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Paramedics or parents rush in a child who is not breathing, lethargic, comatose or experiencing seizures.The trauma team, after examining the baby, calls in the attending ophthalmologist to confirm what they may suspect: shaken baby syndrome, the leading cause of death in child abuse cases in the United States.Eappen stressed that ophthalmologists are on the “front lines” in terms of detecting child abuse and reporting any suspected cases—a position reiterated by Dr.

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They will need long-term follow-up care and may require low-vision evaluations, treatment for amblyopia or vitreous surgery.”Dr.

Eappen called for the Academy to treat SBS as it does any other life-threatening diagnosis.

This tragic experience has prompted her to start a foundation for her son ( and to speak across the country about diagnosing SBS and documenting the clinical findings.

She spoke to her Academy colleagues at the Mid-Year Forum in Washington, D.

C., this spring, and one literally could hear a pin drop as she told her story. Eappen notes that she does not remember actually learning about SBS during her residency at Tufts University in the early 1990s. In fact, while there is more awareness about SBS today, it still represents a taboo subject, and oftentimes physicians would rather find some other explanation for retinal hemorrhage than child abuse.

However, this retinal hemorrhage is distinctive—not even severe motor vehicle accidents cause this type of bleeding.”Documentation Is Essential Dr.The differential diagnosis for retinal hemorrhage in this age group includes leukemia, low blood platelets and clotting disorders, said Dr. History and clinical examination, along with the retinal hemorrhage, helps in making the SBS diagnosis.” Conversely, he said, the absence of retinal hemorrhages does not exclude the diagnosis of SBS.Yet the presence of retinal hemorrhage in a suspicious situation makes the diagnosis very likely.“The diagnosis is suspected by the pediatric, trauma or intensive care team.And the ophthalmic findings, when present, are not subtle, but rather obvious.”One of the striking things about retinal hemorrhage and SBS is that this clinical sign in toddlers is relatively unusual. Donahue added, “Other problems can cause retinal hemorrhages, but those are typically very different and the underlying clinical setting is also different.There have, however, been documented cases of shaking which produced no injury.