MONDAY, Oct. 8 (HealthDay News) -- Physicians can use eye
examinations to figure out whether infant and toddler head injuries
were caused by accidental injury or child abuse, suggests a new
study that adds to existing evidence on this method of detecting
At issue is the bleeding in the retina that can occur as a
result of a head injury. The authors of a study released Monday
report that they were able to confirm 93 percent of child-abuse
cases by examining hemorrhages in the retina.
Study lead author Robert Minns, a pediatric neurology professor
at the University of Edinburgh, in Scotland, said the findings
could play an important role in court proceedings involving alleged
child abusers. "Clinicians can now be more precise in their
(evaluation) of abusive head trauma to infants and young children
based on their retinal findings during eye examination," he
It's long been difficult for physicians to determine whether a
child with a head injury was deliberately injured -- as in the
condition known as shaken baby syndrome -- or was hurt in an
accident. To make things more complicated, "there are a minority of
doctors who believe that children cannot be injured by shaking, or
that one cannot prove that they were injured by shaking," Minns
In the big picture, he added, "the challenge is to make a secure
diagnosis to ensure the child's subsequent safety and to prevent
further injury from any abuse."
Eye doctors have long known that child abuse can lead to
bleeding in the retina, which sits in the back of the eye. "A
retinal bleed results when fine blood vessels of the eye tear after
being injured by the force of an injury," said Dr. Fizan Abdullah,
a children's trauma surgeon and associate professor of surgery and
international health at Johns Hopkins University School of Medicine
and Bloomberg School of Public Health, in Baltimore.
But it's been a challenge for researchers to definitively link
retinal injuries to abuse as compared to accidental injuries. In
the new study, researchers examined the medical records of 114
children with head injuries, 79 boys and 35 girls, who were treated
at the Royal Hospital for Sick Children Edinburgh.
They found that a certain kind of retinal injury -- in the
middle layer of the eyes -- was more common in children who were
thought to have been abused. The researchers found that 93 percent
of children who were abused had more than 25 of these injuries.
By contrast, Minns said, the injuries in cases not linked to
abuse were more likely to be in other areas of the retina. The
bleeding linked to abuse may occur because the injuries repeatedly
cause the head to rotate, he said.
Retinal imaging is used to locate the bleeding.
Dr. Brian Forbes, an associate professor of ophthalmology at
Children's Hospital of Philadelphia, put it this way: "The repeated
to-and-fro motion associated with a shaking injury likely has a
progressive tearing effect."
Forbes, who's familiar with the study findings, said they're
consistent with other research. "I believe all young children of
whom there are suspicions of having been abused should be evaluated
by an ophthalmologist," he said.
The study appears online Oct. 8 and in the November print issue
of the journal
For more about
child abuse, try the U.S. National Library of Medicine.
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