Clinical and laboratory observationSevere cough and retinal hemorrhage in infants and young children
Section snippets
Methods
The study was approved by the Ethics Review Board of the Assaf Harofeh Medical Center, Israel. All children aged 3 months to 2 years admitted to the Department of Pediatrics, Assaf Harofeh Medical Center, Israel, with severe coughing were eligible for the study. Severe coughing was defined as (1) coughing ≥3 days, (2) reason for referral to the Emergency Department, and (3) hospitalization required. Children were excluded if there was any evidence of child abuse via history, physical
Results
From July 2004 through September 2005, 122 consecutive patients who met the inclusion criteria were asked to participate in the study, and 100 were enrolled in the study. Of the 100, 65 were male. Patient age ranged from 3 to 24 months, with a mean age of 8.88 months (±6.03 months) and a median age of 7 months. The duration of coughing before the ocular examination ranged from 3 to 31 days, with a mean of 8.04 days (±6.8), and a median of 6 days. Clinical diagnoses at discharge are shown in the
Discussion
Early diagnosis of child abuse is crucial to reduce morbidity and mortality rates.1, 2 However, an incorrect diagnosis may cause severe psychological distress to the family, termed “medical abuse” by Kirschner.8 Although retinal hemorrhages are a potential manifestation of child abuse, especially for “shaken baby syndrome,” their existence has also been described in other clinical settings.1, 2, 3 Recently, Herr et al3 examined 100 infants with forceful vomiting caused by hypertrophic pyloric
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Cited by (34)
Child maltreatment, abusive head trauma, and the eye
2016, Taylor and Hoyt's Pediatric Ophthalmology and Strabismus, Fifth EditionMimics of child abuse: Can choking explain abusive head trauma?
2015, Journal of Forensic and Legal MedicineCitation Excerpt :Forceful vomiting in infants from pyloric stenosis does not result in retinal hemorrhages.20 Severe persistent cough in infants has not been associated with retinal hemorrhages.21 Similarly evidence is lacking that pertussis infection results in retinal hemorrhages.22
Valsalva hemorrhagic retinopathy presenting as a rare cause of impaired vision after a general anesthetic - A case report and review of the literature
2015, Journal of Clinical AnesthesiaCitation Excerpt :Valsalva hemorrhagic retinopathy has also been reported after common medical and surgical interventions including the following: colonoscopy [15], upper endoscopy [16,17], laparoscopy [4,11], laparoscopic cholecystectomy [5], prostate biopsy [50], dental procedures [18,19], lumbar and caudal epidural injection [6-10,12], a seizure [51], choking and an attempted Heimlich maneuver [52], and cardiopulmonary resuscitation (CPR) [53]. Valsalva hemorrhagic retinopathy is generally thought not to occur in children [54,55]; however, there is at least 1 report of retinal hemorrhages in a child who underwent CPR after being admitted for severe dehydration and vomiting, these caused by either the retching and/or CPR [56]. In addition to the difficult intubation and “stormy” anesthetic reported by Duane [13] and in our patient who coughed, 3 cases of VHR have been published after reportedly uneventful general anesthetic administration.
A public hearing. " Shaken baby syndrome: Guidelines on establishing a robust diagnosis and the procedures to be adopted by healthcare and social services staff" Scoping report
2011, Annals of Physical and Rehabilitation MedicineCitation Excerpt :None of 32 children (mean age: 30 months) hospitalized after an epileptic attack had any RH, despite the need for resuscitation in a few cases [155]. No RH was observed in a series of 100 consecutive children with a persistent cough [66]. No RH was observed in a series of 100 children with vomiting due to pyloric stenosis [77].
Eye injuries in child abuse
2011, Child Abuse and NeglectLetter to the Editor
2010, Seminars in Pediatric Neurology