The promise, made to a brain-dead child whose massive head trauma was caused by violent shaking, is one that Rowse is still keeping.

"I promised her that I would do everything in my power to prevent this from happening again," Rowse said.

That vow transformed Kierra Harrison's nana into an advocate for all victims of shaken baby syndrome, the name given to the signs and symptoms exhibited by children who've been repeatedly and forcefully shaken.

Some of the victims, like Kierra, die from their injuries.

Other victims survive with varying degrees of brain damage and impairment that shadow the rest of their lives, said Rowse, a registered nurse with more than 30 years of experience. Even in cases in which the victims aren't paralyzed or blinded by the shaking, Rowse said that brain functions can be affected in ways that impair learning and developmental abilities.

"It's a tragedy," said Rowse, who started two nonprofit organizations dedicated to raising awareness of shaken baby syndrome and supporting the victims and their families. "We have a huge cadre of kids now who look normal and will never be normal."

So far this year, Clark County Family Services has investigated six reports of child abuse that involve allegations of shaking. In 2006, the department handled 12 abuse cases involving allegations of shaking.

The Clark County coroner's office doesn't use the term shaken baby syndrome as a cause of death, said spokeswoman Samantha Charles. Those fatalities are usually classified as blunt force traumas to the head or inflicted abusive injuries.

Between 2003 and 2006, the coroner's office reported 18 such homicides of babies ages 1 year and younger. That number would include any deaths caused by shaking, Charles said.

Lisa Teele, supervisor of the Metropolitan Police Department's abuse and neglect unit, said that crimes involving severe shaking and battering of children are usually triggered by stress or rage on the part of the caregiver.

An infant won't stop crying.

A toddler makes a mess.

The individual watching the child is inexperienced and may lack a close emotional tie to the victim.

Those are the circumstances that can set off a shaking incident that will leave the victim permanently damaged or dead, while the perpetrator faces criminal charges of murder or felony child abuse with substantial bodily harm.

"You can't take it back," Teele said. "Once it's done, it can't be undone."

Rowse knows that all too well. In Kierra's case, authorities said her injuries were inflicted while she was at a Spring Valley home day care. Former child-care provider Alica Wegner was convicted of murder in 1998 in Kierra's death. The Nevada Supreme Court overturned the conviction in 2000, citing a faulty jury instruction during the trial.

Wegner is now free on $100,000 bail, awaiting a new trial set for May 27. The drawn-out process wears on Rowse, who said her grief is hard to bear at this time of year. Kierra's birthday is Dec. 9.

"You just have to learn to redirect it or it will eat you alive," Rowse said.

Rowse's way of coping is to throw herself into her work. In addition to being a nurse manager at Kindred Hospital, Rowse is a public speaker at local high school child-development classes. She trains health care workers and social services workers on the topic of shaken babies. She consults with district attorneys from around the country who are seeking information to prosecute cases involving shaken babies.

People who want Rowse's expert help usually find her through one of her foundations. She runs the Kierra Harrison Foundation for Child Safety, a nonprofit educational organization she operates from her Las Vegas home. She's also co-founder of the National Shaken Baby Coalition, which promotes public awareness and offers support to family members of the victims.

"Some of the most heart-wrenching contacts I've gotten have been at the high schools," Rowse said.

She remembers one student who waited until after her presentation to come up and tell her that a cousin had been shaken to death. It's gotten to the point where Rowse said she can tell if someone in the audience knows someone who's been shaken: They wear the tragedy on their faces.

Part of Rowse's presentations to young people includes a demonstration of shaking.

A baby's neck is a fragile thing, she tells them. And then she shows them just how fragile by vigorously shaking a doll.

Once, at Chapparal High School, Rowse's demonstration of shaking sent a doll's head flying across the classroom. It was embarrassing, Rowse said. But it also showed the force and velocity that shaking brings to bear on the victim.

"Never shake a baby," Rowse repeats over and over to each new audience. "You need to understand the kind of damage you can do."

Clark County Coroner Michael Murphy and his staff are all too familiar with what happens to infants who are shaken. Skulls can fracture. Brains swell. Ribs may be cracked. Bruising in the shape of fingerprints can appear on the arms or around the chest because the child was held so tightly while being shaken.

Investigators with the coroner's office are among the first responders to a crime scene involving a child fatality. Murphy said that his office works with police and other entities to determine what actually happened.

Teele said it's not unusual for a suspect to report that a child injured itself by falling down in the bathtub or tumbling down stairs. The staff at the coroner's office works to determine whether those stories are supported or contradicted by the injuries on the child's body.

"We're looking at the totality of the situation so that we can come up with appropriate answers," Murphy said. "We're putting together the pieces of the puzzle."

Murphy's office reports its findings to both the state and to local law enforcement officials, who then decide how to proceed.

The tragedy of shaken baby crimes is that they're entirely preventable, Teele said. A caregiver who feels pushed to the edge by crying or behavior needs to reach out to a friend or a family member. Call the child abuse reporting hot line, Teele said. Call someone.

"Know when to walk away," Teele said. "It only takes a moment. And then lives can be compromised forever."

Contact reporter Lisa Kim Bach at lbach@ reviewjournal.com or (702) 383-0287.