II. Definitions

  1. Abusive Head Trauma of Infancy (previously known as Shaken Baby Syndrome)
    1. Non-accidental injury in infants with diffuse cerebral injury with cerebral edema
    2. Occurs with or without intracerebral bleeding and Retinal Hemorrhages

III. Pathophysiology

  1. High velocity, acceleration-deceleration injury of brain
  2. Predisposing factors in infants
    1. Weak neck Muscles
    2. Large head to body ratio
    3. Incomplete brain Myelination
    4. Low body mass compared with abuser

IV. Epidemiology

  1. Represents up to 50% of deaths secondary to Child Abuse

V. Symptoms

  1. Irritability
  2. Vomiting
  3. Failure to Thrive
  4. Lethargy

VI. Signs

  1. Classic Triad
    1. Cerebral edema
    2. Subdural Hematoma
    3. Retinal Hemorrhage (85% of cases as performed by pediatric ophthalmology)
  2. Other signs
    1. Acute onset Seizure (common)
    2. Altered Mental Status
    3. Typically no other findings on external exam
    4. Fontanels bulging
    5. Altered respiratory pattern
  3. Examine for other signs of related Child Abuse
    1. See Child Abuse
    2. Facial Bruising
    3. Intraoral injuries (e.g. frenulum tears)
    4. Posterior Rib Fractures

VII. Imaging

  1. CT Head
    1. Indicated for Altered Level of Consciousness or neurologic changes (otherwise, obtain MRI Brain)
    2. Intracranial Bleeding (Subdural Hemorrhage, Subarachnoid Hemorrhage, Intraparenchymal Hemorrhage)
    3. Cerebral edema
  2. MRI Brain with diffusion weighted images
    1. Consider instead of CT Head in clinically stable infant without neurologic changes
    2. Hypoxic-ischemic injury (MRI)

VIII. Diagnosis

  1. Most predictive findings of abusive Head Trauma
  2. Apnea
  3. Seizures
  4. Retinal Hemorrhage
  5. Bruising of the head or neck
  6. Rib Fractures
  7. Long bone Fractures

IX. Differential Diagnosis

  1. See Inconsolable Crying in Infants
  2. See Seizure Causes
  3. Falls from height >1.5 meters (~5 feet)
    1. Falls from lower heights are unlikely to cause severe intracranial Trauma

X. Management: Medical stabilization

  1. ABC Management
  2. Evaluate Altered Mental Status
    1. Sepsis evaluation
      1. Urine Culture, Blood Culture, CSF Culture
      2. Empiric Ampicillin and Gentamicin or Cefotaxime
      3. Include HSV coverage if <3 weeks old
    2. Metabolic evaluation
      1. Consider VBG, CBC, basic metabolic panel, ammonia, Magnesium, Phosphorus
      2. Consider urine toxicology screen
  3. Pediatric Ophthalmology Consultation
    1. Fundoscopic Exam for Retinal Hemorrhages (found in 85% of cases)

XI. Course

  1. High mortality rate (as high as 38% of cases)
  2. Surviving infants have severe brain injury

XII. Complications

  1. Death
  2. Blindness
  3. Cerebral Palsy

XIII. References

  1. Bogdanowicz and Ponce (2020) Crit Dec Emerg Med 34(5):25
  2. Vitale (2012) Minerva Pediatr 64(6):641-7 [PubMed]

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Related Studies

Ontology: Shaken baby syndrome (C0686721)

Definition (MSH) Brain injuries resulted from vigorous shaking of an infant or young child held by the chest, shoulders, or extremities causing extreme cranial acceleration. It is characterized by the intracranial and intraocular hemorrhages with no evident external trauma. Serious cases may result in death.
Concepts Injury or Poisoning (T037)
MSH D038642
ICD9 995.55
ICD10 T74.4
SnomedCT 102458000, 68150004
Dutch shaken baby syndrome, Battered baby syndrome, NAHT, Niet-accidenteel hoofdtrauma, Parent-infant stress syndrome, Shaken baby syndrome, Shaken impact syndrome, Shaken infant syndrome, Whiplash-shaking infant syndrome
French Syndrome des enfants secoués, Syndrome du bébé secoué, SBS (Syndrome du Bébé Secoué)
Italian Sindrome del bambino scosso, Shaken baby syndrome
Portuguese Síndrome do bebé sacudido, Síndrome do Bebê Chacoalhado, Síndrome da Criança Sacudida, Síndrome do Bebê Sacudido
Spanish Síndrome del bebé sacudido, bebé sacudido, bebé zarandeado, infante sacudido, síndrome de infante maltratado (hallazgo), síndrome de infante maltratado, síndrome de infante sacudido - lesión no accidental, síndrome del bebé sacudido, síndrome del lactante sacudido (hallazgo), síndrome del lactante sacudido - lesión no accidental, síndrome del lactante sacudido, Síndrome del Bebé Sacudido
Japanese 揺さぶられっ子症候群, ユサブラレッコショウコウグン
Swedish Shaken baby-syndrom
Czech syndrom lomcovaného dítěte, Syndrom otřeseného nemluvněte
Finnish Ravistellun vauvan oireyhtymä
English shaken infant syndrome (diagnosis), shaken infant syndrome, Shaken infant syndrome, Shaken Baby Syndrome [Disease/Finding], babies shaken, shaken baby, babies shaken syndrome, baby shaken syndrome, baby shaken, shaken baby syndrome, Shaken Baby Syndrome, Shaken baby syndrome (finding), Shaken baby syndrome - non-accidental injury, Shaken baby, Shaken baby syndrome
Polish Zespół potrząsanego dziecka
Hungarian Megrázott csecsemő szindróma
German Shaken Baby Syndrom, Shaken-Baby-Syndrom, Schütteltrauma bei Kindern
Norwegian Shaken baby-syndrom