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Early childhood risk of physical abuse with isolated subconjunctival hemorrhages

Tricia M Tayama1, Zahra Samiezade-Yazd2, Kelly Young-Wolff3

  • 1The Permanente Medical Group, 710 Lawrence Expressway, Dept. 186, Santa Clara, CA, 95051, USA.

Child Abuse & Neglect
|June 4, 2026
PubMed

Insights

Subconjunctival hemorrhages (SCHs) in children rarely indicate abuse. Isolated SCHs show a significantly lower risk of physical abuse compared to non-isolated cases, especially in infants.

Area of Science:

  • Pediatric Ophthalmology
  • Child Abuse Prevention
  • Forensic Pediatrics

Background:

  • Subconjunctival hemorrhages (SCHs) are sometimes considered potential indicators of child abuse.
  • The risk of abuse associated with isolated SCHs in young children remains largely unknown.

Purpose of the Study:

  • To investigate the association between isolated subconjunctival hemorrhages and physical abuse in infants and young children.
  • To determine if isolated SCHs are predictive of current or subsequent physical abuse concerns.

Main Methods:

  • Retrospective cohort study of children aged 1 to 47 months diagnosed with SCHs between 2011 and 2015.
  • Defined isolated SCHs as those without other identified injuries within 7 days.
  • Physical abuse identified via diagnosis codes and medical record review up to age 5.

Main Results:

  • Out of 1281 children with SCHs, only 0.9% experienced physical abuse.
  • Children with isolated SCHs had a significantly lower incidence of physical abuse (0.4%) compared to those with non-isolated SCHs (3.0%).
  • For infants under 12 months, isolated SCHs had a 0.6% abuse rate versus 10.0% for non-isolated SCHs.

Conclusions:

  • The majority of children with SCHs do not experience physical abuse.
  • Isolated subconjunctival hemorrhages are associated with a substantially lower risk of physical abuse than non-isolated SCHs.
Abstract

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