Study Shows that Infants' Eyes May Indicate Physical Abuse

Retinal (internal bleeding) may be a sign of shaken baby syndrome, a sometimes difficult-to-recognize form of physical abuse, according to a study by researchers at the Medical College of Wisconsin. The study was published in Ophthalmology, the journal of the American Academy of Ophthalmology.

Researchers led by Jane D. Kivlin, MD, Professor of Ophthalmology at the Medical College, examined medical records of 123 infants diagnosed with shaken baby syndrome over a 12-year period at Children's Hospital of Wisconsin, a Medical College affiliate. They found retinal hemorrhage in 83% of the 111 patients who had a comprehensive eye exam. In 29% of cases, the hemorrhage had been missed by non-ophthalmologists who also examined the child.

"With their specialized training and equipment, ophthalmologists are uniquely qualified to recognize signs of abuse that other medical professionals might miss," Dr. Kivlin says. "However, ophthalmologists are not the first physicians to see these children. Ophthalmologists are frequently consulted in potential cases of child abuse, but only after there are other signs of severe injury, such as coma, to indicate a high likelihood of abuse. It is in the less severely injured child where an early eye exam could make all the difference."

An infant suffering from shaken baby syndrome typically has been violently shaken, often in an effort to discipline the child or stop it from crying. Shaking can cause a baby's brain to bounce uncontrollably within the skull. Brain tissue may become bruised and swollen, creating a build-up of pressure and bleeding in the brain and in the retina at the back of the eye. Blindness may result. Permanent brain damage or abnormalities are possible, as shaking also tears away blood vessels supplying the brain.

Shaken baby syndrome is difficult to diagnose because the child's caretakers usually omit any knowledge of abuse, and there are few outward signs upon examination of the child. The symptoms admitted by caretakers are typically non-specific, such as lethargy, which could be caused by infection, for example.

"In these situations," Dr. Kivlin says, "retinal hemorrhages are an extremely valuable physical finding that can indicate undiagnosed abuse. If a primary care physician or emergency room staff member consults with an ophthalmologist, it may be possible to discover child abuse the first time it happens -- and save a life. Unfortunately, child abuse is often repeated. We need to recognize the signs because we might not get a second chance."

The study also found that infants who suffered retinal hemorrhage had up to a 38% increased chance of dying. In fact, 29% of infants in the study died from head injuries. According to the study, abused children were usually less than six months old and more likely to be male. Another finding: children who have been physically abused often have eye injuries that are more severe than those occurring from accidents.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.