Nonaccidental Head Injury in Infants: "The Shaken Baby Syndrome Revisited"

Citation:

Conway EE Jr.: Nonaccidental head injury in infants: "The shaken baby syndrome revisited". Pediatric Annals 27(10):677-690, October 1998.

Notes:

• The classic syndrome is an infant with few or no signs of external trauma, retinal hemorrhages, and subdural hematomas.
• Because exhaustion occurs, it is surmised that most shaking probably lasts 20 seconds or less, with perhaps 40-50 shakes.
• 11 infants in a study reported here immediately lost consciousness. Ten others had delays of 1 hour or more.
• "Retinal hemorrhage, when accompanied by intracranial injuries in the absence of a verifiable history of severe accidental injury, is diagnostic of child abuse." (p. 684)
• Indicators that suggest abuse:
  • Explanations of injury are not believable or consistent, or that keep changing
  • Previous history of abuse
  • Caregiver understates the seriousness of the condition or projects blame to a third party
  • Delay in bringing child for medical care
  • Poorly kept child
  • Caregiver is hostile, aggressive, impulsive, inflexible, unreasonable, or cold.
  • Caregiver overreacts to childish misbehavior.
• Characteristics of children most at risk:
  • Premature
  • Neonatal separation
  • Multiple births
  • Congenital defects
  • Mental retardation
  • Difficult temperament
• Characteristics of caretakers most likely to abuse:
  • Abused as a child
  • Previous history of abusing children
  • Substance abuse
  • History of violence
  • Young age
  • Unemployed or financial difficulties
  • Mental illness or depression
  • Poor impulse control
  • Unmarried, lack of family or social support
• Differential diagnoses must be ruled out: bleeding diatheses, rare metabolic disorders such as osteogenesis imperfecta and glutaric aciduria type 1, vitamin K deficiency, liver desease, vol Willibrand's disease, hemophilia.

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