Abusive Head Trauma and the Eye in Infancy

A child suspected of abusive head injury 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 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 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 RCO and an update of the literature since these publications.