Retinal haemorrhages in inflicted traumatic brain injury: the ophthalmologist in court

Abstract

Child abuse is a significant social and public health problem in many societies. One particular form of physical abuse is inflicted traumatic brain injury (ITBI) - the so-called 'Shaken Baby Syndrome'. One of the key features associated with ITBI is characteristic ocular findings - only observed on fundal examination. It is crucial not to miss the diagnosis of ITBI as there may be implications for the safety of the child. The ophthalmologist is one key contributor to the process required to make the diagnosis of ITBI accurately and on the basis of all the relevant evidence. This article discusses some medicolegal implications of examining a child with retinal haemorrhages in the context of suspected ITBI, with practical advice for the ophthalmologist to be as objective and prepared as possible. The scientific validity of some alternative explanations advanced in court is discussed, with a strong emphasis on the literature.