[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Forensic medicine](https://durgical.com/en/forensic-medicine/) › [Clinical forensic medicine](https://durgical.com/en/forensic-medicine/areas/clinical/) › Abusive head trauma (shaken baby) # 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. Updated Nov 5, 2026 ## Key points - Subdural haematoma, extensive retinal haemorrhages and encephalopathy in an infant without trauma to explain them: suspect abuse. - Multilayered retinal haemorrhages extending to the periphery suggest abuse. - Work-up: CT, MRI of brain and spine, skeletal survey, fundoscopy and coagulation. - The infant's crying is the typical trigger for shaking. - Mortality of about one fifth to one quarter of cases, and severe disability is common in survivors. ## 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. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/forensic-medicine/abusive-head-trauma/) ## Elsewhere in DurgiPedia - [Mandatory reporting: public health, violence and abuse](https://durgical.com/en/medical-ethics/mandatory-reporting-public-health-violence-and-abuse/) ## Connections ## Related 1 - [Child maltreatment: signs that should raise concern](https://durgical.com/en/forensic-medicine/child-maltreatment-signs-that-should-raise-concern/) ## Related conditions 1 - [Child maltreatment (physical abuse, abusive head trauma, neglect)](https://durgical.com/en/conditions/child-maltreatment/) [← All of forensic medicine](https://durgical.com/en/forensic-medicine/) 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.)](https://pmc.ncbi.nlm.nih.gov/articles/PMC7044347/) (Frontiers in Neurology (PMC), 2020); [Child Protection Evidence: Fractures (systematic review)](https://childprotection.rcpch.ac.uk/?p=1089) (Royal College of Paediatrics and Child Health, 2020); [Ley 1098 de 2006, Código de la Infancia y la Adolescencia (art. 46)](https://www.funcionpublica.gov.co/eva/gestornormativo/norma.php?i=22106) (Función Pública, Gestor Normativo, 2006). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/forensic-medicine/abusive-head-trauma/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/forensic-medicine/abusive-head-trauma/