[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Ophthalmology](https://durgical.com/en/ophthalmology/) › [Paediatric ophthalmology](https://durgical.com/en/ophthalmology/areas/pediatric/) › Retinal haemorrhages in suspected child abuse

# 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.

Updated Nov 5, 2026

**See it in 3D:** [Retina](https://durgical.com/en/anatomy/retina/)

## Key points

- Multilayered, numerous, peripheral retinal haemorrhages + subdural = suspect abuse.
- Birth haemorrhages resolve within weeks.
- Dilated exam by ophthalmology with photographs.
- Activate child protection and notify.

## 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/ophthalmology/retinal-haemorrhages-in-suspected-child-abuse/)

## Connections

## See it in 3D 1

The structures of Durgical's 3D anatomy where it is found.

- [Retina](https://durgical.com/en/anatomy/retina/)

## Related 2

- [Dilated fundus examination: when and how](https://durgical.com/en/ophthalmology/dilated-fundus-examination-when-and-how/)
- [OCT, fundus photography and angiography](https://durgical.com/en/ophthalmology/oct-fundus-photography-and-angiography/)

## Related conditions 1

- [Neonatal birth injuries (caput, cephalohaematoma, clavicle fracture)](https://durgical.com/en/conditions/neonatal-birth-injuries/)

[← All of ophthalmology](https://durgical.com/en/ophthalmology/)

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](https://www.ncbi.nlm.nih.gov/books/NBK499836/) (StatPearls Publishing (NCBI Bookshelf), 2025).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

---
Source: https://durgical.com/en/ophthalmology/retinal-haemorrhages-in-suspected-child-abuse/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ophthalmology/retinal-haemorrhages-in-suspected-child-abuse/