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


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

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

• Incorrect: If there is a fall or bump to the head, a mastoid fracture is possible, but the nurse suspects that the cause of the injury is shaken baby syndrome.

• Incorrect: Munchausen syndrome by proxy occurs when a caregiver exaggerates, misrepresents, or forces symptoms to occur in those for whom they are caring. Often it is done for attention or sympathy.

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

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