PURPOSE: To evaluate and treat infant retina through the use of a hand-held spectral-domain optical coherence tomography (SD OCT) device in selected cases of Shaken Baby syndrome (SBS). DESIGN: Observational case series. METHODS: A novel SD OCT system was optimized and evaluated for infant imaging. An adult eye was imaged with both a standard clinical SD OCT system and the hand-held system. Four eyes of two infants with a history of SBS were imaged with the hand-held system. One infant was imaged again during follow-up examinations. Robust image processing algorithms were developed to create high-quality images. Images were assessed for usefulness in demonstrating pertinent morphologic features. RESULTS: The novel SD OCT unit proved effective for data acquisition and comparable with conventional chin-rest SD OCT. Rapid data acquisition limited motion artifact within the B-scan, although there was slight motion between B scans. The SD OCT images provided previously unseen details with regard to the morphologic features of retinal lesions in these infant eyes. This information influenced prognosis and management. CONCLUSIONS: As with adults, the hand-held customized SD OCT proved to be an invaluable tool in the differentiation of disease processes or injury in these eyes under study. SD OCT imaging systems may be considered a useful adjunct to RetCam fundus photography for assessment and clinical management in cases of SBS.