How to spot child abuse by looking at the eyes

When an eight-month-old baby was brought to St John’s Medical College Hospital by the parents for irritability and refusing food, the doctors became suspicious. On examination, they found the baby being irritated by blackish blue spots on the body and a bulging anterior fontanel (soft part on top of the head). An examination revealed bleeding in the eye, or retinal haemorrhage. The truth unfolded: the working parents used to leave the baby with a young maid, who had abused the child.

“We see many such cases with a high degree of suspicion. After checking for common bruises, oral injuries, burns and special types of fractures (ribs, skull, thigh bones, little finger), we examine the eyes to ascertain the abuse,” said Dr. Sanjiv Lewin, chief of medical services at the hospital.

How an eye examination helps
  • The retinal bleed is usually in both eyes. In fact, every structure of the eye can be damaged by abuse. Doctors said the patient can suffer a sub-conjunctival haemorrhage or cornea abrasion or laceration, which should be immediately attended to. There could also be a clot behind the cornea (hyphaema) and the lens could get dislocated or the patient could develop a cataract from direct injury.
  • “The bones around the eye could also be fractured. A comprehensive eye examination can usually help identify any such problems, which could be corroborated by discussing with the parents,” added Dr. Murali.

This episode gains significance in the light of American Academy of Paediatrics (AAP) and ophthalmology organisations recently updating their recommendations to physicians for evaluating eye injuries for signs of abuse.

Physicians are mandated reporters of child abuse, and many times the key to detection is in the eyes, according to The Eye Examination in the Evaluation of Child Abuse, published in the August 2018 issue of Paediatrics journal. According to the report, retinal haemorrhage is the most common ocular manifestation of child abuse.

“Child abuse includes neglect, sexual, physical and emotional abuse. We get suspicious when there is denial of trauma or conflicting versions by the caretakers and delay in reaching the child to the hospital,” said Dr. Lewin, who is also a paediatrician.

According to Study on Child Abuse: India 2007, brought out by the Union Ministry for Women and Child Development, two of every three children suffer physical abuse and more than 80% face abuse by their parents.

Shaken Baby Syndrome

Paediatric retina specialists attribute retinal haemorrhage to Shaken Baby Syndrome (SBS). “It has been recognised for years as a ‘non-accidental’ cause of retinal haemorrhage in infants, especially in the West. However, retinal haemorrhages are the most common ocular findings even in ‘healthy’ newborns, and the mere presence of bleeding in the retina must not be taken as a sign of abuse,” said Dr. Anand Vinekar of Narayana Nethralaya.

“We are not sure at this time if retinal haemorrhage due to SBS is truly lower or merely under-reported in our country (compared to the West). A high degree of clinical suspicion and other associated features must co-exist before a specialist can make that diagnosis. Retinal imaging using special infant retinal cameras goes a long way in not only making the diagnosis but also for medico-legal purpose,” Dr. Vinekar said.

In Sankara Eye Foundation, doctors see at least five cases of children with abuse-related eye conditions, mainly SBS. “Most of the abuse seemed to have been done by caretakers. In the absence of external injury, eye-related findings can help identify the abuse happening and, often, help save the life of the child,” said Kaushik Murali, president (medical administration, quality and education) at the Foundation.

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Printable version | Feb 26, 2021 6:22:46 AM |

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