Signs of child abuse can be slight, ever changing, and are so important to saving a child, which is why the American Academy of Pediatrics and ophthalmology organizations have updated their recommendations to physicians for evaluating eye injuries for signs of abuse. Physicians are mandated reporters of child abuse, and many times the key to detection is in the eyes.

In the August 2018 Pediatrics (published online July 23), the AAP Council on Child Abuse and Neglect and AAP Section on Ophthalmology along with the American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, and the American Academy of Ophthalmology publish an updated clinical report, “The Eye Examination in the Evaluation of Child Abuse.”

The report states that retinal hemorrhages are the most common ocular manifestation of child abuse and reviews the diagnosis, technical, and legal issues tied to eye injuries from abuse. The clinical report also reminds that physicians are mandated to report on suspected child abuse. Reports can be made by calling each state’s toll-free child abuse reporting hotline and parents or guardians should be notified about the concerns.