Tokyo). 2017;57(2):82–93

  2. Fortson BL, Klevens J, Merrick MT, Gilbert LK, Alexander SP. Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2016. Accessed January 11, 2018

  3. Child Care Aware. Health and safety training. Accessed January 11, 2018

  4. American Academy of Pediatrics. Abusive head trauma: how to protect your baby. Web site. Updated November 21, 2015. Accessed January 11, 2018


Content in the STANDARD was modified on 05/30/2018.