Written by Hannah Harp
Spoon Feed
Subconjunctival hemorrhage (SCH) is not more common in infants and toddlers with Valsalva-associated problems like cough, vomiting, or constipation, and clinicians should avoid attributing SCH in infants and toddlers to these causes.
Summary
This study examines the prevalence of SCH among infants and young children presenting to emergency care with symptoms related to cough, vomiting, or constipation. SCH was found to be rare in this population, with only 2 cases identified among 4,717 encounters (0.4 per 1000 cases). Notably, no significant difference in SCH prevalence was found between children with or without these Valsalva-associated symptoms. Given its rarity in non-traumatic cases, SCH should not be routinely attributed to minor symptoms, and evaluations for potential abuse should be considered for unexplained SCH in young children. (AI generated)
You’ve got to look below the surface
We have all seen teenagers and older kids with SCH or petechiae from coughing and vomiting. But at what size is a body unable to generate enough force to burst a blood vessel? Over the course of 36 months, one pediatric emergency department analyzed every encounter for patients between ages of 1 and 36 months, specifying in real time if SCH was a physical exam finding. All encounters were categorized as being Valsalva-related (cough, vomiting, constipation) or not Valsalva-related. Obvious causes of SCH including birth trauma, facial trauma, and known non-accidental trauma were excluded. Overall, there were 4,717 encounters included in the analysis, and only 2 cases of SCH were identified. One of these occurred in a toddler with cough, and one occurred in a toddler with no Valsalva-associated condition. In the end, the study is underpowered because of the low prevalence of SCH in this age group, so it’s difficult to draw firm conclusions. However, it raises an interesting question — when can SCH be explained away, and when is it an indication for further evaluation for non-accidental trauma?
Editor’s note: I will take a stab at that answer. Given how rare SCH was from 1-36 months – assuming no obvious explanation – I will broaden the workup and consider a non-accidental mechanism. ~Clay Smith
Source
Subconjunctival Hemorrhages Are Rare Among Infants With Cough and Gastrointestinal Conditions. Pediatr Emerg Care. 2024 Oct 30. doi: 10.1097/PEC.0000000000003293. Epub ahead of print. PMID: 39475329
