Abusive head trauma and the eye in infancy

Abstract

A child suspected of having an abusive head trauma (AHT) is referred by paediatricians to an ophthalmologist for evaluation. The incidence of abusive head injury in children is highest in infancy and less frequently seen in children over 3 years of age. Retinal haemorrhages (RHs) have a high positive predictive rate for abusive head injury. In the presence of head injury without any plausible medical explanation the description of the retinal findings help in distinguishing between abusive injury and other causes. It is incumbent on the ophthalmologist to be familiar with the clinical presentation, the differential diagnosis, and controversies associated with attributing the presence or absence of retinal findings to abusive head injury in children. The guidance was developed by a guideline working party (GWP) from the Royal College of Ophthalmologists (RCO) and the Royal College of Paediatrics and Child Health (RCPCH). It brings together previous publications of the RCO1, 2, 3 and an update of the literature since these publications. The publication is a summary of the updates of the full version of the document, with its appendices available on the websites of the RCO (www.rcophth.ac.uk) and the RCPCH (www.rcpch.ac.uk).