Research progress of shaken baby syndrome and its preventive measures / 中国实用护理杂志

Shaken baby syndrome, also known as abusive head trauma, is one of the deadliest and most devastating forms of child abuse.This paper reviewed the risk factors, cognitive status and preventive measures of shaken baby syndrome, in order to provide reference for the prevention of shaken baby syndrome and further research on shaken baby syndrome.

Behavioral Characteristics and Medicolegal Identification of Infanticide / 法医学杂志

Due to the concealment and incidence higher than reported statistics, infanticide should attract the attention of legal medical experts.The infanticide process has common behavioral characteristics.The perpetrators are most frequently biological mothers who are unmarried, with inferior education, and lack of routine pregnancy tests.Medicolegal identification of infanticide cases includes identification of live births and causes of death.Besides the classical lung floating test, there are other methods to identify live births such as pulmonary interstitial emphysema, CT imaging examination, immunohistochemical examination of umbilical cord vitality markers.Neonatal line measurement is the only way to identify live births in corpse with severe decomposition.The main causes of death in infanticide are mechanic asphyxia and fatal head trauma.Shaken baby syndrome, as a common abusive head trauma, is pathologically characterized by the triad of encephalopathy, subdural haemorrhage (SDH) and retinal haemorrhage (RH).During the autopsy of suspected shaking baby syndrome, in addition to carefully examining cervical cord, the possibility of pathological temporal lobe hemorrhage should also be ruled out.

Smartphone Fundus Photography in an Infant with Abusive Head Trauma

PURPOSE: To report fundus photography using a smartphone in an infant with abusive head trauma. CASE SUMMARY: An 8-month-old male infant presented to the emergency room with decreased consciousness and epileptic seizures that the parents attributed to a fall from a chair. He had no external wounds or fractures to the skull or elsewhere. However, computerized tomography of the brain revealed an acute subdural hematoma in the right cranial convexity and diffuse cerebral edema, leading to a midline shift to the left and effacement of the right lateral ventricle and basal cistern. The attending neurosurgeon promptly administered a decompressive craniectomy. Immediately after the emergency surgery, a fundus examination revealed numerous multi-layered retinal hemorrhages in the posterior pole extending to the periphery in each eye. He also had white retinal ridges with cherry hemorrhages in both eyes. We acquired retinal photographs using the native camera of a smartphone in video mode. The photographer held the smartphone with one hand, facing the patient's eye at 15–20 cm, and held a 20 diopter condensing lens at 5 cm from the eye in the other hand. Our documentation using a smartphone led to a diagnosis of abusive head trauma and to obtain the criminal's confession, because the findings were specific for repetitive acceleration-deceleration forces to an infant`s eye with a strong vitreoretinal attachment. CONCLUSIONS: This ophthalmic finding had a key role in the diagnosis of abusive head trauma. This case presented the diagnostic use of a smartphone for fundus photography in this important medicolegal case.

Avaliação do Conhecimento sobre Trauma Craniano Violento por Pais Brasileiros / Brazilian Parents' Knowledge on Abusive Head Trauma

RESUMO A ocorrência do trauma craniano violento (TCV) pode estar associada à falta de conhecimento de pais e cuidadores sobre o desenvolvimento infantil. Neste sentido, o presente estudo pretendeu investigar o conhecimento de pais sobre o choro do bebê, as estratégias para lidar com o choro e as consequências de sacudi-lo. Participaram da pesquisa 83 mães e 7 pais de recém-nascidos, que responderam ao instrumento Questionário sobre o Choro do Bebê. Os resultados do estudo sugerem um desconhecimento por parte dos pais sobre o TCV, principalmente no que se refere à sua gravidade. Além disso, 34,4% dos participantes relataram que sacudiriam seus bebês para fazê-los parar de chorar. Tais resultados parecem indicar a necessidade de desenvolver intervenções de educação parental sobre o TCV, especialmente durante o pré-natal, de modo a contribuir para o aumento do conhecimento dos pais, prevenindo assim tal forma de maus-tratos.

ABSTRACT Abusive head trauma (AHT) may be associated to a lack of knowledge of parents and caregivers concerning child development. This study intended to investigate parental knowledge regarding the crying of babies, how parents deal with a crying baby and the consequences of shaking a baby to make it stop crying. Participants were 83 mothers and 7 fathers of newborns who responded to the Crying Baby Questionnaire. Results suggest a lack of knowledge of AHT, especially regarding its severity. Furthermore, 34.4% of participants reported that they would shake their babies to make them stop crying. These results highlight the need to develop interventions for parent training on AHT, particularly during the prenatal period in order to increase parental knowledge and to contribute to the prevention of this form of child maltreatment.

Abusive Head Trauma: Epidemiological Aspects and Diagnosis / Trauma Craniano por abuso: aspectos epidemiológicos e diagnostico

Objective Abusive head trauma (AHT) is defined as a severe, non-accidental traumatic brain injury. Early recognition and treatment are instrumental in limiting the immediate complications and long-term disabilities. The goal of this study was to describe our experience with traumatic head injuries in children younger than 2 years of age. Methods We reviewed the medical records of 195 children aged under 2 years with suspected AHTwho presented with a head injury without witnessed accidental trauma, between January 2008 and June 2013. Results AHT was considered in 145 children. Familial problems (ρ » 0.008), cutaneous hematoma/bruising (ρ < 0.001), retinal hemorrhages (ρ < 0.001), and bone fractures (ρ » 0.04), were significantly more frequent in the AHT group. Conclusions The association between the subdural hematoma and retinal hemorrhage, resulting from an unwitnessed and incoherent history of trauma, is a strong argument for AHT, particularly when associated lesions and socioeconomic risk factors are evident.

Objetivo O traumatismo craniano por abuso (AHT) é definido como uma grave lesão cerebral traumática não acidental. O reconhecimento e tratamento precoce são fundamentais para limitar as complicações imediatas e sequelas tardias. O objetivo deste estudo foi descrever a nossa experiência em crianças menores de 2 anos de idade, vítimas de trauma craniano. Métodos Foram revisados os prontuários de 195 crianças com idade inferior a 2 anos com suspeita de AHT, sem trauma acidental testemunhado e com diagnostico de hematoma subdural, entre janeiro de 2008 e junho de 2013. Resultados AHT foi considerado em 145 crianças. Problemas socioeconômicos familiares (ρ » 0,008), hematomas e lesões cutâneas (ρ <0,001), hemorragias retinianas (ρ <0,001), e fraturas em ossos longos (ρ » 0,04), foram significativamente mais frequentes no grupo de crianças com suspeita de AHT. Conclusões A associação entre hematomas subdurais e hemorragia retiniana, resultante de uma história incoerente de trauma sem testemunhas, é um forte argumento para a AHT, particularmente quando lesões cutâneas e fatores de risco socioeconômicos forem identificados.

Síndrome del niño sacudido o Shaken Baby Syndrome: Lesiones oculares / Shaken Baby Syndrome: Eye lesions

Introducción: el síndrome del niño sacudido se incluye en la clasificación del maltrato físico. Las lesiones oculares se deben a la tracción producida sobre la retina a partir del vítreo del niño, fuertemente unido a ella, con desgarro de las capas retinales y colección de sangre en la cavidad resultante (retinosquisis hemorrágica). Objetivo: describir las manifestaciones oftalmológicas iniciales y la evolución del síndrome del bebé sacudido. Materiales y métodos: se realiza un estudio descriptivo y retrospectivo de cuatro pacientes con el síndrome del niño sacudido. Las variables analizadas son: sexo, edad, fondo de ojos, ecografía ocular, tratamiento y evolución visual. Resultados: los casos 1 y 2 eran gemelos, uno de ellos presentó manifestaciones a nivel del fondo de ojos y el segundo no, ambos requirieron intervención neuroquirúrgica. El tercero presentaba lesiones a nivel ocular con opacidad de medios por lo cual se le realizó en ambos ojos vitrectomía exploradora. El cuarto caso se trataba de una paciente de 6 meses con hemovítreo en ojo derecho y retinosquisis hemorrágica en ojo izquierdo, y requirió vitrectomía para la resolución del hemovítreo, aunque el resultado visual fue desfavorable. Conclusión: el examen oftalmológico contribuye al diagnóstico del síndrome del bebé sacudido por lo que es necesario en la evaluación de los niños pequeños que presenten lesiones sospechosas de abuso (AU)

Introduction: Shaken baby syndrome is included in the classification of physical abuse. Ocular lesions in the infant are due to traction to the retina from the adjacent vitreous causing with tears of the retinal layers and blood collection in the resulting cavity (hemorrhagic retinoschisis). Objective: To describe early ocular manifestations and outcome of shaken baby syndrome. Material and methods: A retrospective, descriptive study was conducted in four patients with shaken baby syndrome. Sex, age, ocular fundus, ultrasonography, treatment, and visual outcome were analyzed. Results: Cases 1 and 2 were twins, one of them presented with fundus manifestations, the other did not; both required neurosurgical intervention. The third infant had eye lesions with media opacities and therefore exploratory vitrectomy was performed in both eyes. The fourth was a 6-month-old baby girl with hemovitreous in the right and hemorrhagic retinoschisis in the left eye. She required vitrectomy to resolve the hemovitreous, but the result was poor. Conclusion: Ophthalmological examination was useful in the diagnosis of shaken baby syndrome and should therefore be performed in little children in whom child abuse is suspected (AU)

Maltrato infantil: características clínicas usuales / Child Maltreatment: Usual clinical characteristics

En este artículo se presentan las características "visibles" e "invisibles" de las diferentes modalidades del maltrato Infantil (MI) con base en la experiencia de la Clínica de Atención Integral al Niño Maltratado del Instituto Nacional de Pediatría (CAINM-INP). Se presenta y se enfatiza el cuadro clínico de las víctimas del "síndrome del niño sacudido" y se insiste en la necesidad de prevenirlo y diagnosticarlo a tiempo. También se exponen los problemas médicos que generan las manifestaciones clínicas desencadenantes de este síndrome como son: crisis de llanto inconsolable, irritabilidad y rechazo al alimento.

A presentation is made of the "visible" and "invisible" characteristics of the different forms of Child abuse (ChA) based on the experience of the Comprehensive Care Clinic of Abused Children of the National Institute of Pediatrics (CAINM-INP). We present and emphasize the clinical picture of the child victim of "shaken baby syndrome" and insist in the need to prevent and diagnose it in time. We also expose the medical conditions that generate the clinical manifestations that trigger the problem such as: inconsolable crying spells, irritability and refusal to eat.

Trauma craniano violento pediátrico: uma revisão da literatura / Abusive head trauma in children: a literature review

OBJETIVO: Fornecer uma revisão de literatura científica sobre trauma craniano violento pediátrico enquanto forma de maus-tratos físicos contra bebês e crianças, ressaltando prevalência, sinais e sintomas, consequências, fatores de risco para sua ocorrência e, principalmente, estratégias de prevenção. FONTES DOS DADOS: Revisão nas bases de dados MEDLINE, SciELO, LILACS e Web of Science no período de 2001 a 2012 utilizando os termos "síndrome do bebê sacudido" e "trauma craniano violento" em inglês, espanhol e português. SÍNTESE DOS DADOS: O trauma craniano violento é definido como a lesão ao crânio ou ao conteúdo intracraniano de um bebê ou criança menor de cinco anos devido a um impacto brusco intencional e/ou a uma sacudida violenta. Ocorre principalmente com bebês e crianças menores de um ano de idade, e pode resultar em consequências graves, desde deficiências físicas ou mentais até a morte. Apesar de haver sinais específicos para esta forma de maus-tratos, eles podem se confundir com doenças comuns em crianças ou traumas cranianos acidentais, sendo imprescindível o preparo clínico dos profissionais envolvidos na avaliação dos casos para o diagnóstico correto. As estratégias de prevenção devem incluir tanto a identificação precoce dos casos, como a educação parental sobre o desenvolvimento infantil, especialmente sobre o padrão de choro do bebê. CONCLUSÕES: Considerando a gravidade do trauma craniano violento pediátrico, é fundamental que estratégias de prevenção sejam implementadas e avaliadas no contexto brasileiro. Sugere-se que indicadores de sua incidência sejam pesquisados nacionalmente.

OBJECTIVE: To review the scientific literature on pediatric abusive head trauma as a form of physical abuse against infants and young children, highlighting the prevalence, signs and symptoms, consequences, risk factors for its occurrence, and prevention strategies. DATA SOURCE: The MEDLINE, SciELO, LILACS, and Web of Science databases from 2001 to 2012 were reviewed, using the terms "shaken baby syndrome" and "abusive head trauma" in English, Spanish, and Portuguese. DATA SYNTHESIS: Pediatric abusive head trauma is defined as injury to the skull or intracranial contents of a infant or child younger than 5 years due to intentional abrupt impact and/or violent shaking. It occurs mainly in infants and children under 1 year of age, and may result in severe consequences, from physical or mental disabilities to death. Although there are specific signs for this form of abuse, they can be mistaken for common illnesses in children or accidental head injury; thus, clinical training of professionals involved in the assessment of cases to attain the correct diagnosis is crucial. Prevention strategies should include early identification of cases, as well as parental education on child development, especially on the infant's crying pattern. CONCLUSIONS: Considering the severity of abusive head trauma in children, it is critical that prevention strategies be implemented and evaluated in the Brazilian context. It is suggested that its incidence indicators be assessed at the national level.

Prevención del traumatismo cefálico por abuso en los niños / Preventive abusive head trauma in children

El abuso infantil es la causa más común de lesión cefálica grave en los niños de corta edad. A pesar de ello, el traumatismo cefálico abusivo con frecuencia es subdiagnosticado y subinformado. Esto se relaciona parcialmente con el entrenamiento inadecuado que los profesionales de la salud reciben en el reconocimiento y enfoque del abuso infantil. Actualmente, está disponible el contenido curricular para las universidades médicas y programas de residencia. Dadas las altas tasas de muerte y deterioro neurológico grave asociado con el traumatismo cefálico abusivo, la prevención se ha convertido en el centro de atención. Algunas estrategias de prevención mostraron resultados promisorios en mejorar la educación de los padres y en reducir la incidencia de lesiones. Este artículo revisa la epidemiología, las características clínicas y el desenlace del traumatismo cefálico abusivo en los niños de corta edad. También analiza las estrategias de prevención, como la educación y el contenido curricular para los profesionales de la salud.

Child abuse is the most common cause of serious head injury in young children. Despite this, abusive headtrauma is often under-recognized and under-reported. This is partly related to the inadequate trainingthat health professionals receive in child abuse recognition and management. Published curricula are nowavailable for medical school and residency education. Given the high rates of death and serious neurolo-gical impairment associated with abusive head trauma, prevention has become a focus. Some preventionstrategies show promising results in improving parent education and reducing the incidence of injury. Thisarticle reviews the epidemiology, clinical characteristics, and outcomes of abusive head trauma in youngchildren. It also discusses prevention strategies, including education and curricula for health professionals.

Efecto de una intervención educativa dirigida a cuidadores de niños menores de dos años sobre la prevención del síndrome del niño sacudido / Efeito de uma intervenção educativa encaminhada a cuidadores de crianças menores de dois anos para a prevenção da síndrome do bebê sacudido / Effect of patient education and support for caregivers of children under two years on the prevention of shaken baby syndrome

El síndrome del niño sacudido hace parte de la clasificación del maltrato físico. Este afecta, en su mayoría, a niños menores de dos años de edad y sucede cuando el cuidador sujeta al menor y ejerce fuerzas sobre él que le producen aceleración y desaceleración de la cabeza, lo cual ocasiona lesiones cerebrales, óseas, auditivas, oculares, entre otras. Por lo tanto, se pretende determinar el efecto de una intervención educativa encaminada a evitar que los cuidadores de niños menores de dos años ejerzan el sacudimiento, ya sea como mecanismo para calmar el llanto o como demostración de afecto a través del juego. El presente estudio es de tipo evaluativo-cuantitativo realizado a 60 cuidadores de niños menores de dos años, a los cuales se les aplicó un instrumento diseñado a partir de la revisión literaria sobre el síndrome del niño sacudido, el cual indaga acerca de las características sociodemográficas de los participantes y los conocimientos y comportamientos que pueden influir en el síndrome del niño sacudido antes de la intervención educativa y después de esta. Los resultados del estudio demostraron que gracias a la intervención educativa los cuidadores de niños menores de dos años tuvieron un cambio en conocimientos del 84,5%, y en comportamientos, de un 26%. Ello permite concluir que las estrategias educativas dirigidas a cuidadores aumentan sus habilidades y conocimientos en relación con el cuidado...

The Shaken Baby Syndrome is part of the classification of physic abuse. It affects mostly children under two years old and occurs when the caregiver holds the minor and exerts pressure that produces acceleration and deceleration of the childs head generating an impact that causes brain, osseous, hearing, ocular injuries. Therefore is intended to determine the effect of an educational intervention in order to avoid the shaking, no matter if it is used as a mechanism to calm the babies crying or as a demonstration of affection through playing. The present investigation is an evaluative-quantitative study conducted at 60 caregivers who were given a tool designed from existing literature on Shaken Baby Syndrome which inquires about sociodemographic characteristics of the participants and the knowledge and behaviour that can influence the Shaken Baby Syndrome before and after the educational intervention. The result of the investigation showed that thanks to the educational intervention, the caregivers had an improvement in knowledge in 84.5% and in behaviour in 26%. This leads to the conclusion that the educational strategies aimed at caregivers increased their skills and knowledge in relation to the care...

O síndrome do bebê sacudido faz parte da classificação de maus-tratos infantis. Afeta principalmente crianças menores de dois anos de idade e acontece quando o cuidador segura a criança e faz forças que produzem a aceleração e desaceleração da cabeça do bebê e que causam danos ao cérebro, ossos, ouvidos, olhos e outros. Assim, pretende-se determinar o efeito de uma intervenção educativa destinada a impedir que os cuidadores de crianças menores de dois anos exerçam a sacudida como mecanismo para a detenção do choro ou como uma demonstração de carinho através do jogo. Este é um estudo de avaliação e quantitativo realizado com 60 cuidadores de crianças menores de dois anos, no qual foi aplicado um instrumento concebido a partir da literatura existente sobre o síndrome do bebê sacudido que pergunta sobre as características sociodemográficas dos participantes e dos conhecimentos e comportamentos que podem influenciar no síndrome do bebê sacudido antes e depois da intervenção educativa. Os resultados do estudo mostraram que através da intervenção educativa para cuidadores de crianças com menos de dois anos se obteve uma mudança no conhecimento do 84,5% e 26% no comportamento; fato com o que pode-se concluir que as estratégias educativas dirigidas aos cuidadores incrementam as habilidades deles e os conhecimentos em relação com o cuidado...

El síndrome del niño sacudido / The shaken baby syndrome

Dentro de las múltiples manifestaciones de la violencia intrafamiliar, una de las que más atención atrae es aquella dirigida hacia los niños y uno de los cuadros mas estudiados ampliamente es el Síndrome del Niño Sacudido, causado cuando un niño pequeño es tomado por un adulto del tórax y sacudido hacia atrás y adelante. El mismo es una entidad clínica reconocida por la medicina actual, con factores predisponentes y cuadro clínico identificable por el personal medico y de salud en contacto con pacientes pediátricos de corta edad. La importancia de la difusión de las características del Síndrome del Niño Sacudido es fundamental para su identificación así como también la concientización en la población de la gravedad de las consecuencias que esto conlleva para su prevención.

Among the multiple manifestations of intrafamiliar violence, one of the most alarming is the used against children; and of this one of the most studied cases are of the Shaken Baby Síndrome, caused when an adult grabs a little child from the thorax and shakes him backs and forth. It is reconized as a clinical identity by today´s medicine, with predisponent factors and identifiable clinics by the physicians and health care workers in contact with pediatric patients at early ages. The importante of the information of the characteristics of the Shaken Baby Syndrome is fundamental for its identification also the concientization of the citizenship about the serious consequences derived to enhance its prevention.

Síndrome de la niña y el niño sacudidos: hallazgos anatomoclínicos / Shaken baby syndrome: anatomoclinic features

El síndrome del niño sacudido es una de las formas más severas de maltrato infantil que ocurre principalmente en niños menores de un año. Por la vulnerabilidad de las víctimas y por las secuelas que puede producir, incluyendo la muerte, es necesario, en el abordaje clínico, tener presente la sospecha diagnóstica ante lesiones de explicación insatisfactoria por parte de los encargados del menor. Asimismo si se trata de un abordaje médico legal deben tenerse las consideraciones necesarias para documentar las lesiones, tanto en el paciente vivo, como en los casos de homicidio, para colaborar con la administración de justicia. Para ello se debe tratar de implementar una metodología homogénea para la realización de dichas pericias, tanto en la parte clínica como patológico forense. En este artículo se describe la forma habitual de presentación clínica del síndrome del niño sacudido y se expone una guía básica para la realización de autopsias medico legales en casos de muertes por esta causa.

The shaken baby syndrome is one of the most severe presentations of child abuse that is seen in children especially under the first year of age. The great vulnerability of this group of patients and the serious consequences that they may encounter in the future, including death, are enough reason to inquire, during the clinical approach, about the possibility that the patient being attended may be a victim of physical abuse. From a medico-legal evaluation, it is pertinent to document and describe thoroughly the physical lesions in the living patient and in cases of homicide, in order to contribute scientifically in the administration of justice. For that reason it is essential to follow a uniform methodology in the management of both the clinical and the forensic assessment. This article reviews the usual clinical presentation of the shaken baby syndrome and proposes a basic guide to evaluate the autopsies in cases of deaths originated by this cause.

Shaken Baby Syndrome: A Case Report

Shaken baby syndrome (SBS) is an extremely serious form of abusive head trauma that occurs when infants are subjected to rapid acceleration, deceleration, and rotational forces, with or without impact, resulting in a unique constellation of fractures, intracranial hemorrhages, and intraocular hemorrhages. Presenting complaints are often nonspecific; hence, it is important that all health care providers be able to recognize the clinical features that constitute SBS. Infants who have been shaken and injured have a high mortality rate. Approximately 25% of shaken babies die from their traumatic brain injuries. The infants who do not die may have permanent, often severe damage to their vision, hearing, thinking, and learning capabilities. They may be blind, have seizures, have spasticity, have small heads with lack of growth of brain tissues, and may be severely mentally retarded. Prevention is the best care for SBS, and community education of parents and guardians may reduce the incidence of SBS. We report a case of SBS without external signs of trauma.

Clinical Progress of Three Cases of Shaken Baby Syndrome / 대한소아신경학회지

Shaken baby syndrome develop as a form of child abuse, with the majority of cases occurring during the first year of life. It results from extreme rotational cranial acceleration and deceleration effects induced by violent shaking of an infant. The characteristic injuries include subdural and subarachnoid hemorrhages, and retinal hemorrhages. We experienced three cases of shaken baby syndrome. Although the history of trauma was little known, all of these cases had subdural hemorrhages. We present the cases with a review of related literature.

Five Cases of Shaken Baby Syndrome

Shaken baby syndrome is a serious form of child abuse, mostly involving children younger than 2 years. It results from extreme rotational cranial acceleration induced by violent shaking. The characteristic injuries include subdural hemorrhage, retinal hemorrhage, and fracture of ribs or long bones. If physicians have no recognition of, or suspicion about, shaken baby syndrome, this syndome is difficult to diagnosis because of a lack of obvious external signs and failure of the abuser to admit his or her actions. In addition to the high mortality, 60% of survivors have significant long term neurologic and developmental abnormality. The authors experienced five cases of shaken baby syndrome presented with seizures or vomiting, without external signs of trauma. All of these cases had subdural hemorrhages, and four cases had retinal hemorrahges. In our follow up, two children were found to have sequelae such as quadriplegia, monoplegia, and developmental delay. We emphasize that early recognition and prompt treament are key to overall success of case management. The incidence of shaken baby syndrome can be reduced through public awareness and education of parents not to shake a babies.

Shaken Baby Syndrome

Head injury in the youngest age group is distinct from that occurring in older children or adults because of differences in mechanisms, injury thresholds, and the frequency with which the question of child abuse is encountered. "Shaken baby syndrome" has results in intracranial and introcular hemorrhages with no evidence of external trauma. The cause of these injuries is vigorous shaking of an infant being held by the chest, shoulders, or extremities. Severe head injuries commonly diagnosed as shaking injuries require impact to occur and that shaking alone in an otherwise normal baby is unlikely to cause the shaken baby syndrome. "Shaken impact syndrome" has the advantage of being more inclusive of verifiable impact mechanisms and of reflecting the extreme forces that appear to be necessary to produce these often devastating injuries. All clinicians must recognize the wide spectrum of injuries in child abuse to ultimate protect the victim or other children in an at-risk situation. And physicians play an important role in diagnosis, management and prevention of child abuse and shaken baby syndrome.

A Case of Shaken Baby Syndrome Without External Signs of Trauma

PURPOSE: Shaken baby syndrome (SBS) can be developed by shaking a baby violently as a serious form of child abuse. It is found frequently among babies younger than two years old, particularly less than six months old. The syndrome is hardly diagnosed because it is found when the parents or baby-sitters tend to disguise the intention of abuse. The authors have experienced a case of shaken baby syndrome in 3 months old infant without the external signs of trauma and we herein report a case of SBS with a review of related literatures. METHODS: Three months old female infant was admitted for convulsion without fever. Magnetic resonance imaging showed subdural hemorrhage and funduscopic examination showed bilateral retinal hemorrhage. CONCLUSIONS: Ocular examination including funduscopy is important because SBS is difficult to be diagnosed. Ophthalmologist may play an important role in the diagnosis of this syndrome.

A Case of Shaken Baby Syndrome

Shaken baby syndrome refers to the group of nonaccidental injuries occuring in infants and children as a consequence of violent shaking. The characteristic injuries include subdural and subarachnoid hemorrhages, retinal hemorrhages, traction-typed metaphyseal fracture of long bone and fractures of the ribs. General physical findings may include bruising and burns, but sometimes no extracranial injuries are detected. Affected children are nearly always under 2 years of age or younger. Common symptoms include lethargy, irritability, seizures, increased or decreased muscle tone, poor feeding, impaired consciousness, vomiting and apnea. We experienced a case of shaken baby syndrome in a 3-month-old girl. Although the history of trauma(shaking) is little known, our findings of clinical and radiographic features corresponded to shaken baby syndrome. (J Korean Pediatr Soc 2000;43:851-855)