RETINAL BLEEDINGS IN YOUNG-CHILDREN SUSPI CIOUS 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 exter nal injuries are often missing, the shaken baby syndrome may easily be overlooked. Intraocular bleeding is a major diagnostic sign and can p rove the diagnosis, if child abuse is suspected by the paediatrician. Thus critical family situations can be uncovered and long term help ca n be initiated. Patients Between 1991 and 1997 seven babies (age two t o nine months) with intraocular bleedings were examined. Diagnosis, di fferential diagnosis and prognosis of the shaken baby syndrome are pre sented with these children. Results In two of the seven children a non -accidental trauma and shaken baby syndrome was obvious. In three case s the diagnosis of a shaken baby syndrome was most probable. In one ch ild intraocular bleeding was possibly caused by a fall three months ea rlier. One child had retinal bleedings after resuscitation. In two cas es a vitrectomy was performed. The follow up was two months to six yea rs. In two children intraocular bleeding resolved completely, three ch ildren developed mild to severe amblyopia and two children became blin d. Vitrectomy could not prevent loss of sight. Conclusions Sudden cere bral symptoms or intraocular bleedings in otherwise healthy young chil dren are suspicious for child abuse. A shaken baby syndrome has to be considered. Thus funduscopic examination in mydriasis is obligatory. T he prognosis depends on the severeness of ocular hemorrhages and cereb ral leasions.