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A case example can help understand how to approach the medical evaluation once there are concerns for abusive head trauma. In this case, a 6 month-old white female was taken to the hospital by the caretaker after the infant was found unresponsive in her crib; there was no history of trauma. In the ED, the infant required intubation. There was no external evidence of injury on physical examination; Lab work showed mild anemia, normal coagulation and negative tox screens; Head CT imaging showed intracranial blood without fractures or external soft tissue swelling and an eye exam suggested retinal bleeding; Skeletal survey found multiple posterior rib fractures; The child later died and medical examiner was notified.