Updated: 11/29/2021

Shaken Baby Syndrome

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Snapshot
  • A 23-year-old mother brings in a 3-month-old baby boy to the emergency room. She reported that he seemed to have difficulty breathing and was lethargic – “just not himself.” She denied any inciting trauma. On physical exam, he was lethargic with an unequivocal neurological exam. However, there is localized swelling on the right occiput. An ophthalmologic exam shows retinal hemorrhages. A head CT showed cresent-shaped hemorrhage. The child abuse team is consulted.
Introduction
  • A form of child abuse resulting in cranial injury
    • blunt force trauma
    • shaking
    • both the above is referred to as shaken baby syndrome
  • Epidemiology
    • 40% of deaths from child abuse occur in those younger than 12 months
    • abusive head injury is the most common cause of death
  • Associated conditions
    • subdural hematoma   
      • rupture of bridging veins
      • hematoma develops over time (venous bleeding is slow)
Presentation
  • Symptoms
    • seizures
    • difficulty breathing
    • apnea
    • lethargy 
    • absence of traumatic event in combination with these symptoms has high specificity for abusive head injury
  • Physical exam
    • localized swelling on head
    • retinal hemorrhages (60-85%)
    • bruising
    • may have no findings at all
Evaluation
  • CBC to test for underlying bleeding disorder
  • Non-contrast CT imaging
    • crescent shaped hemorrhage that crosses suture lines
    • cannot cross tentorium
    • midline shift due to mass effect
  • Skeletal survey for additional signs of abuse
  • Consultation with child abuse team (social worker, nurse, and physician specializing in child protection)
Differential Diagnosis
  • Bleeding disorder
  • Accidental trauma
  • Apparent life-threatening event
Treatment
  • Supportive care
  • Inform child protective services if suspicious of abuse
Prognosis, Prevention, and Complications
  • Prognosis
    • mortality rate 13-23%
  • Prevention
    • parental education
  • Complications
    • neuromotor abnormalities
    • speech and language impairment
    • seizure disorder

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Questions (2)

(M2.PD.17.4678) A 3-month-old boy is brought to the emergency department by his mom for breathing difficulty after a recent fall. His parents say that he rolled off of the mattress and landed on the hard wood floor earlier today. After an extensive physical exam, he is found to have many purplish bruises and retinal hemorrhages. A non-contrast head CT scan shows a subdural hemorrhage. He was treated in the hospital with full recovery from his symptoms. Which of the following is the most important follow up plan?

QID: 107248

Inform child protective services

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(9/9)

Provide parents with anticipatory guidance

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(0/9)

Provide home nursing visits

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Reassurance that accidents are common

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(0/9)

Referral to genetics for further testing

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(0/9)

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