Accidents are bound to happen in all populations, especially with active children. Active listening, case history, and clinical findings differentiate between accident and abuse. Analyzing subjective and objective findings will allow the OD to make the decision if an accident or abuse occurred.
Case reports of ocular trauma from accidents and abuse are presented with subjective and objective findings and clues that help the practitioner discern one from another.
By the numbers
Children youth, and teens experience high levels of victimization. Crimes against young people can range from abuse and neglect to assaultive violence and homicide. There were 686,000 child maltreatment victims or 9.2 per 1000 children in 2012.1
In 2012, 44 percent of all child maltreatment were white, 21 percent were African American, and 21.8 percent were Hispanic. Of those children, 36.6 percent of the time the mother was the perpetrator, 18.7 percent of the time the father was the perpetrator, and 12 percent of the time someone other than the parent was the perpetrator.1
Breaking down abuse cases by category:1
78.3 percent neglect
18.3 percent physical abuse
10.6 percent other abuse
9.3 percent sexual abuse
8.5 percent psychological maltreatment
2.3 percent medical neglect
Neglect (29.7 percent) and physical abuse (24.6 percent) have the highest percentage of children aged two years and younger. Teens age 12 to 14 have the highest risk of sexual abuse (26.3 percent).1
Girls and boys are victims of abuse at a rate of 9.5 per 1,000 children and 8.7 per 1,000 children, respectively.1
An estimated 1,593 children died as a result of maltreatment in 2012. Forty-four percent of these children were under a year old. Eighty percent of child fatalities were caused by the child’s parents. Twenty-seven percent of fatalities were caused by the mother alone, 8.6 percent of all homicide victims were children and youth under the age of 18—of that number 52.8 percent were aged 17 to 19 years.1
1. Child, Youth, and Teen Victimization. The National Center for Victims of Crime. Available at: https://victimsofcrime.org/docs/default-source/ncvrw2015/2015ncvrw_stats.... Accessed 8/7/19.
2. Togioka BM, Arnold MA, Bathurst MA, Ziegfeld SM, Nabaweesi R, Colombani PM, Chang DC, Abdullah F. Retinal hemorrhages and shaken baby syndrome: an evidence-based review. J Emerg Med. 2009 Jul;37(1):98-106.
3. Maguire SA, Lumb RZ, Kemp AM, Moynihan S, Bunting HJ, Watts PO, Adams GG. A systematic review of the differential diagnosis of retinal hemorrhages in children with clinical Features associated with child abuse. Child Abuse Rev. 2013 Jan/Feb;22(1):29-43.
4. Stanford Medicine. Signs & Symptoms of Abuse/Neglect. Available at: http://childabuse.stanford.edu/screening/signs.html. Accessed 8/6/19.