Child's eye with light and shadow representing the fragility and potential causes of retinal hemorrhages.

Decoding Retinal Hemorrhages: A Guide for Parents and Caregivers

Rhea Morgan in Health & Wellness December 2025 • 4 min read.

"Understanding the difference between retinal hemorrhages caused by abusive head trauma and normal vaginal delivery."

Retinal hemorrhages (RH), or bleeding in the retina, can be a scary discovery for any parent or caregiver. While often associated with abusive head trauma (AHT), they can also occur during normal vaginal deliveries (NVD). This article aims to clarify the differences between these two scenarios, providing essential information to help you understand the implications and ensure the best possible care for your child.

The key is understanding that not all retinal hemorrhages are the same. The characteristics of the hemorrhages, such as size, location, and the presence of other associated injuries, can provide crucial clues about the underlying cause. This article will explore these differences based on a study comparing retinal hemorrhages in infants with AHT versus those with NVD.

By understanding the distinctions, parents and caregivers can be better informed when discussing their child's condition with healthcare professionals. This knowledge can lead to more accurate diagnoses and help prevent misinterpretations, ensuring that children receive the appropriate care and protection.

AHT vs. NVD: Key Differences in Retinal Hemorrhages

Child's eye with light and shadow representing the fragility and potential causes of retinal hemorrhages.

A study directly compared retinal hemorrhages in infants diagnosed with AHT to those experiencing NVD. The research meticulously analyzed Retcam images to assess the size, pattern, extent, and severity of the hemorrhages, using the CHOPRH grading scale to quantify the severity.

The study revealed several key differences:

Size Matters: Retinal hemorrhages were significantly larger in the AHT group compared to the NVD group.
Layer Involvement: AHT cases showed a higher incidence of hemorrhages involving all three retinal layers (inner, middle, and outer) compared to NVD.
Vitreous Hemorrhages: Bleeding into the vitreous humor (the gel-like substance that fills the eye) was much more common in AHT cases.
Overall Severity: The CHOPRH grading scale scores were significantly higher in the AHT group, indicating more severe retinal damage.
Associated Systemic Findings: All infants with AHT had other systemic findings such as epidural hemorrhage, loss of consciousness, or seizures, which were absent in the NVD group.

It's important to note that the number of retinal hemorrhages and the zones of the retina involved were not significantly different between the two groups. This suggests that while these factors can be present in both scenarios, they are not as indicative of AHT as the other factors listed above.

What to Do If You're Concerned

If your child has been diagnosed with retinal hemorrhages, it's natural to feel anxious. Remember that retinal hemorrhages can occur in NVD, but certain characteristics are more indicative of AHT. Open communication with your pediatrician or ophthalmologist is crucial. Share any concerns you have and ask them to explain the findings clearly.

If the retinal findings are more extensive than typically expected in NVD, it is essential to explore other factors suggestive of AHT, such as a history of loss of consciousness, seizures, or epidural hemorrhages observed on neuroimaging. A thorough medical evaluation and investigation are necessary to rule out any potential abuse.

Ultimately, your vigilance and proactive approach are key to ensuring your child's safety and well-being. By understanding the nuances of retinal hemorrhages and maintaining open communication with healthcare professionals, you can advocate for the best possible outcome for your child.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.jaapos.2017.07.079, Alternate LINK

Title: Comparison Of The Characteristics Of Retinal Hemorrhages In Abusive Head Trauma Versus Normal Vaginal Delivery

Subject: Ophthalmology

Journal: Journal of American Association for Pediatric Ophthalmology and Strabismus

Publisher: Elsevier BV

Authors: So Young Kim, Donny W. Suh

Published: 2017-08-01

Everything You Need To Know

What are retinal hemorrhages, and what are the different potential causes?

Retinal hemorrhages (RH), or bleeding in the retina, can occur in both abusive head trauma (AHT) and normal vaginal deliveries (NVD). They are not the same. The characteristics of the hemorrhages, such as size, location, and the presence of other associated injuries, provide clues about the underlying cause. Understanding these differences helps ensure children receive the appropriate care and protection. The RH in AHT are generally much more severe, the impact of the severity is that a child is possibly a victim of abuse and the medical staff must provide proper reporting.

What are the major differences between retinal hemorrhages caused by abusive head trauma and those caused by normal vaginal delivery?

The key differences lie in the characteristics of the retinal hemorrhages. Specifically, in cases of AHT, the retinal hemorrhages were significantly larger, involved all three retinal layers, and were more frequently accompanied by vitreous hemorrhages (bleeding into the gel-like substance filling the eye). The overall severity, as measured by the CHOPRH grading scale, was also significantly higher in the AHT group. The implication is that the child requires more intensive medical care and the medical team needs to investigate the cause.

What is the significance of vitreous hemorrhages in relation to the cause of retinal hemorrhages?

Vitreous hemorrhages, the bleeding into the vitreous humor, are much more common in cases of abusive head trauma (AHT) than in normal vaginal deliveries (NVD). The presence of vitreous hemorrhages is a strong indicator that the underlying cause may be AHT. This is a critical distinction, as it can help healthcare professionals accurately diagnose and treat the child. This means that the child has likely suffered a traumatic injury that requires immediate attention and further investigation, including possible intervention by child protective services.

What does a higher score on the CHOPRH grading scale indicate?

The CHOPRH grading scale is used to quantify the severity of the retinal damage. Scores are significantly higher in abusive head trauma (AHT) cases. This means the damage to the retina is more extensive and severe. This information helps in making the right diagnosis and determining the extent of care needed. The severity also points to the potential for long-term visual impairment.

What should I do if my child is diagnosed with retinal hemorrhages?

If your child is diagnosed with retinal hemorrhages, open communication with your pediatrician or ophthalmologist is crucial. Share any concerns and ask them to explain the findings clearly. Because retinal hemorrhages can occur in normal vaginal deliveries (NVD), not all cases are the same. However, certain characteristics are more indicative of abusive head trauma (AHT). Understanding these differences ensures children receive appropriate care and protection and is vital to ensure accurate diagnosis and prevent misinterpretations.