Symptoms:

The symptoms can vary from mild to severe. They may include:

• Extreme irritability or other changes in behavior
• Lethargy, sleepiness, not smiling
• Poor feeding, lack of appetite
• Decreased alertness
• Loss of consciousness
• Pale or bluish skin
• Vomiting
• Convulsions (seizures)
• Not breathing

There are usually no physical signs of injury, such as bruising, bleeding, or swelling. In some cases, the condition can be difficult to diagnose and may not be identified during an office visit. However, rib fractures are common and can be seen on x-ray.

An ophthalmologist examining the infant's eyes may bleeding behind the eye or retinal detachment. There are, however, other causes of bleeding behind the eye and they should be ruled out before making a diagnosis of shaken baby syndrome. Other factors must be considered.