An infant presents with seizures, lethargy, poor feeding, and bilateral retinal hemorrhages. The presentation is most consistent with which diagnosis?

• A. Child abuse (shaken baby syndrome)
• B. Meningitis
• C. Febrile seizure
• D. Leukemia

Answer: (A)

When an infant presents with seizures, lethargy, poor feeding, and bilateral retinal hemorrhages, think about abusive head trauma from shaking. The rapid acceleration‑deceleration forces can cause brain injury with seizures and lethargy, and the same forces can rupture fragile retinal vessels, producing bilateral retinal hemorrhages. This combination is a classic clue to nonaccidental trauma in infants and helps explain the neurologic symptoms.

Meningitis can cause seizures and lethargy but retinal hemorrhages are not a typical key finding. Febrile seizures occur with fever and usually don’t involve retinal hemorrhages or the same level of neurologic injury. Leukemia can cause fatigue and systemic symptoms, but this presentation with retinal hemorrhages and acute neurologic signs in an infant points much more toward abusive head trauma.