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Neonatal Injuries in Child Abuse Follow-up

  • Author: Nitin C Patel, MD, MPH, FAAN; Chief Editor: Amy Kao, MD  more...
Updated: May 15, 2015

Further Outpatient Care

See the list below:

  • The patient may require continued physical and occupational therapy after discharge.
  • Continued follow-up with a neurologist is recommended.
  • Closely watch the patient for spasticity, and control this with medication as needed.

Further Inpatient Care

See the list below:

  • Further inpatient rehabilitation therapy may be indicated to manage the acute intracranial pathology, depending on the severity of injury.
  • If long-term inpatient care is required, the patient should be transferred to a pediatric rehabilitation unit for maximal multidisciplinary care.

Inpatient & Outpatient Medications

See the list below:

  • Antiepileptic medication may be indicated if evidence of seizures is noted.
  • Neurosurgeons tend to prescribe prophylactic therapy for all patients. However, this practice is not a universal recommendation.


The main complications after shaken baby syndrome affect the neurologic and visual systems.

After retinal hemorrhages resolve, the following visual complications may occur: macular thinning, retinal pigment epithelial atrophy, and visual loss.

Wilkinson et al showed that the degree of retinal hemorrhage reflects the degree of neurologic injury.[16]

Patients with bilateral retinal hemorrhages tend to have acute, severe neurologic injury.

Large subhyaloid hemorrhage, vitreous hemorrhage, or diffuse involvement of the fundus is likely to be associated with severe neurologic injury.

Neurologic complications include varying degrees of learning disabilities, spasticity and weakness, hydrocephalus, developmental delay, acquired microcephalus, seizures, hearing loss, and cortical blindness.



The prognosis depends on the severity of the neurologic injury and the involvement of other organ systems.


Patient Education

For excellent patient education resources, visit eMedicineHealth's Children's Health Center. Also, see eMedicineHealth's patient education article Child Abuse.

Contributor Information and Disclosures

Nitin C Patel, MD, MPH, FAAN Professor of Clinical Pediatrics and Neurology, Southern Illinois University School of Medicine; Private Practice, Columbia Center for Child Neurology

Nitin C Patel, MD, MPH, FAAN is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, American Headache Society, Child Neurology Society

Disclosure: Nothing to disclose.


Bhagwan I Moorjani, MD, FAAP, FAAN Consulting Staff, Department of Neuroscience, Director, Department of Neuroscience, Division of Evoked Response Laboratory, Children's National Medical Center

Bhagwan I Moorjani, MD, FAAP, FAAN is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Robin D Riggins, RN, MSN, CPNP Pediatric Nurse Practitioner, Department of Pediatric Neurology, University of Missouri Health Care Hospitals and Clinics

Robin D Riggins, RN, MSN, CPNP is a member of the following medical societies: National Association of Pediatric Nurse Practitioners, American Association of Neuroscience Nurses

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Kenneth J Mack, MD, PhD Senior Associate Consultant, Department of Child and Adolescent Neurology, Mayo Clinic

Kenneth J Mack, MD, PhD is a member of the following medical societies: American Academy of Neurology, Child Neurology Society, Phi Beta Kappa, Society for Neuroscience

Disclosure: Nothing to disclose.

Chief Editor

Amy Kao, MD Attending Neurologist, Children's National Medical Center

Amy Kao, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, Child Neurology Society

Disclosure: Have stock from Cellectar Biosciences; have stock from Varian medical systems; have stock from Express Scripts.

Additional Contributors

Robert Stanley Rust, Jr, MD, MA Thomas E Worrell Jr Professor of Epileptology and Neurology, Co-Director of FE Dreifuss Child Neurology and Epilepsy Clinics, Director, Child Neurology, University of Virginia School of Medicine; Chair-Elect, Child Neurology Section, American Academy of Neurology

Robert Stanley Rust, Jr, MD, MA is a member of the following medical societies: Child Neurology Society, Society for Pediatric Research, American Headache Society, International Child Neurology Association, American Academy of Neurology, American Epilepsy Society, American Neurological Association

Disclosure: Nothing to disclose.

  1. Caffey J. Multiple fractures in long bones of infants suffering from chronic subdural hematoma. AJR Am J Roentgenol. 1946. 36:163-73.

  2. Kempe CH, Silverman FN, Steele BF, et al. The battered-child syndrome. JAMA. 1962 Jul 7. 181:17-24. [Medline].

  3. Gilkes MJ, Mann TP. Fundi of battered babies. Lancet. 1967. 2:468-9.

  4. Caffey J. On the theory and practice of shaking infants. Its potential residual effects of permanent brain damage and mental retardation. Am J Dis Child. 1972 Aug. 124(2):161-9. [Medline].

  5. Geddes JF, Hackshaw AK, Vowles GH. Neuropathology of inflicted head injury in children. I. Patterns of brain damage. Brain. 2001 Jul. 124(Pt 7):1290-8. [Medline].

  6. Geddes JF, Vowles GH, Hackshaw AK, et al. Neuropathology of inflicted head injury in children. II. Microscopic brain injury in infants. Brain. 2001 Jul. 124(Pt 7):1299-306. [Medline].

  7. HHS. U.S. Department of Health and Human Services: Administration for Children and Families. Child Maltreatment 2011. [Full Text].

  8. Missouri Department of Social Services Children's Division. Missouri Child Fatality Review Program Annual Report from 2011. Available at Accessed: June 24, 2013.

  9. Bates B. Abused Moms Are More Likely to Spank Infants. Pediatric News. July 2008. Available at

  10. Kanter RK. Retinal hemorrhage after cardiopulmonary resuscitation or child abuse. J Pediatr. 1986 Mar. 108(3):430-2. [Medline].

  11. Brian Forbes, MD, MPH. Abusive head trauma in infants and young children: Ophthalmologic aspects. UpToDate. Available at Accessed: July 27, 2011.

  12. Cindy Christian, MD Erin E Endom, MD. Evaluation and diagnosis of abusive head traum in infants and children. UpToDate. Available at Accessed: July 27, 2011.

  13. Madonna Behen. Abusive Head Trauma in Infants Doubled During Recession: Study. US News And World Report. Available at http://health.usnews.con/health-news/family-health/brain-and-behavior/articles/2011/04/13. Accessed: July 22, 2011.

  14. Christian CW. The evaluation of suspected child physical abuse. Pediatrics. 2015 May. 135(5):e1337-54. [Medline].

  15. Christian CW, Block R. Abusive head trauma in infants and children. Pediatrics. 2009 May. 123(5):1409-11. [Medline].

  16. Ludwig S, Warman M. Shaken aby Syndrome: a reiew of 20 cases. Ann Emerg Med. 1984 Feb. 13 (2):104-7.

  17. Alexander R, Sato Y, Smith W, Bennett T. Incidence of impact trauma with cranial injuries ascribed to shaking. Am J Dis Chld. 1990 June. 144(6):724-6.

  18. Andreadou E. Yapijakis C, Paraskevas GP, et al. Hereditary neruopathy with liability to pressure palsies: the same molecular defect can result in diverse clinical presentation. J Neurol. 1996 Mar. 243 (3):225-30.

  19. Bruce DA, Zimmerman RA. Shaken impact syndrome. Pediatr Ann. 1989 Aug. 18 (8):482-4, 486-9, 492-4.

  20. Coody D, Brown M, Montgomery D, et al. Shaken baby synddrome: identification and prevention for nurse prctitioners. J Pediatr Health Care. 1994 Mar-Apr. 8(2):50-6.

  21. Donohoe M. Shaken baby syndome (SBS) and non-accidential injuries (NAI). Vaccine Website. Available at Accessed: March 18, 2009.

  22. Duhaime AC, Alario AJ, Lewander WJ, et al. head injury in very young children: mechanisms, injury types, and ophthalmologic findings in 100 hospitalized patients younger than 2 years of age. Pediatrics. 1992 Aug. 90 (2 Pt 1):179-85.

  23. Duhaime AC. Gennarelli TA, Thibault LE, et al. The shaken baby syndrome. A clinical, pathological, and biomechinical study. J Neurosurg. 1987 Mar. 66(3):409-15.

  24. Ewigman B, Kivlahan C. Child maltreatment fatalities. Pediatr Ann. 1989. 18(8):476-8, 480-1.

  25. Geddes JF, Plunkett J. The evidence base for shaken baby syndrome. BMJ. 2004 Mar 27. 328(7442):719-20.

  26. Giardino AP, Christian CW, Guardino ER. A Practical Guide to the evaluation of Child Physical Abuse and Neglect. Thousand Oaks, Calif: Sage. 1997.

  27. Hahn YS, Raimondi AJ, McLone DG, Yamanouchi Y. Traumatic mechanisms of head injury in child abuse. Childs Brain. 1983. 10(4):229-41.

  28. Ingrahan FD, Matson DD. Subdural hematoma in infancy. J Pediatr. 1944. 24:1-37.

  29. Lancon JA, Haines DE, Parnet AD. Anatomy of the shaken baby syndrome. Anat Rec. 1998 Feb. 253(1):13-8.

  30. Manning SC, Casselbrant M, Lammers D. Otolaryngologic manifestations of child abuse. Int J Pediatr Otorhinolaryngol. 1990 Sep. 20(1):7-16.

  31. Singer HS, Kossoff EH, Hartman AL, Crawford TO. Shaken baby syndrome (shaken-impact syndrome). Treatment of Pediatric Neurologic Disorders. Taylor& Francis; 2005. 329-344.

  32. Spaide RF, Swengel RM, Scharre DW, Mein CE. Shaken baby syndrome. Am Fam Physician. 1990 Apr. 41(4):1145-52.

  33. Truth Foundation. Shaken Baby Syndrome: Questions and Controversies. Truth Foundation. Available at

  34. US Department of Health and Human Services. Administration for Children and Families. Factsheets/Publications. Child Maltreatment Reports. Child Maltreatment 2006: Reports from the States to the National Child Abuse and Neglect Data Systems. Available at http://hyyp://www.acf/

  35. Wilkinson WS, Han DP, Rappley MD, Owings CL. Retinal hemorrhage predicts neurologic injuryi n the shaken baby syndrome. Arch Ophthalmol. 1989 Oct. 107 (10):1472-4.

CT scan shows a subdural hematoma.
CT scan shows cerebral edema with loss of gray matter–white matter distinction.
T1-weighted MRIs reveal bilateral chronic subdural hematomas as well as severe encephalomalacia involving the parietal, occipital, and temporal lobes.
T1-weighted MRIs show chronic bilateral subdural hematomas.
T2-weighted MRIs show encephalomalacia after shaken baby syndrome.
Sagittal MRIs show chronic subdural hematoma.
Funduscopic image shows intraretinal hemorrhages, subhyaloid hemorrhages, localized hemorrhagic choroid detachments, and thin retinal folds.
Flair and T2 images reveal intrahemispheric bleeding.
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