Researchers say criterion for diagnosing child abuse based on faulty evidence

March 25, 2004

WINSTON-SALEM, N.C. - At least one of the "definitive" criteria used to diagnose child abuse may be wrong, report researchers from Wake Forest University Baptist Medical Center in the current issue of the British Medical Journal.

"If you read the medical literature, certain eye findings have been considered diagnostic for shaken baby syndrome," says Patrick E. Lantz, M.D., a forensic pathologist at Wake Forest University Baptist Medical Center. "This isn't supported by objective scientific evidence and could result in innocent caregivers going to jail."

Lantz and colleagues researched published reports about perimacular retinal folds, which is a buckling of the retina, the light-sensitive membrane that lines the back of the eye. The injury has been reported in shaken baby syndrome, caused by vigorous shaking of an infant or young child. The shaking may cause bleeding around the brain and in the eyes, resulting in blindness, and can also result in brain damage leading to death.

"Statements in the medical literature indicate that perimacular retinal folds result from the movement of the gel within the eye when an infant or young child is shaken, and that they have no other cause in young children with head injuries," said Lantz. "But our literature review showed that this conclusion is not based on scientifically valid comparative or experimental studies." Lantz and colleagues researched the issue after being involved in the case of a 14-month-old-child who died with perimacular retinal folds and other injuries. The child's father reported that a television set had toppled over, landing on the child's head. However, because of the diagnosis of perimacular retinal folds and hemorrhages, Child Protective Services suspected child abuse and removed a sibling from the home.

"Our investigation found no indication of child abuse other than the eye findings," said Lantz.

A review of the current medical literature showed that the condition has been reported in cases of shaken baby syndrome. However, no studies have compared whether the condition is also present in similar accidental head injuries in young children.

"Some physicians observed perimacular retinal folds in diagnosed cases of shaken baby syndrome and jumped to conclusions," said Lantz. In the case of the 14-month-old child, an investigation by police, a child abuse specialist, and a medical examiner corroborated the father's report and the sibling was returned to the home.

"We found that the eye findings in this case were caused by an accident," said Lantz. "But when you read the current medical literature, the presence of perimacular retinal folds and hemorrhages in a young child with a serious head injury are considered diagnostic for shaken baby syndrome and cannot be from anything else. When physicians read that, they may stop investigating other potential causes, which could have serious consequences. Until good scientific evidence is available, we urge caution in interpreting eye finds out of context." Lantz said the 14-month-old child also had other eye injuries that some professionals consider diagnostic for child abuse. He said the evidence base for these assumptions has problems similar to the evidence surrounding perimacular retinal folds and could also lead to false allegations.

Lantz's co-researchers were Sara H. Sinal, M.D., pediatrician and child abuse expert, Constance A. Stanton, M.D., neuropathologist, and Richard G. Weaver, Jr., M.D., pediatric ophthalmologist, all with Wake Forest University Baptist Medical Center.
-end-


Wake Forest Baptist Medical Center

Related Child Abuse Articles from Brightsurf:

Screening may bypass one-quarter of child abuse cases
Up to one-quarter of people who suffer child sexual abuse might be passed over for treatment because of current screening procedures, according to UC Riverside psychology researchers.

Molecular stress indicator not observed in survivors of child sexual abuse
Researchers and medical experts have long known that child sexual abuse has profoundly negative effects on the health of survivors; however, an international team of researchers was not able to find a link between the abuse and telomere length, considered an indicator of cellular aging and health.

Research shows child abuse and neglect results in increased hospitalizations over time
In a new study published in the leading international journal, Child Abuse and Neglect, University of South Australia researchers have found that by their mid-teens, children who were the subject of child protective services contact, are up to 52 per cent more likely to be hospitalised, for a range of problems, the most frequent being mental illness, toxic effects of drugs and physical injuries.

Research helps police understand child to parent abuse more than ever before
Researchers have provided detailed insights and recommendations to help one of the UK's largest police forces recognise, report and analyse instances of violence from children towards parents.

Drug reduces the risk of child sexual abuse
A drug that lowers levels of the male hormone testosterone in the body reduces the risk of men with pedophilic disorder sexually abusing children, a study from Karolinska Institutet published today in the journal JAMA Psychiatry shows.

Child abuse awareness month during COVID-19 pandemic
This Patient Page calls attention to risk factors for child abuse during the COVID-19 pandemic and discusses ways to reduce stress and risk of child abuse during social isolation.

Infant home visiting program linked to less child abuse
Family Connects, a nurse home visiting program for newborns and their parents, is linked to substantial reductions in child maltreatment investigations in children's earliest years, according to new research from Duke University.

Child abuse associated with physiologically detected hot flashes
Childhood abuse has been shown to lead to an array of health problems later in life.

Injury more likely due to abuse when child was with male caregiver
The odds of child physical abuse vs. accidental injury increased substantially when the caregiver at the time of injury was male, according to a new study published in The Journal of Pediatrics.

Child abuse linked to risk of suicide in later life
Children who experience physical, sexual, and emotional abuse or neglect are at least two to three times more likely to attempt suicide in later life, according to the largest research review carried out of the topic.

Read More: Child Abuse News and Child Abuse Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.