Update from the Ophthalmology Child Abuse Working Party: Royal College Ophthalmologists

Abusive Head Trauma

“…They are rarely seen with accidental TBI (Bechtel et al, 2004;Christian, Taylor, Hertle, & Duhaime, 1999;Vinchon, Defoort-Dhellemmes, Desurmont, & Dhellemmes, 2005). RH associated with AHT are characteristically numerous, involve multiple layers of the retina, and extend beyond the posterior pole to the peripheral retina (Adams et al, 2004;Wygnanski-Jaffe et al, 2006).…”

A Witnessed Short Fall Mimicking Presumed Shaken Baby Syndrome (Inflicted Childhood Neurotrauma)

“…With regards to the ocular findings in inflicted neurotrauma, the medical literature is quite expansive [8][9][10] but does reflect clinical outliers [11,12] . Given this, the author's conclusion: 'Unless and until the ocular findings of presumed shaken…”

Perimacular retinal folds and nonaccidental injury—Yes, No, or Maybe?

“…6 It appears that there are certain points that the experts have to agree to disagree; however, most would agree that the scientific evidence to support the diagnosis of shaken baby syndrome might be not as reliable as we want and more research in this area would be welcomed.…”

“…The working party has also published an update roughly at the same time 6 and concluded that 'it is highly unlikely that the forces required to produce retinal haemorrhage in a child less than 2 years of age would be generated by a reasonable person during the course of (even rough) play or an attempt to arouse a sleeping or apparently unconscious child'. 6 It appears that there are certain points that the experts have to agree to disagree; however, most would agree that the scientific evidence to support the diagnosis of shaken baby syndrome might be not as reliable as we want and more research in this area would be welcomed.…”