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