“The time to swelling becoming apparent is usually within an hour or two …. Nevertheless, the development of a haematoma on the head may sometimes take some hours and can occur very uncommonly more than 24 hours after impact but hardly ever after more than 48 hours…. The development of a haematoma the size of that recorded in G would be expected to be relatively rapid and be within a small number of hours and not exceptional as in more than 24 hours. This time at which the haematoma was first seen in G may not be a reliable indicator of the time when causative impact occurred. The haematoma was measured on imaging to be approximately 5mm depth which may not have been easily visible on cursory inspection. There was a changeover of carer responsibility that complicates timing: mother and her mother during the afternoon and early evening period of 02.01.20 — swelling not seen; maternal grandmother alone 02.01.20 evening to afternoon 03.01.20 period — swelling seen at the end of this period. There was no described accident during these periods …. As most haematomas reach their final swelling size within a few hours and almost all within 24 hours, a causative impact according to carer reports would seemingly have occurred in the period of 24 hours up to 03.01.20 afternoon, most probably on 03.01.20. The exception to this reasoning would be if the haematoma slowly accumulated which is uncommon, or if it were borderline size in terms of person recognition even by the same person on different occasions or that person in constant caring contact.”
“The maternal grandmother was I understand in a position to observe G during part of the afternoon of 02.01.20, the evening (perhaps night) of 02.01.20, and a number of hours in the morning and afternoon of 03.01.20. In that time, a swelling was not noted by the maternal grandmother. The possibilities to account for this were: • The haematoma could have been slowly accumulating – it was never very deep at 5-6mm to be not recognisable until a ‘threshold size’ had been reached. That slow accumulation is unusual for a sub-galeal haematoma but does occur. • It could have been recognisable, noted and ignored. • It could have - what I consider most likely - occurred on 03.01.20 because that sequence/scenario is the by far the most common for a haematoma of this type.” • The haematoma could have been slowly accumulating – it was never very deep at 5-6mm to be not recognisable until a ‘threshold size’ had been reached. That slow accumulation is unusual for a sub-galeal haematoma but does occur. • It could have been recognisable, noted and ignored. • It could have - what I consider most likely - occurred on 03.01.20 because that sequence/scenario is the by far the most common for a haematoma of this type.”
“If G had hit her head on the edge of the table (e.g. height 300m approx.) or against a hard object connected to it from a standing position (e.g. head at 700m) as understood by pushing a ‘walker’, the fall (not vertical) could generate a terminal velocity at impact that may be enough to cause a skull fracture, and along with it, a haematoma. The likely hard object impacting surface would increase the likelihood of a resultant fracture a little. A small cross-sectional area of the impacting site, like an edge or small protrusion, would be likely to further increase the possibility of fracture. However, in each of the latter scenarios (edge or protrusion), a bruise that was linear or of impact site shape, may have been expected.”
“I cannot say that the fall described onto the wooden play table is a likely cause of G's injuries. However, based on this evidence and the fact that the soft tissue swelling was noticed a few hours later, I cannot exclude it as a remotely possible cause of the fracture.”
“The paramount consideration for any court dealing with [an application to withdraw care proceedings] is accordingly the question whether the withdrawal of the care proceedings will promote or conflict with the welfare of the child concerned. It is not to be assumed, when determining that question, that every child who is made the subject of care proceedings derives an automatic advantage from having them continued. There is no advantage to any child in being maintained as the subject of proceedings that have become redundant in purpose or ineffective in result. It is a matter of looking at each case to see whether there is some solid advantage to the child to be derived from continuing the proceedings.” 18. This approach is consistent with s.1(5) of the Act, which provides that: “where a court is considering whether or not to make one or more orders under this Act with respect to a child, it shall not make the order or any of the orders unless it considers that doing so would be better for the child than making no order at all.”
“the parents were not looking after G during the period when this incident. On balance of probability the experts - a plausible explanation has been put forward by the grandparents as to how G sustained the injury.” 25. There follow these paragraphs in the approved note of judgment: “Local authority have insufficient evidence to cross the threshold for the LA to continue with the advocation of their application. The current state of the evidence to suggest that the court should revisit this evidence by testing out the evidence of the lay parties – put on the court an impossible evidential burden – the court will not be in a better position than it is at the present time. Parents are entitled to see the evidence put against them. They have met that case, there is no further evidence to meet. To expect them to go into the witness box is to reverse the burden of proof is contrary to the whole ethos of the stat of s.31 of CA.”
“the evidential burden remains the same. It is not necessary, proportionate to pursue a fact find”
"Evidence cannot be evaluated and assessed in separate compartments. A judge in these difficult cases must have regard to the relevance of each piece of evidence to other evidence and to exercise an overview of the totality of the evidence in order to come to the conclusion whether the case put forward by the local authority has been made out to the appropriate standard of proof."
“It is important to remember (1) that the roles of the court and the expert are distinct and (2) it is the court that is in the position to weigh up the expert evidence against its findings on the other evidence. The judge must always remember that he or she is the person who makes the final decision.”
“In a case where the medical evidence is to the effect that the likely cause is non-accidental and thus human agency, a court can reach a finding on the totality of the evidence either (a) that on the balance of probability an injury has a natural cause, or is not a non-accidental injury, or (b) that a local authority has not established the existence of the threshold to the civil standard of proof … The other side of the coin is that in a case where the medical evidence is that there is nothing diagnostic of a non-accidental injury or human agency and the clinical observations of the child, although consistent with non-accidental injury or human agency, are the type asserted is more usually associated with accidental injury or infection, a court can reach a finding on the totality of the evidence that, on the balance of probability, there has been a non-accidental injury or human agency as asserted and the threshold is established.”
“It cannot be over-emphasised that it is the judge, not an expert or group of experts, who has the responsibility of making the findings in family cases involving allegations of child abuse. Only the judge hears the totality of the expert evidence, including cross-examination by specialist counsel which often, as in this case, brings to the fore issues that are less apparent from the written reports. Only the judge considers all the expert evidence together, and has the opportunity to identify strands and patterns running through that evidence. And only the judge is able to consider all of the evidence – including expert medical evidence and the testimony of family members and other lay witnesses.”