Paediatricians and their opinions in child protection
matters, especially in Courts, are coming under increasing scrutiny and
challenge. Why are they so often, so wrong?.
Many of the leading paediatricians in the U.K. who are engaged in child
protection cases appear to be in a state of confusion and uncertainty
regarding their future role as `Expert’ witnesses in legal proceedings
concerning alleged child abuse.
This has largely come about after medical evidence in recent criminal and
civil cases was exposed as lacking in scientific rigour and on occasions to
be little more than fanciful speculations and theories which had little
basis in medical research. These theories have come under increasing
scrutiny and challenge by Courts, the media, and by other, more discerning
professionals engaged in child protection work.
In particular, Munchausen Syndrome By Proxy, Shaken Baby Syndrome, Repressed
Memory Syndrome, Satanic Ritual Abuse, Parental Alienation Syndrome,
Dissociative Disorder, and a wide range of similar labels have been
seriously questioned in professional and media circles and have been found
wanting in scientific authenticity and can be seriously questionable
regarding their validity and utility.
Medical theories of child abuse such as Shaken Baby Syndrome appear to have
been used as a first choice in a differential diagnosis by some
paediatricians called in after a child has died of indeterminate causes, or
if faced with a very sick child and an overtly anxious parent, and without
undertaking a thorough and exhaustive examination of all of the possible
causes of the child’s illness, has blamed the parent for the child’s illness
– Fabricated or Induced Illness in Children.
In these instances such possible causes which paediatricians are failing to
consider include : genetically inherited disorders, birth injuries, surgical
injuries, poisoning by toxic substances in the environment, severe allergic
reactions, vaccine damage, reactions to prescribed medications (e.g.
Cisapride/Propulsid – this drug was withdrawn by the U.K. government after
at least five recorded deaths of children and several hundred children had
been caused serious harm. The manufacturer, Jannsens have offered $US90m in
damages to families worldwide) or a combination of such medications, viral
infections, or disorders such as chronic fatigue syndrome, cystic fibrosis,
coeliac disease etc.
Many paediatricians refuse to consider vaccine damage as a possible cause of
a child’s illness despite valuable and credible personal testimony from
parents and the most recent medical research which is exposing this link.
A classic example of serious medical error in this respect was the case of
Megan Armstrong in Northumberland in England. Based on the evidence of two
paediatricians, social workers were prepared to place Megan’s name on the
Child Protection `At Risk’ Register and to apply for a Court Order to remove
her from her parent’s care. The paediatricians claimed that her `Failure to
thrive’ was caused by her parent’s lack of care. The day after this decision
was taken Megan was seen by another specialist who found that she had a
brain tumour in her frontal temporal lobe and which was not only affecting
her normal growth and development, but also was causing her eyesight to
deteriorate.
There are many, many other similar examples including the children of Sally
Clark and Angela Cannings.
Some pediatricians are not prepared to accept other possibilities of
diagnosis and are often single-minded in their accusation that a child’s
illness or injury is child abuse. Nor are they prepared to request a
specialist advice from such as a geneticist, haematologist, or a
toxicologist who could give other explanations. Often the matter has to
reach a Court before other medical experts can challenge the pediatrician's
opinions when these matters could have been resolved without the cost and
time involved and the trauma and heartache for the child and the family.
More commonly in Courts however, the errors of diagnosis by paediatric
expert witnesses go unchallenged as defence lawyers have difficulties
finding an alternative expert witness who is willing to challenge the
diagnosis.
Some of the most common errors and shortcomings of pediatricians in making a
differential diagnosis and arriving at a conclusion of child abuse which
have been brought to public attention by Dr Michael Innis, a retired
Haematologist are listed below.:
1. “A Bleeding Nose in an infant is evidence of attempted
suffocation”. A haematologist can provide at least twenty possible
explanations as to why a child may suffer a nose bleed and attempted
suffocation will not be one of them. Yet one paediatrician in England
asserted that a father had murdered a child after seeing a television
programme in which a father said the child had had a nose bleed.
2. “Bruises on the back of an infant must be inflicted since the infant
is not mobile enough to bruise itself”. - Spontaneous bruising and
bleeding are a feature of a disorder of haemostasis of which the commonest
at this age are Vitamin C and K deficiencies and Alloimmune
Thrombocytopenia. All should be checked by a haematologist.
3. “Posterior rib fractures are highly indicative of non-accidental
injury and are most commonly sustained as a result of compression of the
chest as the baby is held as it is shaken,” a direct quotation from a
Court case in England. This speculation or better described as a myth or
fabrication, is particularly distressing as fractures of different ages are
then held to be evidence of repeated episodes of shaking. There is good
evidence that without adequate Vitamin K bones are liable to spontaneous
fractures and appropriate tests for Vitamin K Deficiency Disease should be
carried out before such accusations are made.[1].
4.“Abused infants may have bleeding around the brain and in the eyes –
the alleged hallmarks of SBS - but most also bear signs of the violence
which killed them such as fractures, bruises, burns, malnutrition or
neglect.” Regrettably this is the commonly held opinion of medical
experts giving evidence for the Prosecution in cases of alleged child abuse.
It ignores the fact that fractures and bruises can result from deficiencies
of Vitamins C and/or K [1,2] and these deficiencies are not necessarily the
result of neglect. In fact Vitamin C deficiency is not uncommonly iatrogenic
as the result of the number of vaccines given to these infants[3,4]. Vitamin
K deficiency is often due to immaturity or infection of the liver.
Rutty et al; [5] have warned of the possibility of mistaking retinal and
subdural haemorrhages for child abuse but the message does not seem to have
registered in some circles.
As regards fractures and bruises found on a child. It is absurd to demand a
detailed explanation from a parent for many such injuries. How is a parent
expected to explain such injuries to a doctor? - How can a 20 year old
distressed and bewildered mother be expected to say to a doctor :
“You know doctor, there are several Vitamin K dependent proteins in the
body which require to be carboxylated by the enzyme gamma-glutamyl
carboxylase before they become functional. Without Vitamin K these proteins,
some of which control haemostasis and prevent bruising, and others which
control mineralization of bone and prevent fractures, cease to be
carboxylated and and hence bruises and fractures are likely to occur[1]. And
what is more doctor, last week you gave my baby an antibiotic for his cough.
That could have destroyed the Vitamin K 2 forming bacteria in his gut
thereby adding to his problem of a lack of Vitamin K to protect him from
bruises and fractures.
That is my explanation doctor. I hope you can understand it and don’t report
me to the police or social services, they may take my baby away and kill all
my dreams.”
If the doctor cannot explain it he should consult the literature on the
subject.
5. So-called “Burns” on a child are also often misinterpreted by
medical “Experts”. In one example an innocent man was sent to prison on the
basis of flawed evidence by a medical `Expert’ who swore that the marks on
the child were cigarette burns, whereas they were clearly the lesions of
microscopic polyarteritis that one can see in Kawasaki Disease. The
“burns” that Victoria Climbie was alleged to have suffered are also most
probably of a similar origin. They will almost certainly show the
characteristic findings of Kawasaki Disease – neutrophilia, lymphopenia, AST
> ALT.
6. Retinal Haemorrhages. The Royal College of Ophthalmologists
Working Party concluded in terms of the force required to cause retinal
haemorrhages “..no absolute values can be given for the angular acceleration
forces required to produce injury, but there is good evidence that they must
be considerable.”
No one has ever observed such “angular acceleration forces” being applied to
the infant. If it has not been observed it is imagined and hence has no
scientific validity. Rutty et al; have drawn attention to Retinal
haemorrhages in Late Onset Haemorrhagic Disease of the Newborn.[5]
False allegations of child abuse and child murder and consequent false
imprisonment of parents and carers, are rife in the English speaking world
and are largely the result of what can be described as “pseudological
fantasies” and fanciful speculations of paediatricians.
Benefits and protection for patients and public, especially in the area of
false accusations of child abuse are long overdue, and medical `experts’
must continue to be challenged and exposed when they have failed to consider
the widest possible differential diagnosis before reaching a conclusion of
child abuse and to have undertaken the most exhaustive and detailed
examination possible for other, more likely, causes of a child’s injuries or
illness utilising the expertise of other health professionals, rather than
rely on their own, albeit limited, knowledge.
It is long overdue that the Royal College of Paediatrics and Child Health
and other medical associations set up a formal system of verification and
validation of theories of child abuse utilising the most up-to-date
scientifically-based research from around the worlds, which would have some
authenticity in Courts and would hopefully prevent maverick paediatricians,
psychiatrists, and psychologists simply inventing their own
dogmatic pet theories or adopting the junk-research theories of others in
their professions, to promote their own status in child protection work.
At the least it would ensure that a majority of these medical professionals
were singing from the same song sheet and that the diagnosis of child abuse
was not just a postcode lottery for children and their families.
References:
1. Innis MD. Vitamin K Deficiency Disease Jour Ortho Mol Med
March 2008
2. Clemetson CAB. Caffey Revisited. A Commentary on the Origin of “Shaken
Baby Syndrome”
Jour Amer Phys & Surg vol 11;2006: 20-21
3. Kalokerinos A. Every Second Child Thomas Nelson (Australia) Ltd 1974
4. Clemetson CAB Is it “Shaken Baby,” or Barlow’s Disease Variant. A A P S
2004;Vol 9 No 3:
5. Rutty GN, Smith M, Malia RG. Late Form Hemorrhagic Disease of the
Newborn. A Fatal Case Report with Illustrations of Investigations Which May
Assist Avoiding the Mistaken Diagnosis of Child Abuse. Am J Forensic Med
Path 1999;20(1):48-51
ByCharles
Pragnell
Dip.S.W.
March 23, 2008
Diploma in Social Work and Letter of Recognition in Child Care
Expert Witness – Child Protection
and Social Care Consultant
and Child/Family Advocate..
Please read...
Petition answered with Spin and Sophism
The Silence of the Media Lambs!
Doctors in a Dilemma
Are you an `Appropriate’ person?
Childrens Plan
State Terrorism
The Seriously Unhealthy State of Paediatrics
RAD – the Return of a Nightmare
Persecution of Children and Families
Why I am Petitioning the Prime Minister
Vaccines and Child Abuse Accusations
Why did Sally Clark Suffer and Die?
Perverse Reversal of Child Custody
Child Protection in Kangaroo Courts
Fabricated and induced illness in Children
A History of Man’s Inhumanity
A System out of Control
Forced Adoption
