Abusive head trauma (shaken baby)
- Finding
Brain injury inflicted on an infant or young child by shaking, impact or both; it often causes death or severe disability.
What it is
Abusive head trauma is injury to the skull, brain or cervical spinal cord inflicted on a young child by violent shaking, impact or both. It mainly affects children under two and is often a response to the baby's crying. Presentation can be non-specific (irritability, vomiting, drowsiness) or severe (apnoea, seizures, coma). No single finding makes the diagnosis: it rests on the combination of intracranial, ocular and skeletal injuries, and an account that does not explain them.
How to tell it apart
- Accidental short fall: usually a focal injury (linear fracture, epidural haematoma) with a coherent account; extensive retinal haemorrhages are rare.
- Birth trauma: small retinal and subdural haemorrhages in newborns that resolve within weeks.
- Exclude coagulopathies and metabolic diseases (for example, glutaric aciduria type 1) before concluding.
- Imaging cannot reliably date a subdural haematoma.
How to recognise it
- Subdural haematoma, often in several sites (convexity, interhemispheric, posterior fossa) or of mixed density.
- Extensive, bilateral, multilayered retinal haemorrhages reaching the periphery, or retinoschisis.
- Hypoxic-ischaemic injury and cerebral oedema.
- Associated injuries: rib fractures, classic metaphyseal or complex skull fractures, and bruises in protected areas.
- Symptoms: apnoea, seizures, vomiting without diarrhoea, irritability, lethargy and increasing head circumference.
- No account, or a short fall that does not explain the severity.
How it forms
- Shaking causes rotational acceleration and deceleration of a large head on a weak neck, tearing bridging veins and injuring brain tissue.
- Impact adds fractures and contusions; apnoea and hypoxia worsen the brain injury.
- The infant's crying is the most reported trigger, and shaking is often repeated.
Next step: what to do and document
- Stabilise and order a non-contrast head CT; complete with MRI of the brain and spine once the child is stable.
- Order a full skeletal survey, fundoscopy by ophthalmology and coagulation studies.
- Document each caregiver's account separately, with times and witnesses.
- Protect the child and siblings: notify the ICBF and report to the Fiscalía or the judicial police (Law 1098 of 2006, art. 46, item 10).
- Official text checked on 2026-11-05 at funcionpublica.gov.co.
Common mistakes
- Attributing the picture to gastroenteritis or infection without fundoscopy or imaging.
- Not doing a skeletal survey and eye exam in an infant with a subdural haematoma and no clear trauma.
- Dating the subdural haematoma from its imaging appearance alone.
- Accepting a short fall from a bed as the explanation for severe, multiple injuries.
Test yourself
Think of the answer, then tap the question to see it.
Which eye findings suggest abusive head trauma?
Extensive, bilateral, multilayered retinal haemorrhages reaching the periphery, or retinoschisis.
Which studies are ordered for an infant with a subdural haematoma and no trauma to explain it?
CT and MRI (brain and spine), a full skeletal survey, fundoscopy and coagulation studies.
What is the most reported trigger for shaking a baby?
The infant's crying; shaking is often repeated because the crying stops.
Which differential diagnoses must be excluded in abusive head trauma?
Accidental trauma with a coherent account, birth trauma, coagulopathies and metabolic diseases such as glutaric aciduria type 1.
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Educational content on forensic and legal medicine; not legal advice and no substitute for the technical guides of Colombia's National Institute of Legal Medicine and Forensic Sciences. Laws change: each page links the official text and says when it was last checked. For a real case, follow the guide in force and ask the competent authority.
Sources: Advances and future directions of diagnosis and management of pediatric abusive head trauma: a review of the literature (Iqbal O'Meara AM et al.) (Frontiers in Neurology (PMC), 2020); Child Protection Evidence: Fractures (systematic review) (Royal College of Paediatrics and Child Health, 2020); Ley 1098 de 2006, Código de la Infancia y la Adolescencia (art. 46) (Función Pública, Gestor Normativo, 2006).
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