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Retinal hemorrhages in an 8-year-old child: an uncommon presentation of abusive injury

Raymond F Mierisch1, Lori D Frasier, Stephen R Braddock

  • 1*Department of Child Health, University of Missouri-Columbia, Columbia, MO; †Department of Pediatrics, University of Utah, Salt Lake City, UT; ‡Division of Medical Genetics, University of Missouri-Columbia, Columbia, MO; §Department of Ophthalmology, University of Missouri-Columbia, Columbia, MO; ∥Division of Pediatric Critical Care/Pediatric Anesthesiology, University of Missouri-Columbia, Columbia, MO.

Pediatric Emergency Care
|February 6, 2004
PubMed

Insights

Retinal hemorrhages can occur in older children due to abusive shaking injury, not just infants. This case highlights the importance of considering shaken baby syndrome (SBS) in older pediatric trauma patients.

Area of Science:

  • Pediatric Ophthalmology
  • Neurology
  • Forensic Pathology

Background:

  • Retinal hemorrhages are a hallmark of shaken baby syndrome (SBS), typically diagnosed in infants and toddlers.
  • Previous literature has predominantly associated SBS with the infant/toddler demographic.

Observation:

  • An 8-year-old boy presented with coma, respiratory arrest, intracranial hemorrhage, cerebral edema, and severe bilateral retinal hemorrhages.
  • The patient's injuries were confirmed by police investigation to be the result of severe abusive injury, including shaking.

Findings:

  • The case demonstrates that significant retinal hemorrhages can occur in older children following abusive head trauma.
  • Intracranial pathology and retinal hemorrhages in an older child can be indicative of abusive shaking injury.

Implications:

  • The diagnostic criteria for shaken baby syndrome (SBS) should extend beyond infants to include older children.
  • Clinicians should maintain a high index of suspicion for abusive shaking injury in older pediatric patients presenting with intracranial pathology and retinal hemorrhages.
  • This case underscores the need for comprehensive evaluation in pediatric trauma to identify non-accidental injuries.
Abstract

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