Opthalmology

Unit 5: Children & Squint

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2. Non-accidental injury (NAI)

Introduction

  • Non-accidental injury is a form of physical child abuse.
  • It usually occurs under 2 years of age.
  • ‘Child abuse’ covers a wide spectrum ranging from deliberate, harmful acts to  failure to provide adequate care.

History

  • No, or vague history
  • History inconsistent with injuries
  • History changes during consultation
  • Variable history between parent and child
  • Delay in seeking medical attention
Children may be fearful, anxious or aggressive

Systemic Signs

  • Head injuries
  • Skull fractures
  • Bruises on face
  • Bone fractures
  • Subdural and subarachnoid haemorrhage.
  • SHAKEN BABY SYNDROME is the most common presentation in which ocular and intracranial manifestations are present.
  • Injury can be caused by violent shaking and or head injury.
  • The hallmark of shaken baby syndrome is the triad of:
    • encephalopathy
    • subdural hemorrhages
    • retinal hemorrhages.
  • The most common cause of blindness, occurring in 15% of survivors, is damage to the occipital cortex rather than ocular trauma.
  • Retinal haemorrhages are the most common finding, and can vary in size and severity.