Findings in older children with abusive head injury

Does shaken-child syndrome exist?

Hani Salehi-Had, James D Brandt, Angela J. Rosas, Kristen K. Rogers

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Shaken-baby syndrome (SBS) has been hypothesized to occur after shaking by an adult during the first 2 years of life. We wondered whether it is possible to achieve rotational forces sufficient to cause SBS-like injuries in children >2 years of age. The present study describes cases of child abuse in older children who presented with the classic ophthalmologic and intracranial findings of SBS. In this case series, 4 cases of older children (2.5-7 years old; 11.8-22 kg) who died from abusive head injuries and who had diffuse retinal hemorrhages identified antemortem were selected for review. The cases were abstracted from hospital charts, records from autopsies, coroners' and district attorneys' offices, and court transcripts. In all 4 cases the history provided by the primary caregiver did not match the severity of the injuries. Three case subjects presented with patterned bruises. Multilayered retinal hemorrhages and acute subdural hematoma were observed in all 4 cases. At autopsy, diffuse axonal injury was evident in 3 of the 4 cases; all 4 cases had optic nerve sheath hemorrhages. None of the victims had skeletal fractures on radiologic examination or at autopsy. This case series demonstrates that it is possible to observe SBS-like retinal and central nervous system findings in the older and heavier child. Our findings underscore the need for providers to consider intentional shaking as a mechanism of injury in the evaluation of abusive head injury in older children.

Original languageEnglish (US)
JournalPediatrics
Volume117
Issue number5
DOIs
StatePublished - May 2006

Fingerprint

Shaken Baby Syndrome
Craniocerebral Trauma
Retinal Hemorrhage
Autopsy
Wounds and Injuries
Diffuse Axonal Injury
Hematoma, Subdural, Acute
Coroners and Medical Examiners
Lawyers
Hospital Records
Contusions
Child Abuse
Optic Nerve
Caregivers
Central Nervous System
History
Hemorrhage

Keywords

  • Child abuse
  • Retinal hemorrhages
  • Shaken-baby syndrome

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Findings in older children with abusive head injury : Does shaken-child syndrome exist? / Salehi-Had, Hani; Brandt, James D; Rosas, Angela J.; Rogers, Kristen K.

In: Pediatrics, Vol. 117, No. 5, 05.2006.

Research output: Contribution to journalArticle

Salehi-Had, Hani ; Brandt, James D ; Rosas, Angela J. ; Rogers, Kristen K. / Findings in older children with abusive head injury : Does shaken-child syndrome exist?. In: Pediatrics. 2006 ; Vol. 117, No. 5.
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