What is THI-CM/SBS?
What we do
Our Team
Contact Us

What is Traumatic Head Injury - Child Maltreatment/Shaken Baby Syndrome (THI-CM/SBS)?

Shaken Baby Syndrome (SBS) is the group of signs and symptoms that results from violently shaking an infant. It may or may not be a result of an impact to the head.

In Canada, there is a recent transition from using SBS to using the term “Traumatic Head Injury by Child Maltreatment (THI-CM)” within the prevention, health care and research fields. It is considered to be more accurate as it separates the diagnosis (traumatic head injury) from the likely cause of injury (child maltreatment). We will continue to use both THI-CM and SBS throughout this website as SBS is the more commonly known term.

What else is it called?

- Traumatic Head Injury - Child Maltreatment
- Abusive Head Trauma
- Inflicted Head Trauma
- Intentional Traumatic Brain Injury


Crying, especially inconsolable crying, is the most common trigger for shaking and other forms of infant abuse. Inconsolable crying is normal and can be frustrating. Learn ways to soothe your crying baby on our Soothing Techniques page.

What happens during shaking?

When an infant is being shaken, the head moves back and forth in a figure eight motion. This causes the brain and skull to move at different speeds in different directions. As the shaking continues, veins within the skull begin to break, leading to bleeding in and around the brain and eyes. Rib injuries can also occur from increased pressure. However, signs and severity of impact may or may not be visible from the outside.

Baby crying on a bed

Why are babies particularly vulnerable to shaking?

  • Weak neck muscles
  • Relatively large head size
  • Person doing the shaking is much stronger than the baby

In some cases of THI-CM/SBS, shaking an infant can cause serious internal harm even if not visible. A baby may appear normal after being shaken, but can develop health complications over time. Seek help as soon as you can.


Seek immediate medical help if you suspect your child has been violently shaken. Call 911 or take your child to the emergency department.






Signs to look out for


On their own, non-specific signs are not an indicator of SBS. However, if there are multiple signs, it is best to follow-up with your healthcare provider. 










Shaking outcomes

Infants and babies are particularly vulnerable to shaking and the outcome can be devastating. 

1 in 4 babies subjected to shaking will die. Of those who survive, as many as 80% will have negative lifelong consequences such as neurological injury and visual impairment.1,2

Cost of THI-CM

Beyond the heartbreaking toll on families and communities, THI-CM incidents are costly. The lifetime cost of a severe case of THI-CM is estimated to be approximately $6.1 million. Investing in well-developed THI-CM/SBS prevention programs, such as PURPLE, not only promotes child safety and health, but also saves costs to society.

In BC, investing only $5 per newborn on the PURPLE program means a cost savings of $15 per child cost to society and the health care system.3

Of course, the negative emotional and social impact of these preventable deaths far outweighs the financial savings.


Physical abuse is the leading cause of serious head injury in children under the age of two.  Approximately 20% to 25% of babies subjected to shaking die (Keenan HT, et al., 2003; King WJ, et al., 2003).  Of those who survive, as many as 80% have permanent brain damage (King WJ, et al., 2003).

Average cost of THI-CM per case by severity, BC in 2014 $CAD

Graph showing Average cost of THI-CM per case by severity, BC in 2014 $CAD
Graph showing Average cost of THI-CM per case by severity, BC in 2014 $CAD

In BC, investing only $5 per newborn on the PURPLE program means a cost savings of $15 per child cost to society and the health care system.3

Of course, the negative emotional and social impact of these preventable deaths far outweighs the financial savings.

An infant is 4 times more likely to die from shaken baby syndrome than from drowning, motor vehicle crash, poisoning, fire and electrocution combined!4

Want to learn more about SBS?


  1. King, W. J., MacKay, M., Sirnick, A., & Canadian Shaken Baby Study Group (2003). Shaken baby syndrome in Canada: clinical characteristics and outcomes of hospital cases. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 168(2), 155–159
  2. Keenan, H. T., Runyan, D. K., Mashall, S. W., Nocera, M. A., Merten, D. F., & Sinal, S. H. (2003). A population-based study of inflicted traumatic brain injury in young children. Journal of the American Medical Association, 290, 621-626.
  3. Beaulieu, E., Rajabali, F., Zheng, A., & Pike, I. (2019). The lifetime costs of pediatric abusive head trauma and a cost-effectiveness analysis of the Period of Purple crying program in British Columbia, Canada. Child abuse & neglect, 97, 104133.
  4. BC Vital Statistics, Ministry of Health. Data accessed from Chronic Disease and Injury Data Mart, BCCDC (2022).

What we do

Prevent Shaken Baby Syndrome BC (PSBSBC) delivers a primary prevention program to reduce the incidence of shaken baby syndrome in British Columbia. 

We do this by providing timely, relevant, and scientifically sound information to parents, caregivers, and professionals involved in THI-CM cases, including: maternity nurses, health care professionals, and social workers.

We believe it is important to:

Educate the public about early infant crying

Mother with her baby on her knee. Her head is lowered as she sits on a sofa looking tired and stressed.

Normalize the frustrating feelings that can emerge as a result of inconsolable crying and the pressures of caring for a newborn

Top view wide angle sleeping newborn baby lies in a crib arms and legs outstretched.

Understand that it is okay to place the baby in a safe place, walk away, and take a break

Advocate that it is never okay to shake or hurt a baby

How we started

The BC Children’s Hospital Steering Committee on Shaken Baby Syndrome formed in early 2003 to examine the need and potential of a standardized prevention program for BC. A provincial environmental scan was completed, followed by a large three-year randomized-controlled trial. It was determined that the Period of PURPLE Crying® program (PURPLE) was the best program to educate new parents and caregivers. 

Since 2009, PURPLE has been offered to all families of newborns throughout the province via maternity hospitals, home birth public health units, midwifery clinics, and community agencies. We continue to innovate to ensure that reliable and credible health information about infant crying and THI-CM is accessible for all BC families. 

Prevent Shaken Baby Syndrome BC (PSBSBC) is a program of the BC Injury Research and Prevention Unit at BC Children’s Hospital.

Our program has been successful in reducing the rate of THI-CM/SBS in BC. It would not be as successful without the continued support of funding and the dedicated and caring nurses and providers who deliver the program to every newborn family in the province. The following graph highlights the difference between BC’s lower average rate compared to the rest of Canada and the United States.

Graph showing average rate of thi-cm incidence in a population 0-2 years for every 100,000 children in the US, BC, and Canada

Our program is made possible by the continued support of:

Government of British Columbia's Logo
Provincial Health Services Authority Logo
Fraser Health Logo
Interior Health Logo
Island Health Logo
Northern Health Logo
Vancouver Coastal Health Logo
First Nations Health Authority Logo
BC Children's Hospital Logo
University of British Columbia Logo


  1. BC rate: average rate 2017 to 2020. Prevent Shaken Baby Syndrome BC. (2022). BC THI-CM Surveillance System (Version 2022) [Surveillance]. BC Injury Research and Prevention Unit.
  2. The Canadian average rate 2002/03 to 2007/08 is 13% (11.3%-14.9%*) confidence interval. Fujiwara, T., Barr, R. G., Brant, R. F., Rajabali, F., & Pike, I. (2012). Using International Classification of Diseases, codes to estimate abusive head trauma in children. American journal of preventive medicine, 43(2), 215-220.
  3. US rate: Keenan HT, Runyan DK, Marshall SW, Nocera MA, Merten DF, Sinal SH (2003) A population-based study of inflicted traumatic brain injury in young children. JAMA : J Am Med Assoc 290(5):621–626. doi:10.1001/jama.290.5.621Diseases, codes to estimate abusive head trauma in children. American journal of preventive medicine, 43(2), 215-220.

Our Team

Headshot of Dr. Ian Pike

Dr. Ian Pike

Ian is the Director of of Prevent Shaken Baby Syndrome BC (PSBSBC); Director of the BC Injury Research and Prevention Unit (BCIRPU); Professor of Pediatrics at the University of British Columbia; Investigator and Co-Lead of the Evidence to Innovation Research Theme at the Research Institute at the BC Children’s Hospital; and, Scientific Director of The Community Against Preventable Injuries. He holds adjunct appointments at York University, Vancouver Coastal Health, and Fraser Health Research Institutes, and is a member of the Board of Directors of Parachute.

Headshot of Karen Sadler

Karen Sadler

Karen is the PSBSBC Manager. She oversees program delivery, training, outreach, distribution, research, and community education to professionals supporting families of newborns. She leads knowledge translation and new initiatives for PSBSBC.  Karen received her Master of City Planning from the University of Manitoba and has come from the middle and early years sector, specializing in collaborative approaches to community engagement with under represented populations and cross-sectoral integration. She loves dogs, pilates and sunny spots.

Headshot of Fahra Rajabali

Fahra Rajabali

Fahra is the evaluation manager for PSBSBC. She has been a member of the BCIRPU since 2000. She is a specialist in injury data, epidemiology, visualizations, and evaluation. Fahra manages the data at the BCIRPU and is responsible for the data and interface for the Injury Data Online Tool (iDOT). She wears many other “hats” in her work on injury surveillance and conference planning. She is also the BCIRPU’s liaison for Northern, Interior, and Island Health Authorities. Along with her co-workers, Fahra was a recipient of the UBC President’s Staff Award in 2014.

Aygun Ibrahimova

Aygun joined the BCIRPU as a volunteer in 2018, and is currently working as a Graduate Academic Assistant for the Prevent Shaken Baby Syndrome BC program. She received her Bachelor of Science from UBC in 2023 and is now working towards a Master of Public Health degree. She is interested in research focusing on pediatric health and development.


Prevent Shaken Baby Syndrome BC

BC Children's Hospital
4480 Oak Street, F503
Vancouver, BC  V6H 3V4

Providers can order materials:

Order Form