Retinal bleedings in young children suspicious for the shaken baby syndrome

Background The shaken baby syndrome is a form of child abuse in young children. Typical are intracranial and intraocular bleedings. As external injuries are often missing, the shaken baby syndrome may easily be overlooked. Intraocular bleeding is a major diagnostic sign and can prove the diagnosis, if child abuse is suspected by the paediatrician. Thus critical family situations can be uncovered and long term help can be initiated. Patients Between 1991 and 1997 seven babies (age two to nine months) with intraocular bleedings were examined. Diagnosis, differential diagnosis and prognosis of the shaken baby syndrome are presented with these children. Results In two of the seven children a non-accidental trauma and shaken baby syndrome was obvious. In three cases the diagnosis of a shaken baby syndrome was most probable. In one child intraocular bleeding was possibly caused by a fall three months earlier. One child had retinal bleedings after resuscitation. In two cases a vitrectomy was performed. The follow up was two months to six years. In two children intraocular bleeding resolved completely, three children developed mild to severe amblyopia and two children became blind. Vitrectomy could not prevent loss of sight. Conclusions Sudden cerebral symptoms or intraocular bleedings in otherwise healthy young children are suspicious for child abuse. A shaken baby syndrome has to be considered. Thus funduscopic examination in mydriasis is obligatory. The prognosis depends on the severeness of ocular hemorrhages and cerebral leasions.