Retinal and subdural haemorrhages from minor falls?

Retinal and subdural haemorrhages with or without occult bone fractures in children aged <3 years is a characteristic presentation of the shaken baby syndrome (SBS) with or without blunt head impact.1–3 The signs may pose diagnostic dilemmas resulting from an inconsistent history given by the child’s caretakers and the frequent absence of evidence of external injury. Accidental blunt impact that leads to subdural haemorrhage is usually associated with significant trauma, skull fractures and only rare cases of retinal haemorrhage. There is abundant evidence that minor head trauma, in the absence of underlying medical conditions such as osteogenesis imperfecta type I,4 is only very rarely associated with severe intracranial injury or retinal haemorrhage, particularly the extensive multilayered haemorrhages extending to the ora serrata, as seen in two thirds of the victims with SBS.1–3,5 A letter in the …