The evaluation of a child for abuse must avoid both false positive and false negative diagnoses. Retinal hemorrhages can occur in a child for reasons other than abusive head injury.


Conditions that can cause retinal hemorrhage in a child:

(1) vaginal delivery (this should clear within a few weeks of birth)

(2) accidental head trauma

(3) vasculitis

(4) meningitis

(5) glutaric aciduria

(6) thrombocytopenia or other bleeding disorder

(7) profound anemia (probably associated with heart failure and raised venous pressures)

(8) possibly crush injury


Cardiopulmonary resuscitation usually does not result in retinal hemorrhages. If they do occur they are not substantial.


A child with one of these findings could also be abused, but that would need to be substantiated with other findings.


To read more or access our algorithms and calculators, please log in or register.