Shaken Baby Syndrome

Examinations and Tests

Shaken baby syndrome can be difficult to diagnose. The diagnosis can be complicated by:

• Vague symptoms. Irritability, sluggishness, vomiting, and a poor appetite that are often symptoms of shaken baby syndrome also occur with common illnesses, such as the flu, ear infections, stomach flu (gastroenteritis), and kidney infections.
• The lack of visible signs of injury, such as bruises or broken bones.
• One or both parents not knowing that their baby was abused.
• Caregivers not admitting when they have harmed a baby. They may make up stories to explain why a child has signs of trauma.
• Caregivers not seeking medical care right away after they have injured the child. This commonly occurs because the caregiver wants to avoid responsibility and hopes symptoms will go away after the child rests.

Health professionals may suspect shaken baby syndrome when the adults are vague or misleading about what has happened to the child, especially when symptoms are severe and indicate intentional head injury. Diagnosis is confirmed by:

• A medical history with a detailed time line of symptoms. This history includes noting changes in the child's behaviour and when they occurred. This information helps doctors determine when an injury was likely to have occurred.
• A physical examination to look for signs of injury and increased blood pressure.
• Tests to help doctors identify injuries that are commonly associated with shaken baby syndrome.
  • A computed tomography (CT) scan generally is the first test that is done to determine the presence of brain injury. Scans may be repeated to monitor the condition of the child's brain.
  • A magnetic resonance imaging (MRI) test may be used along with a CT scan. Images from this test may help doctors understand more about a child's injuries, such as when they are likely to have occurred.
  • A lumbar puncture (LP) allows a doctor to look for blood in the fluid around the child's spinal cord. The fluid may also be examined for signs of infection that may indicate meningitis as a possible cause for a child's symptoms.
  • X-rays are taken to check for broken bones. X-rays may be repeated 2 weeks later because breaks in bones are sometimes not seen until they begin to heal (healing begins 7 to 10 days after a break). The types of X-rays usually taken are:
    • Skull X-ray.
    • Extremity X-ray.
    • Spinal X-ray.
    • Chest X-ray.

A child may have blood tests to rule out other conditions, such as rare blood disorders and metabolic conditions.

Each province has its own reporting procedures for child abuse or neglect, which includes shaken baby syndrome. Generally, a health professional who suspects shaken baby syndrome must notify local child welfare officials and law enforcement agencies. The person who is suspected of injuring the baby is then questioned and evaluated along with anyone else who provided care for the child. Any other children who were cared for by the suspect should be examined. Older children are interviewed; children age 3 years and younger should have skeletal X-rays taken.

The authorities' primary goal is to protect the baby and other children in the home from further injury. The person who caused the injury may be legally charged and tried for assault.

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Author:	Debby Golonka, MPH	Last Updated: May 9, 2007
Medical Review:	Adam Husney, MD - Family Medicine Michael J. Sexton, MD - Pediatrics Andrew Swan, MD, CCFP, FCFP - Family Medicine
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