Abusive Head Trauma and the Eye in Infancy

  • 16 Jul 2013
  • RCOphth and RCPCH

 Update out for consultation July 2023

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 and published in 2013 by a guideline working party (GWP) from the Royal College of Ophthalmologists (RCOphth) and the Royal College of Paediatrics and Child Health (RCPCH).

In 2022 the RCOphth convened a guideline development group (GDG) chaired by Mr Patrick Watts, to update this guideline on Abusive Head Trauma and the Eye. A draft version has now been released for consultation and the College would welcome any comments or observations on the content, format or recommendations. The consultation runs until 18 August 2023.  The 2013 version of the guideline remains live until the consultation comments have been received, review and the new version published.