1. Shaken-baby syndrome. Produces a constellation of subdural and subarachnoid hemorrhage, traction-type metaphyseal fractures, and retinal hemorrhages. Largely restricted to children younger than 3 years of age, with majority of cases occurring during the first year of life (see Chapter 14, Child Abuse: Physical, p. 70).

2. Subdural hematoma. Accidental subdural hemorrhages have been reported in infants and young children after motor vehicle collisions or falls involving substantial angular deceleration. Infants with enlarged extra-axial spaces, as seen in some cases of shunted hydrocephalus, appear to be at increased risk for subdural or subarachnoid hemorrhage with lesser degrees of trauma.

3. Fracture. Clues to diagnosis include swelling, tenderness, and pseudoparalysis. Unexplained extracranial bony injuries or multiple fractures in different stages of healing are pathognomonic for abuse (see Chapter 14, Child Abuse: Physical, p. 70).

4. Corneal abrasion. Can be quite painful, with dramatic photophobia, epiphora, and resistance to opening of the eyes. Infants may present with excessive crying and not have symptoms referable to the eyes.

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