A long, but good, article describing some of what they look for in pediatric abusive head trauma.
Pediatric abusive head trauma (AHT) most often involves brain injury of infants and young children. Another term for this condition is shaken baby syndrome (SBS). Shaking, blunt impact or the combination can result in neurological injury. AHT is the most dangerous and deadly form of child abuse...
www.ncbi.nlm.nih.gov
Examples:
Retinal Hemorrhages
Retinal hemorrhages are usually more severe in abusive head trauma than an accidental blunt head injury. Retinal hemorrhage is also significantly more common in abusive head trauma than occurs in infants injured accidentally. Retinal hemorrhage in abusive head trauma involves most of the retina, from the ora serrata to the posterior pole of the eye.
Obtaining an ophthalmology consultation within the first 24 hours is important. Small-dot or superficial hemorrhages often resolve quickly. Less dramatic retinal hemorrhages are also found in children as a result of many other causes, such as accidental head trauma, anemia, birth trauma, coagulopathy, cerebral aneurysm, leukemia, and meningitis. As a result, healthcare providers should not use retinal hemorrhage alone to diagnose abusive head trauma. Further, the absence of retinal hemorrhage confined to the posterior pole also does not rule out abuse.
Subdural Hematoma
A subdural hematoma is a common finding in abusive head trauma. Acceleration-deceleration force causes the brain to move within the fixed venous channels and skull. Hemorrhages occur in the subarachnoid and subdural space if there is tearing of the superficial cortical veins.
Rib Fractures
Rib fractures in an infant are common with child abuse. They occur by squeezing the infant’s chest, which generates anterior-posterior compressive forces resulting in fractured ribs. Accidental rib fractures are very uncommon. Most caregivers will deny a history of trauma. The fractures are detected on routine chest X-rays or a skeletal survey. Rib fractures from CPR are also very rare. Essentially, any infant or child with a rib fracture and a history that does not strongly support legitimate trauma should induce further clinical investigation, which should include a chest X-ray and a skeletal survey.
Skull Fractures
Skull fractures are a result of a direct force applied to the head. They may be due to accidental or inflicted head trauma. Abusive head trauma should be considered when the fracture is complex, diastatic (width greater than 3 mm), multiple, occipital, and non-parietal. Any of these types of skull fractures should suggest the possibility of abusive head trauma.