Repeated shaking can lead to subdural bleeding in children. Most commonly, subdural hemorrhage is seen, but subarachnoid bleeding can also occur. Another nervous system finding in children with shaken baby syndrome is brain swelling.
Violent or abusive shaking can lead to bleeding in the layers of the retina, which can be accompanied with papilledema.
Shaken baby syndrome also involves the finding of fractures of the child's ribs or bones where they have been twisted from shaking. A skeletal survey or bone scan may show fractures in various stages of healing.
A CT of the head is important for assessing the extent of injuries in a child with suspected shaken baby syndrome. Often, an MRI can be used, as these are better for imaging retinal bleeds.
A skeletal survey is a series of X-rays of all the bones in the body. This is important for detecting all of the injuriese in a child with suspected shaken baby syndrome. Often, these surveys find bones in various stages of healing from repeated abuse.
It is important to document all of the injuries found in the child. This is helpful in providing information to the authorities, as well as for proper management of the child's injuries as treatment continues.
If there is a suspicion for shaken baby syndrome, child protective services should be notified immediately. A constellation of symptoms is highly indicative of child abuse, however, it should be noted that many of these symptoms can occur from non-abusive pathologies, such as gestational trauma, vitamin C deficiency or seizure disorders.
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