Findings in Older Children With Abusive Head Injury: Does Shaken-Child Syndrome Exist?

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.

Retinal haemorrhages and related findings in abusive and non-abusive head trauma: a systematic review

“…11,12,14,15,17,18,47,56,61,64,66 (Vinchon raw data set)13, 16,67 Data set 2: Highly selected case series/studies with o10 subjects each. 3,[5][6][7][48][49][50][51][52][53][54][55][57][58][59][60]62,63,65,68 Data set 3: Both of the above data sets combined.…”

Abusive Head Trauma: Judicial Admissions Highlight Violent and Repetitive Shaking

“…The main goal is to take appropriate action with regard to the offender and prevent new episodes of violence against the child, siblings, or even other children in the neighborhood. 18,19 With early identification of shaken infants, families can be offered adequate social interventions.…”

Retinal Hemorrhages in Low-Risk Children Evaluated for Physical Abuse

“…12 It is important to recognize that AHT can occur in older children 20 and that the possibility of RH should be considered in these children. Our data suggest that the low-risk criteria identified by Thackeray and colleagues may also be relevant in older children.…”