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In a study published in Pediatrics, researchers say you should consider retinal hemorrhages in a young child to be a sign of abuse until proven otherwise. Some clinicians believe retinopathy may also occur during bouts of severe vomiting, but this study's findings don't support that assumption.


Researchers studied the medical records of 100 infants treated for hypertrophic pyloric stenosis, a cause of forceful vomiting. Most of the infants had several instances of projectile vomiting before undergoing surgery to correct their condition. None had retinal bleeding.


Although acknowledging that something other than child abuse may cause retinal bleeding in infants, the researchers say these unusual conditions can be ruled out through history, exam, and lab tests. They recommend routine dilated eye exams for children being evaluated for complaints that may reflect child abuse, such as vomiting, lethargy, and irritability.




"Does Valsalva Retinopathy Occur in Infants? An Initial Investigation in Infants with Vomiting Caused by Pyloric Stenosis," Pediatrics, S. Herr, et al., June 2004.