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The ramifications of failing to diagnose child abuse in any of its iterations are enormous. Most shaken children, the subject of the article by Binenbaum and colleagues1 in this issue of JAMA Ophthalmology, are younger than 2 years and often present with additional findings of central nervous system injury, lethargy (or worse), and other signs of poorly explained trauma. Not every child presents in this fashion. Shaking can occur along a continuum, with some infants showing retinal hemorrhages only, at least at first. Shaking is only one aspect of a constellation of problems the affected infant confronts.
Good WV. Association of Vaccinations in Young Children and Retinal Hemorrhages. JAMA Ophthalmol. 2015;133(11):1266. doi:10.1001/jamaophthalmol.2015.3017