Shaking a child or an infant may cause a fatal head injury without external marks. Violent shaking may cause nerve damage, brain swelling, and slight bleeding on and over the brain. Retinal hemorrhages may also occur, but these can only be seen with an ophthalmoscope unless the eyes are removed at autopsy. There may be contusions on the arms or chest where the infant was grabbed while being shaken. Other blunt impact injuries are often present.
A child usually becomes unconscious or noticeably abnormal within minutes of the violent act. Since there may be no obvious signs of abuse, emergency room personnel may not be suspicious of any foul play. An investigation should be conducted on any child who is dead on arrival or dies in the emergency room. If a child dies in an emergency room, the scene of injury should be visited and investigated.
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