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Shaken Baby Syndrome

Fig. 1 Blood vessels in babies are fragile which makes the brain and eyes more susceptible to bleeding from non-accidental trauma.

What is shaken baby syndrome?

Shaken baby syndrome (SBS) is a constellation of findings (including serious brain injury) that occurs when a baby is shaken repeatedly or the head impacts a hard object. Many cases occur when a frustrated caretaker shakes a crying baby in an effort to quiet the baby. Baby heads are disproportionately large and the blood vessels are fragile, which makes the brain and eyes more susceptible to bleeding from non-accidental trauma [See figure 1]. The bleeding can lead to permanent eye and/or brain damage.

Why is an eye examination done?

The eyes are examined in suspected cases of SBS for bleeding (retina hemorrhage) in the retina. Hemorrhage may occur above (pre-retina), within (intra-retina), or underneath (sub-retina) the retina. The retina may also be split in half (retinoschisis).

How is the inside of the eye examined?

Dilating eye drops are administered to enlarge the pupil and facilitate the view of the retina. The retina is visualized using an ophthalmoscope and special lenses. Fundus photographs are sometimes obtained.

Are other tests done to evaluate for SBS?

An eye examination is part of a systemic wide evaluation of a baby suspected of having SBS. The evaluation usually includes brain imaging (MRI or CT scan), bone x-rays (looking for fractures) and a social evaluation to asses for abuse risk. In addition, blood tests are usually performed to check for other conditions such as bleeding disorders.

Do babies suffer permanent damage from shaken baby syndrome?

Retina hemorrhages often resolve spontaneously, but amblyopia can develop quickly in an infant when vision is blocked by the hemorrhage. If the blood does not clear within weeks-months, eye surgery to remove the blood before amblyopia develops may be indicated. Permanent damage to vision can also occur as a result of direct eye and/or brain injury. Scarring of the retina and/or atrophy of the optic nerve may become evident months after the injury. In addition, brain injury may result in developmental delay, seizure, paralysis, and even death.

Where can I learn more about shaken baby syndrome?

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