Petechiae and subconjunctival hemorrhages in a child after a visit to the dentist

Area of Science:

• Ophthalmology
• Pediatrics
• Forensic Medicine

Background:

• Subconjunctival hemorrhages and facial petechiae are uncommon oculo-cutaneous findings in children.
• These signs can indicate increased intrathoracic pressure, potentially due to strangulation or traumatic asphyxia.

Observation:

• A 5-year-old female presented with facial petechiae and bilateral subconjunctival hemorrhages post-dental appointment.
• The child reported physical restraint and impact by the dentist.
• Initial EMS assessment suggested an allergic reaction.

Findings:

• The patient was diagnosed with traumatic asphyxia, evidenced by extensive facial petechiae, subconjunctival hemorrhages, and facial swelling.
• The diagnosis was made despite initial mischaracterization of symptoms.

Implications:

• Medical providers must recognize the signs of traumatic asphyxia in pediatric patients.
• Non-accidental trauma should be a primary consideration, especially in the absence of a clear accidental injury history.
• Reporting child physical abuse by healthcare providers, though not mandated, is crucial for patient safety and preventing future harm.