Shaken baby syndrome consists of intracranial and intraocular hemorrhage in the absence of signs of direct trauma in infants who have sustained whiplash/shaking injuries. We evaluated 14 consecutive cases of presumed shaken baby syndrome seen at the University of Michigan Hospitals, Ann Arbor, between August 1983 and March 1988, to determine if the severity of retinal hemorrhage was predictive of the severity of acute neurologic injury. The severity of retinal hemorrhage was based on the type and size of hemorrhage and the extent of fundus involvement. We found a significant correlation between retinal hemorrhage severity and acute neurologic findings. Diffuse fundus involvement, vitreous hemorrhage, or large subhyaloid hemorrhages were associated with more severe acute neurologic injury.