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Retinal Hemorrhages– Sign of Child Abuse or Not?

Retinal hemorrhages are no longer conclusive of child abuse.

The retina is a thin layer of tissue at the back of the eye that separates the eyeball from the brain. Evidence that blood vessels have been broken on the retina used to be a sure indicator that the infant or child had suffered some type of Shaken Baby Syndrome (“SBS”) or Abusive Head Trauma (“AHT”). Retinal hemorrhages are not apparent to the naked eye. Rather, an ophthalmologist must conduct an examination to detect them.

Common Beliefs about Retinal Hemorrhages

It used to be that evidence of retinal hemorrhages were conclusive of SBS or AHT, absent some severe injury such as a car accident or falling from a two-story window. This belief rested on three primary grounds:

  1. Acceleration/Deceleration. Damage to the retina can only occur based upon a traumatic shaking that occurs during SBS. This is known as “vitreo-retinal traction theory.” Or, a mechanical shaking like one shaking a gallon can of paint.
  2. Abuse is the only cause. Specialists in the 1950’s to the 2000’s believed that there was zero incidence of SBS or AHT in accidental trauma cases. It only occurs in cases where there has been abuse.
  3. Other indicators present. Retinal hemorrhages may also be accompanied by intracranial pressure, usually from bleeding or fluid collections.

A New Understanding

It was only until the 2000’s that some doctors and specialists began to believe that retinal hemorrhages were a secondary phenomenon. The infant/child could suffer primarily from raised intracranial pressure, intracranial hemorrhage, fluctuations in blood flow, bleeding/clotting, hypoxia, aneurisms, severe infection, several natural diseases and/or time on life support that would cause the retinal hemorrhages. Further, it is nearly impossible for an ophthalmologist to differentiate, from a forensic perspective, the occurrence of “mild” versus “moderate” retinal hemorrhages. In other words, a diagnosis of having retinal hemorrhages was no longer viewed 100% as a primary sign of SBS or AHT because ophthalmology cannot support the specific finding of “child abuse” as compared to other non-criminal pathologies of retinal hemorrhages. Rather, retinal hemorrhages could occur secondarily to some medical issue that was not abuse-related at all. This is not the first time that a long-standing scientific belief regarding child abuse has been debunked. (See article on Rib Fractures). Both traumatic (SBS and AHT) and non-traumatic injury can lead to retinal hemorrhages. They are not necessarily proof of SBS or AHT.

If you’ve been accused of aggravated assault on an infant, endangering the welfare of a child, or any type of abuse of a child by CYS or the police– call an attorney. Do not let their experts, the caseworker or the police talk you into taking the fall for something you didn’t do.