No matter how tired or angry you are, never shake a baby

9. No matter how tired or angry you are, never shake a baby

Cost: There is no monetary cost. The real difficulty lies in resisting the urge to shake a baby when you’re exhausted or upset.

In plain terms: A baby’s head makes up a large proportion of their body size, yet their neck muscles are still very weak. Shaking them forcefully can cause bleeding inside the brain and eyes, potentially leading to death or lifelong disabilities. Gentle rocking while trying to soothe them is not dangerous; the real risk comes from uncontrolled, violent shaking. When you feel yourself losing control, place the baby back in their crib and step away for a few minutes. Letting them cry for a short while is far safer than holding them and shaking them.

Benefit: Because a baby’s head is proportionally large and their neck muscles are underdeveloped, violent shaking can result in intracranial and retinal hemorrhage — bleeding in both the brain and eyes. This can be fatal or leave lasting impairments. Such harm is distinct from any gentle rocking used to calm them. Medically, injuries caused by shaking or impact are termed “abusive head trauma.” This condition is the leading cause of death from head injuries among children under 2 years old. In the United States between 1999 and 2014, it accounted for nearly 2,250 deaths of children under 5.

Evidence grade: B

Sources: Spies EL, Klevens J (2016). Fatal Abusive Head Trauma Among Children Aged <5 Years — United States, 1999–2014. MMWR 65(20):505-509. <https://doi.org/10.15585/mmwr.mm6520a1>; Choudhary AK et al. (2018). Consensus statement on abusive head trauma in infants and young children. Pediatric Radiology 48(8):1048-1065. <https://doi.org/10.1007/s00247-018-4149-1>

Notes: When you truly feel you’re about to lose control, the safest action is to return the baby to their crib and leave the room for a few minutes. Allowing them to cry briefly is much safer than holding them and shaking them. This advice is especially vital for parents who care for their children alone and often suffer from sleep deprivation. For guidance on managing your own emotions, please refer to Section 3.