| OTHER POSSIBLE CAUSES OF SUBDURAL HAEMORRHAGES
Case 1 - Undetected birth trauma Test case. Proves that most Doctors are ignoring their own consensus on ‘shaken baby syndrome’. The three criteria they say are consistent with shaking are a subdural haematoma
Our son Riordan only had a subdural haemorrhage yet Social Services and Police were still contacted. Medical notes which went missing were found by a Doctor who took our side and these notes showed that the hospital had discharged Riordan at 10 days of age with an undetected subdural haemorrhage - the likely cause of which may have been birth trauma. Riordan’s head grew almost 4cm (3.8cm) in the first 10 days of his life [the average head growth for a child is 8cm in a year]. With the exception of cases 6 and 8, all our other cases had only one or two of the criteria for shaken baby syndrome. Case 8 - Misdiagnosis of shaken baby syndrome - Missed cot death Paediatric Neurologists v Neuro Pathologists. Neuro Paediatricians work with a live infant and have to rely on diagnostic tools to diagnose a case - Paediatric/Forensic Pathologists work with dead tissue and are more able to determine the actual cause of death. Grandfather and mother accused of shaken baby syndrome after 5 wk old baby died in June 98. Cot death (SIDS) was proved after a post mortem. The brain bleed [was not a subdural but a vessel at the back of the baby's head had burst due to CPR], bleeding behind the eyes and and other injuries were directly as a result of CPR being carried out for 40 minutes on a baby of this age - not shaken baby syndrome, which the injuries mimicked. The death of the baby in this case saved the family from being charged with attempted murder. Case 4 - Infection link Registered childminder and parents accused of shaken baby syndrome and charged with GBH, when their 8 month old baby fell over onto a carpeted floor and stopped breathing. Mother had an infection [which has been known to cause a meningitus type infection in the newborn leading to brain bleeds], baby was delivered by ventouse cap [baby was left with visible banana shaped lump, bruising and a misshapen head]. A Doctor did diagnose a subdural haematoma yet he was still discharged with the instructions to bring him back to hospital if he became unwell. Parents did not realise the seriousness of the situation or what a subdural was. Doctors also failed to act on baby's abnormal 4cm head growth over the first 17 days of his life [the average head growth for a child is 8cm in a year], even though the mother repeatedly took the baby back to her GP with concerns over the baby's skull. During the investigation the parents other child's anus was examined for signs of abuse, which revealed nothing and the Childminder lost her job and was deregistered by the Council. Case 7 - Undiagnosed vaccine damage - Missed cot death Solicitor accused of shaken baby syndrome. Baby died in February 98. Medics did not consider the fact that the baby received a vaccination on the same day that it died. This couple also lost another baby a year earlier [ incidentally 9 days after receiving a triple vaccine], the cause of death was given as ‘lower respiratory tract infection’. A professor who was appointed by the CPS to carry out a post mortem said "I am very unhappy with both these babies - I don't know what killed them." Even so the old case has now been re-opened and and the mother has now been charged with double murder. Mother gave birth again in November 98 and baby was immediately taken into care Case 5 and Case 10 - Accident/Race A 10 month old baby fell off his activity gym and suffered a seizure - several days earlier he had hit his head on the corner of a ornamental coffee table, both his parents were accused of shaking him and were arrested and charged with GBH. The baby spent 6 months in care. The baby is now back at home but under a Full Care order until he is eighteen. The parents plan to Appeal. A Father was accused of murder and has been in custody since May ‘98 after he accidentally dropped his 8 week old baby who later died. Even though both these families were able to give a reason for their baby's injury as an accident this was dismissed by Doctors. Non caucasian babies are more likely to suffer a subdural after a small fall because of thinner bone density in their skulls [see info pack p4 paras 1&2]. Both these babies were Asian. With the exception of one Doctor, no one visited the scene of the accident involving either baby. Case 11 - Brittle Bone Disorder Parents accused of shaken baby syndrome after their 4 and half week old baby was taken to hospital and a subdural haematoma was discovered. Baby has been in care since discharge from hospital in February this year. Baby was found to have a fracture to the ankle and knee, which Doctors have been unable to age or give a date for. Baby's birth was difficult and baby was delivered by ventouse cap and forceps. Baby was a poor feeder from birth. Mothers birth notes have gone missing and the birth notes have sections that cannot be found. A medical link between a hybrid of the Brittle Bone condition called Ostragenus Imperfecta were not considered as possible causes for fractures in the limbs and Ehlas Danlas (weakness in blood vessels which stem from a lack of collagen in babies with O I ) leading to brain bleeds was not looked at. Case 1 - Test Case: Edwards-Brown - London How many babies are discharged from hospital after birth with an undetected subdural? How many parents are there like us who
are witnessing clinical symptoms of a subdural and don't realise it? ie. in the first four weeks of his
life, Riordan’s hands would jerk up and down and it reminded Ian and I
of Tommy Cooper in its manner. Later on we were to learn that he was in
fact suffering moro seizures. He also suffered from projectile vomiting,
which I put down to him being more like me as baby as I used to possett
a lot. This word possetting [slight regurgitation by small babies] was
used by a health visitor that I saw one day and so I started to refer to
his vomiting spells as possetting. His large head I put down to the fact
that both his father and I had larger than average heads. Unbeknown to us, all these symptoms
were consistent with a subdural haemorrhage.
How many babies are misdiagnosed while suffering from a subdural brain haemorrhage? Riordan was misdiagnosed as having a subarachnoid haemorrhage, after he made his first visit to our GP and was referred to hospital This type of brain bleed we were told was common amongst premature babies and he would be able to lead a normal life. Riordan was failed twice by doctors, once at birth and again at 12 weeks and was left at risk of death or disability if his rebleed had been major after a knock or fall both of which Riordan never had. A sneeze could have been enough to retrigger a re-bleed. Our baby enjoyed good health right up until the day he had a seizure Riordan was a big, happy baby who ate and slept well. This flies in the face of Dr’s who say that subdurals in a baby cause it to collapse and become unconscious soon after the injury has occurred. It took Riordan 6 months after his subdural to collapse. Cases, 4 and 5 babies also enjoyed good health up until their collapse. Our son did not have retinal haemorrhaging nor any other injuries The consensus amongst most Dr’s is that a subdural haemorrhage, retinal haemorrhaging and other injuries equals child abuse [shaken baby syndrome]. Riordan and 7 of the families highlighted (see grid breakdown of cases) only had one or two of the above criteria. Why was this ignored? Neuro Pathologist v Paediatric Neurologists Medical opinion needs to be challenged on brain injury in children and its causes in order to debate the conflict between Paediatric Neurologists and Neuro Pathologists. Too often "the balance of probability" is used by a Paediatrician in the same context as "beyond reasonable doubt" is used by a prosecution lawyer in a criminal court. This is a Paediatrician alleging that child abuse has taken place in the absence of hard evidence but in the belief that subdurals in babies and children can only be caused through excessive trauma and force. Standard of Proof Seeing a more rigorous standard of proof established, a code of practice that Doctors and Social Workers would have to follow including Dr’s reviewing and considering other causes of subdural haemorrhages. ie. Accident - "Small infants rarely
sustain serious injury from accidents in the home and any brain injury
with subdural and retinal haemorrhage should raise suspicions of abuse.
Babies can, however, be dropped accidentally or fall from changing tables
and sustain linear fractures and epidural haemorrhages.... In the absence
of clear signs of abuse we cannot jump to the conclusion that injury is
non-accidental just because there is brain injury or subdural haemorrhage.
... There are too many variables and unknowns to allow a categoric statement
that a certain fall did or did not injure a child. ... Evidence given in
court must be unbiased and factual; we must not allow our rightful abhorrence
of abuse in all its forms to blind us to the precept that a person is innocent
until proven guilty." Race - "... Violent shaking is
considered to be a crucial cause of SDH in non-accidentally injured infants.
...A retrospective review was conducted of all head injured infants (up
to 18 months old) treated at Atkinson Morley’s Hospital over a recent 20
year period. Twenty-eight infants with a SDH were identified. CT scans
were reviewed and each SDH greater than 0.5cm thick was morphometrically
analysed. 17 infants were Caucasian, 10 were non-Caucasian and one was
of mixed race. A race-dependent pattern of SDH pathophysiology was noted,
with non-Caucasian infants with a head injury more likely to have a SDH
than Caucasian infants. ...They were also more likely to have a large SDH
and to suffer post-traumatic seizures. Our findings do not support shaking
as the only cause of infant SDH formation and also suggests that non-accidental
injury is a less common cause of SDH than it is believed to be." The bland assurance from a social services department that a note has been made in the file is not acceptable. The bungling incompetence and appalling levels of communication, even between departments in the same council has to be seen to be believed. A paragraph somewhere at the back of file notes after a case has been dropped, exonerating the parents from having caused a NAI is not enough. People move on from their jobs, files can be poorly maintained and corrected etc, leaving families open to re-investigation if another incident occurs, leaving the threat of their other children being removed from their care very much alive. Hence the need for the following
Legacy of child protection procedures If you work with children as case 3 shows you immediately lose your income while the investigation is carried out. Once over, you then have to go through a series of assessments to find out if you can work with children again and if not this can and does block your chances of working directly with children in any capacity. In our case, I have been unable to return to work (cannot get benefit ) as I cannot find a member of my family or registered childminder to cover a 45 minute window that exists between his nursery closing and me returning from work. One childminder I did ask told me that she would find it too stressful to watch Riordan because of the brain haemorrhage. By law you have to leave your child with one of the above people - many people don’t [ie. child is left with a friend or non-registered child minder that they are happy with]. Even if it was an option, being on records means that we could never use that route. If Riordan suffered a rebleed while in someone’s care that did not match the above criteria both the carer and us would be in very serious trouble. Like the family in Case 3 (para above) we have lost one half of our income. Three years on after our the CPP our debts now run into many thousands [debt was looked at by social services during the investigation as a potential reason for stress in the family] - this could affect the mortgage on our home, repossession would be a disaster for the whole family. Going through a CPP that operates on a guilty until proven innoncent basis, leaves families petrified of their child suffering a re-bleed. Your life becomes fixated on preventing your child from falling over, hitting their head and rebleeding. Your marriage, health, relationship with your child and life suffer irrevocably. The irony is that the children involved in these cases suffer the most because of the inflexibility of Dr’s and Social Workers. Small children have to live through their parents post traumatic stress. They have to live in the middle of the mess left behind. It's like being hit by a juggernaut. There is documented evidence of a child actually being battered for the first time by an innocent parent unable to cope, after going through a social services investigation. The child ended up in care. CPP's and it's "lottery" system To prove the abuse of Child Protection Procedures (CPP's) and get a review of social worker practice To highlight the "lottery" system that determines how a case of suspected child abuse is dealt with. ie. a referral that comes into a harassed social worker dealing with numerous case loads at 4.30pm in the afternoon, a social worker that operates on a 9 - 4.30pm basis and does not investigate or record correct information on case files, or the social worker who gets a referral at 9.30am on a Monday morning, with no cases pending. In short, Social Services are under funded under staffed under trained and do not attract the best. In our case, I was filed as having a nervous breakdown, a psychiatric history, very depressed, agoraphobic and hysterical. The lottery system gave us a social worker from the 9 - 4.30 group. "Voluntary Care" To prove that parents are pressured into putting their child into voluntary care or into foster care when there is no proof but "a balance of probabilities". It saves the social worker a lot of time and paper work. The end result can be children spending long periods of time in care without the evidence being independently tested. This then introduces many other aspects into the equation, for instance, if the case doesn't go to court then social workers evidence isn't independently investigated and they do not have to prove what they are saying. In one particular case we've heard of, there was no evidence that the child had ever been abused but now the child has been abused while in foster care. [this was not a head injury case]. A review of the Appeals process against the abuse of Child Protection Procedures. Southwark Council's response has demonstrated that their approach to our appeal was a sham. An independent panel of social workers upheld all of our points bar a handful and yet the Council completely rejected every single point, after two years of work. (see House of Lord Ruling in 1995 - Bedford Case). A review of Social Worker Practice in CP Procedures nationally
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