When his mother returned to work after maternity leave, Umar was placed at the same childcare centre his older brother had attended for over a year. There was no reason for his parents to worry.
Then one morning, about two months ago, Umar’s mother received a phone call saying her baby was having trouble breathing.
“My wife and I rushed to the childcare centre. When we arrived, Umar was weak and unconscious. We took him to a clinic immediately before he was referred to a hospital,” said his father, who asked to be known only as Siddiq.
Doctors initially suspected a lung infection but further investigations, including an MRI scan, revealed a far more serious cause. Despite having no visible bruises or wounds, Umar had suffered a severe internal head injury believed to have been caused by violent shaking.
The hospital lodged a police report and referred the case to Universiti Malaya Medical Centre (PPUM), where it was managed by the Suspected Child Abuse and Neglect team.
Umar’s case highlights a dangerous and often overlooked form of abuse known medically as non-accidental injury (NAI): injuries that are not consistent with the explanation given, the child’s developmental stage, or accidental trauma.
According to PPUM clinical specialist in general paediatrics Dr Kong Sik Thien, NAI frequently involves the head and eyes, particularly in infants.
“In cases of head abuse, babies often develop subdural haemorrhage, which is bleeding beneath the lining of the brain. This can lead to brain swelling, seizures and breathing difficulties – and, in some cases, require emergency surgery,” she said.
One of the greatest challenges, she added, is that many infants show no obvious external signs in the early stages.
“Sometimes there are subtle signs parents may overlook, such as unexplained bruises. Bruising in babies who are not yet crawling or walking is illogical and should be taken seriously,” she said, citing marks on the back, buttocks, or bruises resembling lines or finger imprints as red flags.
NAI is not rare: Kong said PPUM treats more than 200 child abuse and neglect cases annually, some of which involving serious brain and eye injuries. Most of these patients are under one year old.
“All cases involving brain and eye injuries are usually very serious and most require intensive care. Some cases have resulted in death,” she said.
An internal PPUM study of over 70 cases in the past seven to eight years found that about 60-70% of incidents occurred while infants were under the care of non-family members.
Diagnosing NAI, Kong stressed, is never done lightly.
“We obtain a full account from caregivers, examine the baby, conduct brain imaging and full-body X-rays. If injuries cannot be reasonably explained, suspicion becomes stronger,” she said, adding that injury patterns involving multiple areas of the brain or eyes are rarely seen in ordinary accidents.
Eye examinations are also crucial – PPUM consultant ophthalmologist Dr Nurliza Khaliddin said violent shaking can cause retinal haemorrhages that mirror brain injury severity.
“When a baby is shaken, the optic nerves and blood vessels are also affected. Severe eye findings usually indicate severe brain injury,” she explained.
Such injuries can have lifelong consequences. “These injuries can lead to amblyopia, or lazy eye, which cannot be corrected. Some children may appear to recover physically, but later develop learning difficulties or delayed cognitive development,” she added.
On prevention, Kong urged parents to ensure childcare centres are registered and adequately staffed, and to observe their baby’s condition before and after care.
Nurliza, meanwhile, offered simple but critical advice to caregivers overwhelmed by persistent crying.
“If a baby cries uncontrollably, place the baby in a safe spot and take time to calm yourself. Shaking a baby, even briefly, can have devastating consequences,” she said.
Umar now lives with severe brain injury. “He’s now like a newborn baby again,” Siddiq concluded softly.