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There are various signs and symptoms of AHT. The consequences of less severe cases may not be brought to the attention of medical professionals and may never be diagnosed. In most severe cases, which usually result in death or severe neurological consequences, the child becomes immediately unconscious and suffers rapidly escalating, life-threatening central nervous system dysfunction (NCSBS, nd).
The symptoms can vary from mild to severe. They may include (Adamsbaum, et al., 2010; Levin, 2010; Chiesa & Duhaime, 2009; NIH, 2009; NCSBS, nd; Reece & NCSBS,
ndf; ):
- Decreased responsiveness
- Decreased level of consciousness, alertness, lethargy, sleepiness
- Hypotonia, or decreased muscle tone; limp arms and legs
- Rigidity or posturing
- Extreme irritability, or other changes in behavior, especially fussy, whiny, and fretful behavior, despite attempts at comforting and soothing
- Not smiling or vocalizing
- Loss of consciousness
- Loss of vision
- Seizures
- Apnea, or periods of no breathing
- Dyspnea, or difficulty breathing
- Tachypnea
- Bradycardia
- Pale or bluish skin
- Poor feeding, lack of appetite
- Poor sucking or swallowing
- Vomiting
- Head or forehead appears larger than usual or soft-spot on head appears to be bulging
- Inability to lift head
- Fixed dilated pupils, pupils of unequal responsiveness and size
- Subdural hematoma
- Coma
- Rib fractures
- Inability of eyes to focus or track movement or unequal size of pupils
- Closed head injury
- Central nervous system injury as evidenced by central nervous system hemorrhaging
- Heart may stop
- Death
The characteristic injuries of AHT are subdural hemorrhages (bleeding in the brain), retinal hemorrhages (bleeding in the retina), damage to the spinal cord and neck, and fractures of the ribs and the ends of long bones (Case & NCSBS, nde). These injuries may not be immediately noticeable. AHT injuries usually occur in children younger than 2 years old, but may be seen in children up to the age of 5 (NINDS, 2010). Babies, newborn to one year (especially babies ages 2 to 4 months), are at greatest risk of injury from shaking (CDC, ndb).
The most commonly described symptoms include: Vomiting, seizure, apnea, lethargy and poor feeding (Chiesa & Duhaime, 2009). But because these symptoms can be an indication of a range of health problems, they may not be diagnosed as AHT.
There may not be any physical signs of injury, such as bruising, bleeding, or swelling. According the National Center for Shaken Baby Syndrome (NCSBS) (nd), grab-type bruises on arms or chest are rare. In some cases, the condition can be difficult to diagnose and may not be identified during an office visit. However, rib fractures are common and can be seen on x-ray (NIH, 2009).
Retinal bleeding is very common. Indeed it is considered a cardinal manifestation of abusive head trauma by some authors (Levin, 2009; Levin, 2010). There may be retinal detachment, which is a separation of the retina (the light-sensitive membrane in the back of the eye) from its supporting layers. Documented incidence of retinal hemorrhages in abusive head injury cases has ranged from 35-100%, more typically a rate of about 80% (Chiesa & Duhaime, 2009). There are, however, other factors must be considered (NIH, 2009) since other causes of bleeding behind the eye should be ruled out before diagnosing shaken baby syndrome. Retinal hemorrhages are a very rare occurrence after cardiopulmonary resuscitation and are typically minor when compared to child abuse cases (Chiesa & Duhaime, 2009). Continue on to Consequences of Abusive Head Trauma
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