MOBILE, Ala. — A Mobile man is charged with aggravated child abuse after investigators say he abused a 3-month-old, causing severe brain injuries.
According to court documents, 19-year-old Joshua Smiley Jr. shook the baby, causing the infant to suffer severe brain bleeds, two hemorrhages between the brain and skull and one behind the eye.
Investigators said the baby shows signs of shaken baby syndrome.
Jail records show Smiley has been released on a $60,000 bond. He is scheduled to be back in court on Sept. 23.
The Term Has Changed
Jessica Kirk is a pediatric hospitalist with Thomas Hospital. She said that while the term shaken baby syndrome is commonly used, it is now referred to as abusive head trauma.
The terminology shift reflects a broadening of what clinicians recognize. Abusive head trauma covers injury caused by shaking, impact or a combination, rather than implying a single mechanism.
Kirk said it typically affects children under five years old. The primary trigger is inconsolable, persistent crying that overwhelms a caregiver.
What to Look For
“Some of the symptoms that you might see in an infant that has had some head trauma would be excessive fussiness; they’re not eating well; they’re not waking up to feed,” Kirk said. “They might be vomiting or have a seizure, but they may have none of those signs.”
“One thing we want parents and caregivers to look for is any bruise on an infant that’s not pulling up and starting to walk and stand and cruise. So if you see any of those warning signs, we want those infants to be checked out immediately,” Kirk said.
That bruising guidance is a well-established clinical rule and worth understanding. Infants who are not yet mobile — not pulling up, cruising or walking — do not generally acquire bruises through ordinary activity, because they cannot yet put themselves in situations that produce them. A bruise on a pre-mobile infant is treated as a finding that warrants evaluation.
Why Infants Are Most at Risk
According to the CDC, babies under one year old face the highest risk of abusive head trauma. Infants have weak neck muscles as their bodies continue to develop.
An infant’s head is also disproportionately large and heavy relative to body size, and the brain and its supporting structures are still developing. Those factors together mean forces an older child would absorb without injury can cause serious harm in a baby.
Lifelong Consequences
Kirk said once a baby is diagnosed with abusive head trauma, their lives can change forever.
“It is an incredibly common and devastating problem,” Kirk said. “And talking about the long-term effects of it, we see everything from long-term seizure disorders, deafness, blindness, intellectual disability. Some children may have problems with their eyes themselves. We’ve had children that have had actual difficulty with walking. And then some of them make amazing comebacks after their very devastating injury.”
According to the CDC, abusive head trauma is the leading cause of fatal head injuries in children under the age of two.
What Does Not Cause It
Kirk said activities like bouncing a baby on your leg will not cause abusive head trauma. It is caused by high-velocity injuries, such as a baby’s head being hit hard against a wall, vigorous shaking or slapping.
That clarification matters, because anxiety about ordinary handling is common among new parents. Normal play, rocking, car travel and routine caregiving do not produce these injuries.
What a Caregiver Should Do
Kirk said that if a caregiver starts to get aggravated, it is best to step away.
“We recommend that they put the infant down safely in the crib, walk away somewhere else in the building, like right outside the door, and then calm down for 10 or 15 minutes,” Kirk said. “And phone a friend if you need to. There’s no shame in that.”
The advice is deliberately concrete because the situation it addresses is a predictable one. Persistent infant crying peaks in the first months of life and is, for many babies, unrelated to anything a caregiver can fix. A baby left safely on its back in a crib for fifteen minutes is not in danger; a baby held by an overwhelmed caregiver may be.
Reporting and Support
Suspected child abuse in Mobile County can be reported to the Mobile Police Department, the Mobile County Sheriff’s Office or the Alabama Department of Human Resources. The Childhelp National Child Abuse Hotline is available 24 hours a day at 1-800-422-4453, and offers support to caregivers who feel they are at risk of losing control as well as to people reporting concerns.
The Case
Smiley has not been convicted of any offense and is presumed innocent unless and until proven guilty in a court of law. Aggravated child abuse is a felony under Alabama law. He is due back in court Sept. 23.