An eight-month-old infant recently had a seizure and is lethargic and bradycardic upon arriving at the emergency room. The X-ray result revealed a retinal hemorrhage. The nurse suspects that the child is showing signs and symptoms of:

Shaken baby syndrome


•Characteristic signs of shaken baby syndrome include retinal hemorrhages, multiple fractures of long bones, and subdural hematomas. There is usually no external signs of injury.

•Risk factors for parents include substance abuse, unrealistic expectations for the child, and high levels of emotional stress.

•If there is a fall or bump to the head, a possible finding could be mastoid fracture, but it is not shown in this situation.

•Munchausen Syndrome by proxy occurs when a caregiver exagerates, misrepresents or forces symptoms to occur for those who they are caring for. Often it is done for attention or sympathy.

•Sexual abuse must be suspected when there are bruises, bleeding, lacerations or irritation of the external genitalia, anus, mouth or signs of verbal threats.

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