Retinal haemorrhages in suspected child abuse
- Topic
Many retinal haemorrhages reaching the retinal edge in an infant with brain injury strongly suggest abuse. An ophthalmologist examines and documents them.
See it in 3D: Retina
What it is
Abusive head trauma (shaken baby syndrome) is a leading cause of death and disability from child abuse. Retinal haemorrhages are present in most cases. Their pattern helps tell abuse from other causes: numerous haemorrhages in several layers of the retina, spreading to its periphery, with or without a split in the retina (retinoschisis), strongly suggest abuse when no other explanation exists. Recognising them protects the child and siblings.
Key facts
- Infant (usually under 1 year) with vomiting, irritability, seizures, apnoea or reduced consciousness, and no clear history of major trauma.
- Subdural haemorrhage and encephalopathy, often with fractures or bruises.
- Numerous, multilayered retinal haemorrhages extending to the periphery; macular retinoschisis.
- Birth-related retinal haemorrhages are common but usually resolve within the first weeks of life.
In clinical practice
- Other causes to consider: birth, severe accidental trauma (such as a car crash), bleeding disorders, leukaemia, severe hypertension, meningitis.
- A few haemorrhages at the back of the eye are non-specific; the extent and pattern matter.
- The fundus exam must be dilated and done by an ophthalmologist, ideally with photographs.
Next step / Initial management
- Suspected abusive head trauma: admission, brain imaging, skeletal survey, coagulation tests and dilated fundus exam by ophthalmology within 24 to 72 hours, with photographic documentation.
- Activate the child protection pathway and notify the competent authorities according to Colombian law (ICBF and the health sector's reporting route).
- Examine siblings and other children at home.
- Document findings precisely: they may be used in legal proceedings.
Test yourself
Think of the answer, then tap the question to see it.
Which retinal haemorrhage pattern suggests abusive head trauma?
Numerous haemorrhages in several retinal layers extending to the periphery, often with retinoschisis, without another explanation.
How long do birth-related retinal haemorrhages usually last?
They usually resolve within the first weeks of life.
What must the doctor do when abusive head trauma is suspected?
Admit, complete the medical workup with a dilated fundus exam by ophthalmology, and activate the child protection pathway with mandatory notification.
Connections
See it in 3D1
The structures of Durgical's 3D anatomy where it is found.
Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once.
Sources: Pediatric Abusive Head Trauma (StatPearls Publishing (NCBI Bookshelf), 2025).
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Representative model, for educational purposes only.