Shaking-impact syndrome of infancy.

Shaking-impact syndrome (SIS) is a leading cause of traumatic brain injury in infants and young children. Evaluation of these children requires a detailed history and physical examination as well as documentation of intracranial injury with neuroimaging, a dilated fundoscopic examination, a skeletal survey and other laboratory studies. Debate still exists as to the exact mechanisms of brain injury in these patients. The various contributions of shaking alone, shaking with impact, and apnea are discussed. Differences of injury type and severity between accidental traumatic brain injury and SIS are delineated. The long-term neurodevelopmental outcome for survivors of SIS is generally poor. Because few treatment options are successful in reducing the morbidity and mortality of this syndrome, prevention may be the only reasonable solution.