A Local Authority v Mother & Ors [2026] EWFC 96

[2026] EWFC 96Case No Redacted
IN THE FAMILY COURT
Venue Royal Courts of Justice, Strand, London, WC2A 2LLDate 30 th January 2026THE HONOURABLE MR JUSTICE MCKENDRICK
A LOCAL AUTHORITYApplicantMOTHERRespondentsFATHERRespondentCHILD (By the Children’s Guardian)Respondent
MISS JUSTINE LATTIMER and MISS ZARA MAHMOOD (instructed by Legal Services, A Local Authority) for ApplicantMR TIMOTHY BOWE KC and MR GEORGE SMITH (instructed by the Smith Partnership) for First RespondentMR NICHOLAS HOWELL-JONES and MISS LAUREN STARMER (instructed by Timms Solicitors) for Second RespondentMR CHRISTOPHER ADAMS and MR CHRISTOPHER RANK (instructed by Staffordshire Family Law Solicitors) for Children’s Guardian
Approved Judgment.............................THE HONOURABLE MR JUSTICE MCKENDRICKThis judgment was delivered in private. The judge has given leave for this version of the judgment to be published on condition that (irrespective of what is contained in the judgment) in any published version of the judgment the anonymity of the children and members of their family must be strictly preserved. All persons, including representatives of the media, must ensure that this condition is strictly complied with. Failure to do so will be a contempt of court.

McKendrick J :

[1]This is my ex tempore judgment following a fact-finding hearing in public law proceedings concerning the subject child, T, who is around 2 years old.[2]After four days of evidence and submissions, I have found the disputed allegations of fact, as set out in the threshold document as put forward by the applicant local authority, to be almost completely true. I therefore I make the findings of fact as advanced by the local authority with one amendment, to which I will come. In that respect, I say at the outset that I do not accept the parents’ case that these injuries were caused at birth. I endeavour to set out my reasons for doing so.[3]This judgment is in nine parts –(i) the background;(ii) the hearing – the agreed and disputed threshold;(iii) the professional factual evidence;(iv) the evidence of the parents and their witnesses;(v) the expert evidence;(vi) the Evidence Matters forensic evidence from devices;(vii) the agreed law;(viii) the parties’ submissions, and(ix) analysis and findings.

PART 1 - THE BACKGROUND

[4]The applicant is A, the local authority. They have been represented at this hearing by Justine Lattimer and Zara Mahmood. The first respondent is the child’s mother. She has been represented at this hearing by Mr Timothy Bowe KC and George Smith, counsel. The second respondent is the child’s father. He has been represented at this hearing by Nicholas Howell-Jones, counsel, and Lauren Starmer, counsel. The third respondent is, of course, the child, T, who acts via her Guardian. T has been represented through her Guardian at this hearing by Christopher Adams, counsel, and Christopher Rank, counsel.[5]T was born at a Hospital by way of an elective caesarean section. The caesarean section operation note found within the maternity and obstetric wards confirms that it was a routine, uneventful entry and the condition of the baby was “well, no concerns”. I will return to some of that evidence shortly. During the procedure it appears it might have been the case that a single forcep blade was used. Again I will return to that issue. Consequently, after birth, there was bruising to T’s head and left cheek from a forcep blade. This was noted by a delivery midwife.[6]T was discharged with her mother from hospital during the evening of the following day. Two days post birth there was a face-to-face postnatal assessment completed in the family home by a community midwife who did not note marks or bruises to T’s skin and describes the visit as unremarkable. Photographs were taken around this time.[7]On day 5 post birth, there was a routine day 5 assessment at a GP surgery. This was carried out by a midwife. The mother and father both attended this appointment and a day 5 heel prick test was undertaken, along with a full check of T who was stripped off because she was to be weighed. The midwife did not note any marks or bruising and the mother did not raise worries or concerns.[8]A further visit took place by a professional in the family home, eleven days post birth. Both parents were present. T was again weighed. No observations were made by the professional regarding injuries or bruises.[9]On day 17 post birth, a further face-to-face postnatal discharge appointment was completed at the medical centre by a community midwife. During this visit, the community midwife did not note marks or bruises on T’s skin.[10]It is clear that this family were not known to the local authority prior to the events which I now describe.[11]On day 30 post birth, T was taken to the GP by the mother and was seen in a consultation. This was largely related to thrush in her mouth. A small blister was noted on her upper lip compatible with the use of the dummy. She was given oral treatment for thrush. The consultation notes make no reference to the mother raising concerns about bruising but it is clear from the evidence that I have seen that bruising was apparent, a significant bruise on the left cheek of T, and that was apparent from photographs I have seen from day 25 post birth.[12]On day 31 post birth, the mother made a telephone call to the Children and Family Single Point of Access and, G, a health visitor, was spoken to. “Telephone call from Mum into hub today. Mum advised that T seems to keep developing bruises to her face. Mum reported they attended the GP recently regarding oral thrush and mentioned bruising then and was advised to monitor for now. Mum reported she has woken up today and T has a large bruise from her eye to her cheek and looks as if she has a black eye. Mum reported nothing has happened, she has been sleeping in her crib in a baby sleeping bag. Mum advised she has already called the GP today and requested an appointment and is hopefully on the list for a telephone call as all face to face appointments have now gone. Mum rather upset and is worried about the bruising. Mum explained that her sister and mother (maternal grandmother and auntie) both have a blood condition called APS that causes spontaneous bruising and clotting and is concerned that T may also have this. Mum advised she also required blood thinners when she was pregnant. Advised Mum its important that T is seen face to face today. Advised Mum I can send a GP communication form to her GP now, Mum consented. Advised Mum if unable to see GP today then suggested to contact 111 or attend a walk in centre as its important to be reviewed and have it documented on her records. Mum advised happy to do whatever is needed. Progress notes reviewed, no Safeguarding concerns and Mum reports no possible way T could of obtained a bruise to her face. Mum reports T seems well in herself, happy, alert - no temperature and feeding as usual. Reassurance given but urged for for Mum to have the bruising reviewed today. Open access to hub extended. GP Communication form sent via. Hub to discuss concerns with Safeguarding in light of bruising on non bruising baby.” T was subsequently seen by Dr H at the surgery at 11.06. “‘I saw T on day 31 post birth at 11am with her mother. Her mother had called half an hour earlier concerned that T had bruises on her face and right thigh which had appeared in the last 2 weeks without any clear explanation. I was made aware that she had had a forceps delivery at the time of her emergency caesarean section when she was born …. ……….. ……. My examination revealed bruise on the left cheek, under her chin and on the right anterior side, but no other bruising or other skin lesions. The child was comfortable and not distressed. I had never met her mother before, but I had no reasons to doubt her concerns about her child's bruising but there was reference to a family history of a blood disorder, but no information was available at that time. I did speak to our midwife who was present in the surgery at that time, and she said when she undertook her check on mother and baby on the day 17 post birth, there was no visible bruising so they cannot have been caused by the forceps delivery. I was fairly confident that mother was not likely to cause any immediate harm, so l arranged to review her again with me on the day 34 post birth, in 3 days. Later that day I received a phone call from a social worker C, who informed me at that point that it was the health visitor that had brought this to her attention, and it was the health visitor who had recommended that mother make an appointment to see me. I was unaware of this at the time I consulted a few hours earlier…”. G, the health visitor, made a referral on safeguarding grounds. She also contacted the mother. “Following teams meeting with three professionals, decision was to follow bruising in non mobile baby policy and contact Childrens Advice and Support CAS. HV to contact Mum prior to this to inform her of policy. Telephone call back to Mum . Explained to Mum that i had liaised with my Safeguarding Team and as per the policy any unexplained bruise on a non mobile baby needs to be referred to CAS. Explained to Mum that she has done everything correctly and that its likely a medical will be requested which can then identify and underlying medical conditions. Enquired if Mum has heard from the GP, Mum advised she has literally just got back from the GP who reviewed T and is unsure about the bruising, advised to use Arnicare and wants to see them again in 3 days. Explained to Mum again that any bruise on a non mobile baby needs to be reported to Children Social Care. Mum consented to referral and understands why one is required. Advised Mum if further concerns or bruising appear to seek urgent medical attention. Telephone call to SCAS, details shared. Allocated to Social Worker and awaiting call back.”[13]In the light of these visits and the assessment of the GP, a joint section 47 Children Act 1989 investigation enquiry was undertaken and a strategy discussion took place. T was visited, as were her parents, by Children’s Services. Given the concerns raised, T was admitted to Hospital during the evening of day 31 post birth for the purposes of blood tests and scans and with the possibility of a child protection medical.[14]That child protection medical examination was subsequently undertaken on day 32 post birth by two clinicians. Dr A and Dr B describe a number of bruises as follows:(i) a brownish bruise underneath the chin just to the left of the midline of a dark red spot at the anterior end of the bruise;(ii) a brownish faint bruise at the right forehead;(iii) a brownish faint bruise on the right cheek below and lateral to the right eye;(iv) an almost triangular shaped bruise measuring 1.5 to 2cm vertically and 1cm across at the area underneath the left eye. The bruise was dark red in colour and the area below being yellowish-brown;(v) a brownish-greyish region to the left cheek;(vi) a brownish-grey bruise on the inside of the right knee; and(vii) a brownish bruise midway down the anterior aspect of the right leg; and(viii) a cluster of about seven oval-shaped brownish bruises appearing in a horizontal pattern on the right side of the middle third of T’s back.[15]On day 33 post birth, a skeletal survey was undertaken. This confirmed that T had a metaphyseal fracture of the distal right tibia with surrounding healing callus and periosteal reaction, metaphyseal fractures of the proximal and distal left tibia with a small amount of periosteal reaction along the shaft of the tibia. These are metaphyseal irregularities of medial aspects of both femurs, i.e., the thigh bones, with callus formation relating to the posterior distal femur. There was a faint periosteal reaction noted along the distal shaft of the left femur in irregularity of the distal femur posteriorly. These appearances are suggestive of further metaphyseal fractures. As a result, a child protection medical report was drafted. “T is a 1 month old, baby delivered at 38 weeks gestation by elective caesarean section with forceps extraction. She was noted have bruising to her face after birth which mother reports had faded. On day 25 post birth, she was noted to develop bruising on her left cheek with a further bruise underneath the left eye a few days later. As these bruises were unexplained, a referral was made to social care, and a child protection medical examination was requested and completed on day 32 post birth. Mother reports she has a diagnosis of protein S deficiency in pregnancy and was on blood thinning medication. Maternal protein S deficiency can be inherited but causes blood clots and not excessive or easy bruising as discussed with haematology team at A Children's Hospital. T's presentation and bruises are not suggestive of this condition and her clotting screen was normal which indicate that T is not susceptible to easy bruising. During the examination T was noted to have several bruises noted on her body as detailed in this report. The faint brown bruising on the right side of the head (2) and right cheek (3) and on the lower side of her left cheek (5) could be in-keeping with fading bruises from the forceps reported to be used at delivery for which mum had shown some pictures. The bruises beneath the left eye extending to the left cheek (4) are unexplained as these appeared within the last week from day 25 post birth and mum reports that the bruising from forceps marks were already fading. I would also not expect the appearance of new bruising at this stage following the delivery. The multiple oval bruises to the right side of T's back (9) which give the impression of fingertip marks are unexplained and I would not expect to occur with normal handling. The bruises under her chin (1) and noted on the legs (6,7,) are also unexplained and would not be expected to occur with normal handling of a non-mobile infant. There are also multiple fractures noted on the skeletal survey which in a non-mobile infant is suspicious of non-accidental injury. In my opinion and based on the information gathered from the child protection medical examination and absence of plausible explanation, the injuries are highly likely to be non-accidental in nature.’ It is important to note that a consultant paediatrician, alongside Dr A, signed off that child protection medical and, in their opinion, the injuries which I have just described were, in their view, highly likely to be non-accidental in nature. Some photographs were taken in the early morning of day 31 post birth and further photographs were taken later in the day on day 31 post birth.[16]On day 38 post birth the local authority applied for care orders. It is not necessary for me to track in this judgment the various hearings that have since taken place, but an interim care order was made on day 40 post birth and further case management hearings have taken place up to the hearing before me today. That is the background.

PART 2 - THE HEARING – THE THRESHOLD – THE ISSUES

[17]For the purposes of this hearing I have asked the parties to set out the facts which are agreed in the threshold and I have been provided with that document. 1. PRESENCE OF INJURIES T presented with the following injuries:(i) A brownish bruise underneath the chin just to the left of midline with a dark red spot at anterior end of the bruise.(ii) A brownish faint bruise on the right forehead, measuring 0.5 x 0.5cm.(iii) A brownish faint bruise on the right cheek below and lateral to the right eye measuring 0.5x0.5cm.(iv) An almost triangular shaped bruise measuring 1.5-2cm vertically and 1cm across with the area underneath the left eye. The bruise was dark red in colour and the area below being yellowish brown.(v) A brownish greyish fading lesion to the left cheek.(vi) A brownish grey bruise on the inner side of the right knee, measuring 0.5 x 0.5cm.(vii) A brownish bruise midway down the anterior aspect of the right leg, measuring 0.5 x 0.5cm.(viii) A cluster of about 7 oval shaped brownish bruises appearing in a horizontal pattern on the right side of the middle 3rd of T’s back. Each measuring between 0.5 to 1cm in diameter.(ix) A metaphyseal fracture of the distal left femur.(x) A metaphyseal fracture of the proximal left tibia.(xi) A metaphyseal fracture of the distal right femur.(xii) A metaphyseal fracture of the distal right tibia. 2. NON-SPECIFIC INJURIES The injuries listed below are non-specific and are on the balance of probabilities, not inflicted: (i) A brownish faint bruise on the right forehead, measuring 0.5 x 0.5cm. (ii) A brownish faint bruise on the right cheek below and lateral to the right eye measuring 0.5x0.5cm. (iii) A brownish grey bruise on the inner side of the right knee, measuring 0.5 x 0.5cm. (iv) A brownish bruise midway down the anterior aspect of the right leg, measuring 0.5 x 0.5cm 3. RELEVANT BRUISING The bruising about which the LA seeks findings are: (i) A brownish bruise underneath the chin just to the left of midline with a dark red spot at anterior end of the bruise. (ii) An almost triangular shaped bruise measuring 1.5-2cm vertically and 1cm across with the area underneath the left eye. The bruise was dark red in colour and the area below being yellowish brown. (iii) A brownish greyish fading lesion to the left cheek. (iv) A cluster of about 7 oval shaped brownish bruises appearing in a horizontal pattern on the right side of the middle 3rd of T’s back. Each measuring between 0.5 to 1cm in diameter. 4. TIMING OF THE BRUISING (i) T was born by way of an elective caesarean section. Following T’s birth, bruising was present to both sides of T’s head and on her left cheek. It was an instrumental birth. (ii) No bruising was noted during the primary visit conducted by the community midwife at the parents’ home on day 2 post birth, however: a. Some bruising due to the forceps used on the day of T’s birth, was still present on day 2 post birth. (iii) No bruising was noted when T was examined by the duty community midwife, D, during a day 5 assessment of the child at the local surgery on day 5 post birth however: a. Some bruising due to the forceps used on the day of T’s birth was still present on day 5 post birth. (iv) No bruising was noted during the new birth visit conducted by the health visitor, at the parents’ home on day 11 post birth. (v) Bruising to T’s left cheek was no longer visible by day 17 post birth. (vi) No bruising was seen during the postnatal community midwife discharge appointment on day 17 post birth. (vii) The mother’s initial account to the police, local authority and child protection medical examiner was that the bruise to the left cheek about which the LA seeks a finding first appeared on day 25 post birth. There is a photograph of this bruise in the Evidence Matters Disclosure taken on day 25 post birth. 5. CAUSATION OF BRUISING (i) T had no organic condition or illness that (a) predisposes her to bruising or (b) would cause her to bruise upon the application of a lesser degree of force]: 6. CAUSATION OF THE FRACTURES (i) The metaphyseal fractures are typically the result of severe twisting/torsional force applied at the end of the bone The radiological appearances of this fracture are non-specific with a regard to the exact mechanism of causation. The same fracture pattern could occur from an accidental or inflicted injury. (ii) Metaphyseal fractures can occur at birth. The incidences of these fractures occurring at birth is unknown, but is believed to be relatively low. (iii) The level of force required to cause such fractures is unknown but in the opinion of the radiologist is excessive, significant and greater than that used in the normal care and handling of a child. (iv) Such fractures would not have been occasioned by normal domestic handling, over-exuberant play or rough inexperienced parenting. (v) There were multiple (not less than three) applications of force to occasion the fractures to T. (vi) Each of the fractures was in the region of 2-4 weeks old on day 32 post birth. (vii) The radiological expert opinion cannot exclude the birth injury as a possible cause of the metaphyseal fractures and is unable to determine the probability of this.[18]There is also an unagreed threshold document. INFLICTED INJURIES 1. The Local Authority assert that the following injuries are inflicted:(i) A brownish bruise underneath the chin just to the left of midline with a dark red spot at anterior end of the bruise.(ii) An almost triangular shaped bruise measuring 1.5-2cm vertically and 1cm across with the area underneath the left eye. The bruise was dark red in colour and the area below being yellowish brown.(iii) A brownish greyish fading lesion to the left cheek.(iv) A cluster of about 7 oval shaped brownish bruises appearing in a horizontal pattern on the right side of the middle 3rd of T’s back. Each measuring between 0.5 to 1cm in diameter.(v) A metaphyseal fracture of the distal left femur.(vi) A metaphyseal fracture of the proximal left tibia.(vii) A metaphyseal fracture of the distal right femur.(viii) A metaphyseal fracture of the distal right tibia. 2. The parents do not accept that the injuries listed above were inflicted. TIMING OF THE BRUISING 3. The Local Authority assert that whilst it is not possible to accurately date the bruising, a bruise is a transient injury, becoming apparent within days, if not quicker. The parents do not accept this. 4. The Local Authority assert that it is more likely than not that the applications of force causing the bruising were inflicted after day 17 post birth. The parents do not accept this. CAUSATION OF BRUISING 5. The Local Authority assert that the bruising T presented with was inflicted by one or other of the parents and was not caused during the birth. The parents do not accept this. 6. The bruises were caused by an external application of force sufficient to break the blood vessels / capillaries causing bleeding under the skin. Partially Accepted by M in the Response to the Amended Threshold:
“The mother accepts bruising is caused by force damaging blood vessels/capillaries but does not accept that the appearance of bruising means that force was applied to that particular area. While T was in hospital she was seen to have bruising under her eye. The mother was informed by one of the paediatricians that the skin on T’s face was thin and the bruise had ‘travelled’.” • Partially Accepted by F in the Response to the Amended Threshold: “The second respondent accepts that this is the typical formulation of bruising however does not accept that T’s bruises were caused by force particularly as it was suggested whilst in hospital that a bruise on T’s face had travelled.”
The level of force required to cause such bruising would be: (a) greater than the force used in normal or rough handling; and (b) known to the perpetrator to be of a level that was causing T harm. • Denied by M in the Response to the Amended Threshold. • Denied by F in the Response to the Amended Threshold:
“It is accepted that this is what is reported by the experts in this case however it is not accepted by the second respondent that that is how T sustained her bruising.”
CAUSATION OF THE FRACTURES 7. The Local Authority assert that the fractures were inflicted by one or other of the parents and were not caused during the birth. The parents do not accept this. TIMING OF THE FRACTURES 8. The fractures did not occur at birth, either through incident or organic reason in utero, during labour (assisted or otherwise) or by medical care afforded post labour. The parents do not accept this. The expert radiologist reported fractures to be in the region of 2-4 weeks. The mother does not accept the fractures are not birth related. PERPETRATOR(S) OF THE INJURIES 9. At all times during the likely window in which the bruising and metaphyseal fractures were occasioned to T, she was in the care of either her mother, father or both of her parents. 10. Neither parent, nor any other person, has provided an account which can adequately explain the bruising and metaphyseal fractures that T has suffered. The parents do not accept this. 11. The bruising and metaphyseal fractures were occasioned by one of the parents. If present when a given injury or injuries was/were caused, the other parent has failed to protect T. The parents do not accept this.[19]As can be seen from the agreed and the disputed threshold documents, the purpose of this hearing was to try findings of fact. The purposes of this hearing was to determine the allegations as made by the local authority and as disputed by Father and Mother. Broadly speaking, although the detail of the disputed threshold document has to be grappled with, the issues for this hearing were therefore the following broad topics:(i) are the agreed injuries inflicted or not;(ii) were the bruises caused after day 17 post birth or not,(iii) were the bruises caused by the parents or by the birthing process,(iv) were the fractures caused by the parents or the birthing process, and(v) the ultimate questions are really can the findings at paragraphs 9, 10 and 11 of the disputed threshold be made.[20]To determine those issues, whilst it had been anticipated at an earlier case management hearing there would be a cast of some nineteen witnesses, at the end of the day at this five-day hearing I heard the evidence of the jointly instructed consultant paediatrician, Dr Birch, the jointly instructed consultant obstetrician, Mr Brocklesby, Mother, Father, and then I heard submissions.

PART 3 – THE PROFESSIONAL FACTUAL EVIDENCE

[21]At a case management hearing, directions were given for single joint experts in the fields of obstetrics, paediatric radiology and a consultant paediatrician. Those experts were instructed to provide a report. A further case management hearing took place. At that hearing Evidence Matters were instructed to carry out forensic assessments of various devices and report. Permission was given for witness statements from family members and further directions were given for the local authority to file further evidence. Eventually the expert reports, with a number of addendum reports, were filed.[22]The matter came before Lieven J. She determined, as I can see from the recitals, that a fact-finding hearing was necessary and this was what she called “a single issue case”.[23]At what I consider to be a relatively late stage in the proceedings, permission was given for the first time for witness statements from “the medical professionals involved in T’s birth”. The local authority was directed to file and serve those statements. The directions factually set out that those professionals were to set out their evidence of their recall or knowledge of T’s birth. Permission was also given for the community midwives, which I have already described, Ms U and Ms D, to file witness statements. None of the original witnesses of fact have been called but I have read a series of statements, some in the proper witness statement format, some are simply emails.[24]Lieven J’s order directed the following to file witness statements: a surgeon at T’s birth, an anaesthetist, another anaesthetist, an assistant anaesthetist, two circulators, a midwife, another midwife and the responsible obstetric consultant. I am not going to overburden this already lengthy ex tempore judgment by setting out all of that evidence. It is set out at C460 and following in the witness statement section of the bundle. Many of those professionals, who I have just identified and described, could not recall the birth. Some of them simply had reference to the written records which they have considered. It seems clear from the evidence that I have seen that a spinal anaesthesia was given. The anaesthetic evidence was that there were no difficulties.[25]Reference is made by some of those clinicians that this was an uneventful elective caesarean section. Whilst the responsible obstetric consultant, it seems she went on sick leave and I see an email from her saying, “I am sorry but I know nothing about this.” One of those involved is, who I have described as the anaesthetic assistant, and she says, in effect, “If there had been an adverse event, I would have remembered. These cases stand out”, she said, and she considers it was an uneventful planned caesarean section. The surgeon says from the operation notes the procedure was uneventful with no issues during the operation.[26]It was noted that as the responsible obstetric consultant was on sick leave, the person who conducted the delivery was Mr X. He says in an email, but there is no witness statement, that a baby girl was delivered cephalic, i.e., in the head-down position. He says “in very good shape”. He says that the remainder of the operation was unremarkable with minimal blood loss. His email says:
“I do many elective caesarean sections lists every week” and “I cannot remember any thing regarding this case.”
[27]A little more detail is provided by the witnesses that then followed. In U’s witness statement, says that she had contact in the family home on day 2 post birth and at a postnatal discharge visit in the GP surgery on day 17 post birth. She says she knew the parents since day 2 post birth. She was the community midwife between 6 day 2 and day 17 post birth. She saw Mother on two occasions but she notes she was not the midwife during the pregnancy. She says on day 2 post birth the following:
“Reason for contact – initial primary visit in community following from hospital. Face to face contact. Mother and T were in the bedroom and invited myself and a colleague (support worker) upstairs. No postnatal concerns were expressed about or from Mother. She did discuss feeling overwhelmed in hospital but was happier now at home and that she had good family support. T was settled in the crib next to the bed, was undressed by my colleague no marks or bruises to skin noted. Her behaviour was normal; she was feeding well and there were no parental concerns. Both parents interacted appropriately and asked appropriate questions regarding T’s welfare. The visit was unremarkable.”
On day 17 post birth she says this: “Reasons for contact – postnatal discharge appointment Face to face contact. T was undressed by myself and weighed, no marks/bruises on skin noted, no unusual behaviours or abnormal cries/movements noted. No concerns expressed by Mother. Good weight gain of T, taking good amounts of formula and normal amount of nappies. Mother attended the appointment alone with T, no concerns expressed and appropriate questions/no concerns from myself regarding her bond with T or handing of T. Discharged to the care of the local health visitor”.[28]In D’s witness statement she carried out a day 5 mum and baby assessment at a Surgery on day 5 post birth. She says this:
“Seen for day 5 assessment of mum and baby at a surgery. Mother was accompanied by her partner. This was a face-to-face appointment. I checked mum as per routine postnatal check and no worries or concerns were noted as per my documentation. I took the day 5 heel prick test as per guidelines and did a full check of baby stripped off to weigh baby. No marks or bruising was noted as per my documentation. No worries or concerns were expressed by mum.”
[29]The other relevant and important witnesses of fact are the clinicians who saw T in month 2 post birth, and I have quoted in my introduction some of the observations made. They include the GP on day 31, G, the social worker on day 31, and I have already quoted in this judgment the child protection medical report of Dr A and Dr B, a consultant paediatrician, dated day 32 post birth. That is section 3, the professional factual evidence.

PART 4 – THE EVIDENCE OF THE PARENTS

[30]Mother has produced a witness statement. She tells me in this witness statement she discovered her pregnancy and that T was a highly anticipated baby. They had wanted to start a family for nine years so when they found out the news about T they were, as she says, “over the moon”. She considered her pregnancy was high-risk because of her polycystic ovary syndrome and she was aware her sister suffers from a blood condition, antiphospholipid syndrome, which was also considered.[31]From around 20 weeks she suffered from severe headaches and loss of vision. She reported this to her consultant. She was admitted to hospital at about 36 weeks’ gestation because of concerns regarding her speech and vision. MRI and CT scans confirmed that she had not had a stroke or a bleed but there was an issue discussed regarding whether the pregnancy was causing pressure on the brain. Her evidence is that at that meeting it was agreed that T would be born by a caesarean section at 38 weeks.[32]She says that the caesarean section was scheduled for the day of birth. She arrived in the morning at about 7 o’clock and the surgeon and anaesthetist introduced themselves. She was told the caesarean section would happen straightaway and that the anaesthetist explained that was due to pressure on the brain that may be occasioned by the procedure. At paragraph 6 of her statement she says she was taken into surgery and informed the caesarean section would be uncomfortable and that there could be a lot of pulling and pushing. Father was present with her. She had a spinal blocker but she felt uncomfortable and said so. She could not see how many professionals were dealing with the delivery because of the screen but she believed it was two or three professionals and they were using a lot of force to try and deliver T. She says there was so much force her body was bouncing on the table. She felt quite dazed by the procedure. T was born and held by Father. She was not informed that forceps were used to deliver the baby until after the fact. Back on the ward she noticed there was redness and bruising around T’s head and face. The midwife advised her forceps had been used. She says she was shocked by the bruising to T’s face and the nurse advised her to take pictures.[33]Happily, she was then discharged and over a series of days (and I need not detail this in the judgment) her evidence is of happy home life. She was delighted to have T home and to be at home with her husband and it is clear she was contented and happy with T, enjoying visits of many family members and friends.[34]At paragraph 24 of her statement she records the visit of U on day 17. She said the midwife checked T all over and was happy with her development. T was discharged from the midwife service. Her caesarean section scar was checked. She had discussed some concerns about T being unsettled and the midwife advised it sounded like colic. Nothing else of note happened on that day.[35]It is important to consider what Mother says about the days that then follow up to day 36 post birth:
“25. On day 18 post birth I don’t recall visiting anyone or anyone visiting the home. 26. On day 19 post birth I don’t recall visiting anyone or anyone visiting the home. 27. On day 20 post birth I don’t recall visiting anyone or anyone visiting the home. 28. On day 21 post birth I went to get my nails done. T remained in the care of the Second Respondent. I believe my trip to get my nails done was approximately 80 minutes from start to finish. I don’t recall anything else of note happening that day. 29. On day 22 post birth I don’t recall visiting anyone or anyone visiting the home. 30. On day 23 post birth my neighbour P visited however she did not have unsupervised care of T at any time. 31. On day 24 post birth I don’t recall visiting anyone or anyone visiting the home. 32. On day 25 post birth I don’t recall visiting anyone or anyone visiting the home. 33. On day 26 post birth I don’t recall visiting anyone or anyone visiting the home. 34. On day 27 post birth I don’t recall visiting anyone or anyone visiting the home. 35. On day 28 post birth Second Respondent and I took T with my mum, a sibling, my two young relatives to a Zoo. No one had care of T save for the Second Respondent and me. 36. On day 29 post birth I noticed that she was fussy with her bottle there was a little sore on her top inner lip which looked like a blood blister. This was a Sunday, so I resolved to take T to the GP on Monday morning. 37. On day 30 post birth I took T to the GP and spoke to the GP about her top lip and her bruising. The doctor discussed thrush and prescribed antibiotics for her. The doctor did not seem concerned about the bruising to T’s cheek and I was advised to give it a few weeks and bring her back if the issue persisted. On returning home I noted our next-door neighbours were having some work done and this caused some damage to our bedroom wall. I left T with my neighbour, P briefly while I went to speak to our other neighbour. The workmen were smoking cannabis on the roof and were hostile and unhelpful. I called the police, and they attended approximately 2 hours later. By then the workmen were no longer smoking cannabis and the police stated that there was no smell and nothing they could do. My neighbour P had T for approximately 5 minutes. When the Second Respondent came home P advised me to have a bath and advised that the Second Respondent take T for a walk which he did. I believe this was for about 40 minutes. T was fast asleep when they returned. 38. On day 31 I rang the GP as there appeared to be a new bruise which looked like a line on top of the existing bruise. Though I had been advised to wait a few weeks the day before I was not happy with this bruise and called the GP again. I was advised that there were no appointments left. I explained I was concerned about the bruising and asked if they knew of anywhere else I could take T. I was asked to send pictures in which I did. I exhibit these photos marked “M2”
I also rang the health visitor to see who else I could speak to and was told that the health visitor would write to the GP. I received a call from a doctor asking me to bring T to the GP surgery. I took T within 30 minutes of this call, and she was checked. The GP stripped her off and examined T’s front. The GP advised me to come back on day 34 for a review. 39. I received a call from the health visitor stating that social services had been informed, and I should expect a call from them. As it got close to the end of the day, I contacted social services myself as I had not heard from them, and I was told they would call before 5pm. I did not receive a call from them but received a message at 5.06pm asking me to call them. I did so but the office was closed. I was then contacted by the GP who advised me that they had received an email from social services, and I also received a call from a police officer who arrived at my home with another police officer and a social worker. 40. On day 32 the police officer called me to state that he was writing a report, and he thought the bruising could be caused by either the Second Respondent or the pet. I am not aware of the pet coming into contact with T. We took T to the hospital following advice and she underwent her Child Protection Medical on this day. We have received conflicting opinions from medical professionals as to the cause of T’s injuries. We were initially told that she had multiple fractures which would be painful for her after her medical. This was devastating to hear we asked if we shouldn’t touch her legs but were told to handle her as normal. 41. The next day an orthopaedic consultant physically examined T and told us that she was not in any pain. The consultant felt her legs and stated said ‘‘I’ll bet my money on it, this is medical, and they are healing fractures’. The social worker and team manager were present when he said this as well as the sister in charge. The team manager informed us that she had reported the orthopaedic consultant because she was not happy with the statement that he had made. 42. On day 36, I was giving T a bottle and noticed a new bruise, I raised this with the supervisor and took a photo of the bruise as did the supervisor. I exhibit this photo marked “M3” I raised this with the doctor however we were told after 9pm by the paediatrician that it was thin skin under her eye, and it was an old bruise travelling. This seems like a different bruise to me, given T’s bruises have changed and moved since birth I do not understand why this explanation also does not apply.”[36]She gave a second witness statement on. In that she describes how her sister was diagnosed with APS, which I have already referenced.[37]She was interviewed by the police. There is a note of that interview but no, as I understand it, recording or formal transcript.[38]She gave evidence and was questioned. In answer to questions from Mr Bowe KC, she set out a bit more detail about her difficulties during her pregnancy and her concerns regarding her vision and difficulties sometimes getting her speech out. She set out the circumstances of the caesarean section and the beginning of day 31 post birth much as she had described it. She, in answer to questions about the child protection medical, said that T was very agitated and tired when pictures were taken early in the morning.[39]In answer to questions from Miss Lattimer, she explained that having T and being at home was everything she had ever dreamed of for nine years. She described it as “a precious time”. She explained that the father was helping and initially they were sharing the nights. She said that the father returned to work on day 16 post birth . She agreed that she was on her own for the day and she was a person who liked structure and routine. She accepted it was difficult and that she was lonely.[40]She was asked if, on day 18 post birth , things were becoming somewhat horrendous as T was vomiting and ill and the pet, was vomiting and was ill. She was on her own. T was screaming and throwing up. When asked if she was struggling she said “yes”. When asked if she was sleep deprived she said “yes”. When asked if she was cross with the father around this time she said “yes”. Certain voice memos were played. When asked if she was at crisis point she said, “No, I don’t believe I was at crisis point.” Friends were supposed to visit on day 22 post birth but were put off.[41]She was asked that something very upsetting must have happened around day 23 post birth and day 24 post birth . She said that was not the case and she was just tired and she cried when she got tired. When asked if this was a low point she said, “I don’t know.” She was asked about whether she had been rowing with the father again and I think her overall view was that they had really been bickering and they were a team but some words were exchanged.[42]In answer to questions, she said that T was her entire world and she wanted everybody, I think meaning her, her husband and T, to be in that world. In answer to questions about photographs taken in the bath on day 19 post birth, she agreed with Miss Lattimer that, yes, T was unblemished. She was asked about whether any pictures were taken on day 24 post birth and I do not think she could recall any. She said she had not deleted any pictures from her phone.[43]She accepted that she had searched “bruising on babies” in the evening of day 21 post birth. She was then asked about a very obvious bruise that was photographed on day 25 post birth. She said she did not know the exact date that that bruise appeared. She was asked in detail by Miss Lattimer about when she first noticed it. She said, “day 25 post birth I think. From the morning, I would say the morning.” She says they were at home and she remembered the bruising. “It was horrific”. However, when asked about the conversation she had with the father about this bruise, she could not remember the conversation with the father. After a series of questions, I understood her evidence to be, in effect, that the message that she sent at 09:38 on the morning of day 25 post birth referencing a “fuck off bruise” was the first communication she had with the father about that bruise and she discussed it, she believes, with him after work. When pushed if that was the first conversation, the message being sent, she could not remember. In effect, her evidence was the photograph and a conversation after work must have been the first time the father knew about the bruise. She denied that she and the father knew about the bruise before that day.[44]When asked why she did not go to the GP, she said that was because she had been taking guidance from her family. She accepted that around day 24 post birth, T was really struggling and she accepted that she was Googling about babies crying around that time. She said, “I was a first-time mother. I wanted to do everything to comfort her.”[45]She was then played a voice note that the father sent to his cousin. That voice note described T squealing and coughing over two days. The mother’s evidence was that she did not recall that and she also said that she did not believe that the father had discussed that description with her. In the light of that, she was asked again about why she did not go to the doctor until day 30 post birth and I think she said she comforted the baby as best she could.[46]Father’s witness statement. In similar fashion to Mother, his witness statement explains how long the couple had tried to conceive a child. He then sets out a detailed chronology at paragraph 4 of his witness statement. In paragraph 4(a) he sets out what took place in the hospital. He said they were told the caesarean section would happen straightaway and he says the anaesthetist explained that Mother may have to be put to sleep because of pressure on the brain. He says he remembers there was a lot of movement at the moment of birth and he recalls two or three professionals using a lot of force to deliver T and that Mother was uncomfortable. He says when they got back to the ward they noticed significant purple and red bruising around T’s head and face and he says the nurse confirmed forceps were used to deliver T.[47]He says he returned to hospital on day of birth and spent time with Mother and T and then he left and they were discharged. He says that it was “such a wonderful feeling going home with the baby we had longed for for so long”, and he says Mother and him took turns in caring for and feeding T.[48]I need not set out the detail but over a number of days from day 2 post birth he explains a happy domestic time with T, Mother and him at home and the variety of family members visiting – that is set out at paragraphs 4(c) to 4(p) – up until day 15 post birth . On day 16 post birth Father returned to work and T was left during the days in the care of Mother. He notices that T was a bit unsettled and there were concerns regarding colic. His account of what took place from day 18 to day 30 post birth is: s. Day 18 post birth – nothing of note happened on this day. I was at work, and T was in Mother’s care for the majority of the day. I had no concerns about T either in the morning or when I came home from work. t. Day 19 post birth – nothing of note happened on this day. I was at work and T was in Mother’s care for the majority of the day. I had no concerns about T either in the morning or when I came home from work. u. Day 20 post birth – nothing of note happened on this day. I was at work and T was in Mother’s care for the majority of the day. I had no concerns about T either in the morning or when I came home from work. v. Day 21 post birth – On this day, Mother went to get her nails done and this was the first time I had been left caring for T on my own for the first time. Every day before then Mother and I had been together, albeit maybe not necessarily in the same room as one another 24/7, but in the same place. Me and T spent around 90 mins, no more than 2 hours, together alone. T slept on my chest, and we watched the football together. T was very settled. I remember the day very well because it was moments like this that I had longed for. Mother came home and we resumed joint care of T. I had no concerns about T. T appeared more settled now she had been taking the infacol. w. Day 22 post birth – nothing of note happened on this day. I had no concerns about T. x. Day 23 post birth – I went to college and Mother had care of T for the majority of the day. Our neighbours, who we would class as friends, P and Q, visited around 7:30pm. I believe they were at our house for a couple of hours. y. Day 24 post birth - nothing of note happened on this day. I was at work, but I had no concerns about T’s presentation either before I left for work or after I returned. z. Day 25 post birth – nothing of note happened on this day. I was at work, but I had no concerns about T’s presentation either before I left for work or after I returned. After setting out that chronology to day 30 post birth, Father then goes on to deny harming T and saying he cannot provide an explanation.[49]He provided a further response to threshold, continuing to deny any knowledge of how the injuries were caused. Like Mother, I note he was interviewed by the police.[50]He too gave oral evidence. He accepted in answer to questions from Mr Howell-Jones that he should have stepped up more and helped out more with the care of T when she came home. He was taken to his witness statement and he was taken to a variety of days in late month 1 post birth when his written witness statement says effectively “nothing of note happened on this day”. That was principally in relation to a number of days from around day 19 post birth to the end of month 1 post birth . He was challenged on the fact that what he put in his witness statement was not true because he did have concerns.[51]He was asked in some detail about his knowledge of the bruise on day 25 post birth. His answer to a series of questions was, “I cannot remember.” He was asked about when he was sent photographs of the bruise and he says he could not remember getting the photographs. He referenced, I think, some confusion regarding bruising healing and coming back, which was a reference to the forcep bruising, but when asked if it had gone on day 15, my understanding was that he said “yes”. He was asked when, using the direct language of Miss Lattimer, he first saw the “fuck off bruise” appear. He could not remember. He says he could not remember if he saw that bruise before he saw it in the photographs. Asked about his discussions with Mother, he said, “Well, we would possibly have had a conversation about it. I can’t remember the conversation.”[52]He was then played the voice note which he sent to his cousin describing T squealing in pain. I understood his evidence to say that that was a bit of exaggeration of what was happening but he was worried. He was asked why he had not told his cousin about the bruise but he did not know. He was asked if he had concealed the bruise from his cousin and he said, “I didn’t feel the need to tell her about the bruise.” Asked again about what he discussed with Mother about the bruise, he could not remember. When he was asked directly did he ask Mother how it was caused, he said, no, he did not feel the need to.[53]He was then taken to the Appendix 1 document, where it appears he suggested that a bruise was caused by T sleeping on her dummy. He was then challenged to say, well, he did remember and he said, no, he could not remember. Then he told me, when I asked him why he had said that is what he believed had happened regarding the bruise and the dummy, he said that was a slip of the tongue and he does not have an explanation.[54]He accepted that Mother was angry with him in the run-up to these events. He did not accept they argued but he accepted they bickered. He says he was not aware that Mother was making Google searches about bruising.[55]He was asked why the photographs stopped on day 21 post birth until day 25 post birth. His answer was that that was downtime for the family. When put to him that something had happened, he denied knowledge of something happening to T either by him or Mother. When asked by Mr Adams about what discussions he had with Mother about going to see a doctor on day 25 post birth, he said he could not remember.[56]In addition to the statements of the mother and the father, there are also statements in writing from a number of others. These include a statement from a neighbour (P). P is a friend and neighbour. I think P briefly looked after T at one stage when Mother was occupied with another matter. There is no suggestion that she is involved in any way. Her evidence is that she had no concerns about Father and Mother.[57]There is a witness statement from the maternal grandmother. She says:
“Mother called me once about T crying and I thought it might be colic.”
She then goes on to recount a visit to the zoo when she saw “a little bruise under her eye”. She does not make any reference in her statement to being contacted about ongoing difficulties in late month 1 post birth.[58]Mother’s sister and T’s aunt. She visited several times. She saw the marks on T’s face after the birth. She visited about a week after discharge of birth and T still had a red mark on her face. I think that was around day 7 post birth. She next saw T at the zoo. Again she does not say anything very much about being contacted by Father and Mother about difficulties in late month 1 post birth.[59]There is also a witness statement from Q who is P’s husband, I think. He is a friend and next-door neighbour.[60]I turn now to the expert evidence.

PART 5 – THE EXPERT EVIDENCE

[61]I start with the expert report of Mr Brocklesby, the consultant obstetrician. He reported initially. He had been provided with the court bundle and the maternity notes for Mother. His summary says this:
“Mother booked in her first on going pregnancy. She had routine antenatal care and was investigated for APS. She had an elective caesarean section at 38+1 week for maternal request and persistent headache. The caesarean section was documented to be straightforward, although there is a discrepancy in the operative delivery notes and the post-natal notes. The post-natal account documents that forceps were applied to T’s head to aid delivery. In my opinion the documented bruising would be consistent with the application of forceps. I am unable to formulate a mechanism of injury that would account for the injuries sustained by T and documented 31 days after birth. Therefore, in my opinion and I believe this would be supported by reasonable body of obstetric opinion, the injuries sustained by T were not caused during the birth process.”
He reviews the antenatal care notes and sets out in some detail about APS testing.[62]He says about the notes in respect of the caesarean section procedure:
“Above is a description of the caesarean section. This documents an uneventful entry and that T was delivered cephalic in good condition. There is no entry to suggest that the delivery required the use of obstetric forceps, although it is not uncommon that they are utilised at an elective caesarean section for a floating head and this will be discussed below.”
He then sets out in copy and paste fashion the postnatal history and he sets that out in some detail. He then says the following:
“The APGAR scores are recorded to be 9 at 1 minute. There is an entry to suggest that at the time of the caesarean section one blade of the forceps was applied to aid delivery of T’s head. Apgar scores: These are a method of determining the condition of the baby at birth. The score is based on the systematic assessment of five criteria: heart rate, respiration, reflex irritability, muscle tone and skin colour. Each of these signs is rated as 0, 1 or 2 at 1 minute of age. However, the Apgar scoring system was devised as an objective indicator of the condition of the neonate at birth and is not a marker of asphyxia/hypoxia. As such, although they are still used widely, they have been superseded by the umbilical cord gas analysis when indicated as this is more robust and objective assessment of neonatal health at birth. This confirms that T was born in good condition.”
He goes on to say that the paediatric note suggests that there were forceps marks to the head and a bruise to the left cheek. He then posts into his notes T’s postnatal body map. This documents, he says, that there was bruising to the left and right parietal regions of the head. He then sets out injuries that were caused to T. Apgar scores: This confirms that T was born in good condition.”

Apgar scores:

[63]He sets out detailed information, which I have read but will not add to the judgment, regarding a birth trauma, caesarean sections, floating foetal head, fractures in utero and fractures in the long bones. I have read and considered all his helpful and generalised advice to the court.[64]He then turns to answer the questions set out in his instructions:
“Please comment upon any matters of significance contained within the medical records of the child and birth records. In my opinion and I believe that this would be supported by a reasonable body of obstetricians, there is nothing with the maternity records that would explain or predispose T to the injuries that she sustained 31 days after delivery. Please comment on the mother’s assertion that this was a traumatic birth, in your consideration is there anything within the records which reveals this was an unusually traumatic birth. The perception of trauma refers to how individuals experience, interpret and respond to potentially traumatic events. Perception plays a critical role in determining whether an event becomes psychologically traumatic for a person. In my opinion and I believe that this would be supported by a reasonable body of obstetric opinion, the delivery as described does not appear challenging to facilitate and did not require complex traction manoeuvres to T’s lower limbs. Although the delivery records do not document that obstetric forceps were applied to aid delivery of T’s head. There is a note that confirms that potentially one blade was applied to T’s head and this would be consistent with the marks that were evident after the delivery (mother’s pictures). This technique is used during a caesarean section where assistance is needed to safely deliver the fetal head without causing trauma to the baby or the uterus. A single blade – usually the left blade of a standard obstetric forceps (Wrigley’s forceps) is gently introduced between the fetal head and the wall of the uterus. The blade is positioned to cradle and guide the fetal head upward through the birth canal or incision. The non-dominant hand is then used to elevate or flex the fetal head abdominally through the uterine incision. The forceps blade acts as a lever, reducing pressure on the skull and aiding controlled delivery. In my opinion this was an unusual delivery in view of the fact that a single forceps blade was utilised to deliver the fetal head. Due to the lack of documentation there is the possibility that there was a full forceps delivery of T’s head (using both blades) and in my opinion this would be more in keeping with an elective caesarean section when the mother is not in labour. However, this discrepancy in the delivery would not, in my opinion and I believe would be supported by a reasonable body of obstetricians, account for the injuries sustained by T as there is no documentation of needing to achieve delivery by forces being applied to T’s legs. Is there anything within the birthing records which points to causation of fractures in the birth which could account for injuries identified at 4 weeks post birth. In my opinion there is nothing within the obstetric medical records that would suggest that the fractures occurred at delivery.”
[65]There is an addendum report and questions were asked by the parties and answered. Was the facial bruising sustained by T at birth unusual in their appearance, location or extent? When bruising occurs from forceps assisted deliveries it usually results in symmetrical bruising on both sides of a newborn's face or head, often corresponding to the shape and position of the forceps blades. The bruise that was observed on T's face would be in keeping with the application of a forceps blade to aid delivery of the fetal head at the time of the caesarean section. Any further comments on the whether these are unusual in appearance, location and extent would need to be addressed by an expert in neonatology as they would look after the baby as obstetricians care and treat the mothers after birth and therefore outside my area of expertise. If the Court determines that the records do not accurately reflect the birth process and that it was not 'straightforward' or 'uneventful' do you accept that there is a possibility that the bony injuries detected in T in February were caused then? In my opinion if the court accepted that the delivery was not straightforward, I cannot identify a plausible mechanism of injury to explain the observed fractures. While femoral fractures may occur from direct trauma during difficult breech deliveries or caesarean sections, they are typically thought to result from excessive torsion and traction to the limb during the procedure. The fact that T was delivered cephalic and there were no reported additional manoeuvres to the limbs and that they would not have been required unless this was a challenging delivery led me to conclude that could not have been caused by a challenging birth. On behalf of the mother:- 1. Is it likely that the full forceps were used during T’s delivery as this is more in keeping with an elective caesarean section when the mother is not in labour despite the post-delivery records referring to a single forceps blade being used to deliver the head. I am unable to assist the court with this question, as there is no evidence from the medical records that two forceps blades were applied, the medical records document that one blade was applied. Therefore, we must assume that this was the case.[66]There is a second addendum. I have read and considered that.[67]Mr Brocklesby gave oral evidence and was questioned. His view, as an obstetrician reviewing Mother’s medical history, was that a caesarean section really was not required for any medical reason. If it was him delivering Mother of her baby, he would have had really no concerns and no need to be more cautious. He does not know why she was prioritised up the list. He said there was nothing in the notes and he cannot see why it was changed. He could not see any pathology for the surgery to be brought forward. He said it could be a question of anaesthesia. Looking at the timings, his view was it really depended on the exact minutes but it was, he said, a pretty standard caesarean section.[68]He then gave evidence about the position of floating heads, which he said was quite common, and that often forceps are used to manipulate the head out. He said that made the procedure more complicated but would not be classified as a complex caesarean section. He said that if two forcep blades were used then you would often see bruising around the temple or the cheeks.[69]He then described the use of fundal pressure in caesarean sections and a factor he described as clinical intervention similar to contractions. He could not understand why there would be a need for any side to side movement though. He accepted pressure was used in caesarean sections. He accepted there was a discrepancy regarding the use of only one blade of the forceps. He said that would not be unusual to use one blade but he, I think, said he would himself have done that. He accepted there were inconsistencies in the note. For example, the fact that one blade was recorded but only later. There were some inconsistencies with the body map and there was an issue regarding the description of the floating head.[70]He accepted that fractures can occur at birth. He said he struggled to see how four fractures could have occurred when explaining when he had delivered a child and there was a fracture, he was clear that he felt that fracture very clearly. He again was asked about whether using a single forcep was unusual and did say that using one blade is unusual but there was nothing to suggest that this was a complicated delivery. In answer to questions about interaction with the baby’s legs, he said, “We do not grab legs. We do not touch the legs.” He explained effectively with cephalic delivery, when the baby is not in a breech position, which is what he described with T’s delivery, the head is down, the head comes out, then the body and the legs are freed. He did say very occasionally fractures occur. My understanding of his evidence was that he had only ever seen in twenty-five years of practice a single fracture, a unilateral fracture. He had never seen multiple fractures at a birth.[71]He was asked a series of questions by Mr Bowe KC about the various discrepancies, which he accepted that there were discrepancies with the notes. He answered a series of questions about the nature of the forceps used. He said some locked and that limited the amount of pressure. He explained that you do need fundal pressure to deliver a child and you need to use some force. He said if two or three people had been used he would say that is quite a lot and one to two is what he would have expected. But he said there is no mention in the notes of another assistant. He did not think mum’s height was a relevant issue. He, in answer to questions regarding the radiological opinion, thought the reference to long bone fractures was a discussion about vaginal delivery and not caesarean section. In answer to a question about whether there would be manipulation of T’s legs which could not have been documented, he answered that that would be “highly unusual”. He emphasised that this was a cephalic delivery. It would be very unusual to put a hand in the cavity and nothing like that was documented. He said even if force had been used on the legs it would be unlikely to cause so many fractures. He says the literature and his experience bears out that multiple fractures like this were unlikely. He emphasised that T was not in a breech position and he emphasised that any surgical team would probably have documented lots of manipulation.[72]The second jointly instructed expert is Dr Karl Johnson. “Radiological Findings There is normal bone density and no evidence of underlying metabolic bone disease. These appearances indicate that from a radiological perspective, T is at no increased risk of fracturing compared to any other child of her age. On the skeletal survey of day 44 post birth: The metaphyseal fracture of the distal left femur, distal right femur, proximal left tibia and distal right tibia show further x-ray evidence of bone healing and the dating of these fractures is unchanged. The appearance of the distal left tibia are unchanged. In my opinion, on the balance of probabilities, the appearances of the distal left tibia are within normal limits and do not represent a fracture. No additional fracture is identified.” On the skeletal survey of day 44 post birth: No additional fracture is identified.”

On the skeletal survey of day 44 post birth:

[73]Dr Johnson sets out his radiological opinion, and that is that T had suffered numerous metaphyseal fractures. He explains there is a metaphyseal fracture in the distal left femur which he estimates in the region of 2-4 weeks of age as of day 33 post birth. There is a metaphyseal fracture in the proximal left tibia which he estimates in the region of 2-4 weeks of age as of day 33 post birth. There is a metaphyseal fracture in the distal right femur, which he estimates in the region of 2-4 weeks of age as of day 33 post birth, and there is a metaphyseal fracture in the distal right tibia, which he estimates in the region of 2-4 weeks as of day 33 post birth. He does, however, say that the radiological dating of these fractures is difficult, imprecise and a subjective estimation. He says:
“Each fracture is the result of significant force applied to the bone. The amount of force required to cause these fractures is unknown, but in my opinion, it is significant, excessive and greater than that used in the normal care and handling of a child. These fractures would not have occurred from normal domestic handling, over-exuberant play or rough inexperienced parenting. At the time that the fractures occurred, T was less than 2 months of age and she would not have had the strength or level of development to self-inflict these injuries. At the time the fractures occurred, I would expect that T would have been in pain and shown signs of distress which would have lasted for some moments. Following this initial distress, the signs and symptoms related to these fractures could have been variable and I would defer to the paediatricians in all aspects of clinical presentation ... … In my opinion, the distal left femoral and proximal left tibial fractures could have occurred from a single episode of trauma applied around the left knee. Overall, from a radiological perspective, the fractures have occurred from at least 3 separate applications of force.”
He cannot determine the chronologies. “To cause any fracture requires both a suitable mechanism and a significant level of force.” He says that metaphyseal fractures can occur at birth. The instance of these fractures occurring at birth is unknown but is believed to be relatively low. He cannot exclude birth injury as a possible cause of the metaphyseal fractures but he is unable to determine the probability of this. He would defer to the paediatricians and obstetricians with regard to whether or not there is anything in T’s history to suggest that metaphyseal fractures could have occurred at this time. “If the court finds the metaphyseal fractures did not occur at birth then I have not been provided with any suitable explanation of significant force applied to T’s legs to account for any of the fractures which she has sustained. In the absence of any suitable history, unexplained fractures of this nature in a child of her age raise concerns regarding possible inflicted non-accidental injury. It is the absence of any suitable history rather than the radiological appearances of the fractures which raise these concerns. In my opinion, the presence of multiple fractures which are the result of numerous applications of force, increases the suspicion of inflicted non-accidental injury. Answers to Specific Instructions 1. Are the injuries described above an exhaustive and accurate account of the injuries? T has suffered numerous metaphyseal fractures. There is a metaphyseal fracture of the distal left femur which I would estimate is in the region of 2 - 4 weeks of age on day 33 post birth. There is a metaphyseal fracture of the proximal left tibia which I would estimate is in the region of 2 - 4 weeks of age on day 33 post birth. There is a metaphyseal fracture of the distal right femur which I would estimate is in the region of 2 - 4 weeks of age on day 33 post birth. There is a metaphyseal fracture of the distal right tibia which I would estimate is in the region of 2 - 4 weeks of age on day 33 post birth. The radiological dating of these fractures is difficulty, imprecise and a subjective estimation. 2. Please outline the extent of the injuries identified. See question 1. 3. Is there any that would made T to be more susceptible to or worsen the effect of these injuries? There is normal bone density and no evidence of underlying metabolic bone disease. These appearances indicate that from a radiological perspective, T is at no increased risk of fracturing compared to any other child of her age. 4. Please give your opinion to the timing of any fracture including: See question 1 a. The possibility or likelihood of any of the injuries having occurred during the birth delivery process and b. The possibility or likelihood of any connection between the identified injuries To cause any fracture requires both a suitable mechanism and a significant level of force. Metaphyseal fractures typically the result of severe twisting/torsional force applied to the end of the bone. The radiological appearances of this fracture are non-specific with regard to the exact mechanism of causation. Metaphyseal fractures can occur at birth. The incidence of these fractures occurring at birth is unknown, but is believed to be relatively low. It is my understanding that fractures of this nature are more likely to occur from difficult or instrumental deliveries. In view of T age, from a radiological perspective, I cannot exclude birth injury as a possible cause of the metaphyseal fractures, but I am unable to determine the probability of this. I would therefore defer to the paediatricians and/or obstetricians with regard to whether or not there is anything in T’s birth history to suggest that the metaphyseal fractures could have occurred at this time. All the metaphyseal fractures could have occurred at the same time but from separate applications of force. Overall from a radiological perspective the fractures have occurred from at least 3 separate applications of force. 5. Please identify all possible mechanisms for any injury. This should include all possible or likely benign or organic causes including those during labour and identifying any factors which would be indicative of or contra-indicative of non-accidental injury. When doing this please include the likelihood of reach possibility with detailed reasons and why you include/exclude each possibility. See question 4. 6. Please comment on whether the injuries accord with any explanations given the parents and if not, why not? At the time that the fractures occurred, T was less than 2 months of age and she would not have had the strength or level of development to self-inflict these injuries. 7. Please comment on whether you consider the injuries are likely to be of accidental, non-accidental/organic, or unknown causes. If the court finds the metaphyseal fractures did not occur at birth then I have not been provided with any suitable explanation of significant force applied to T legs to account for any of the fractures which she has sustained. In the absence of any suitable history, unexplained fractures of this nature in a child of her age raise concerns regarding possible inflicted nonaccidental injury. It is the absence of any suitable history rather than the radiological appearances of the fractures which raise these concerns. The radiological appearances of the fractures are non-specific with regard to the exact mechanism of causation. The same fracture pattern could occur from an accidental or inflicted injury. In my opinion, the presence of multiple fractures which have are the result of numerous applications of force, increases the suspicion of inflicted non-accidental injury. 8. Given the accounts recorded what is your view as to the causation of the injuries in respect of the explanations offered and generally? See question 4. 9. T was born at 38 weeks gestation. Could this increase her susceptibility or have attributed to the cause of any of her injuries? I would defer to the paediatricians in this regard. 10. Please comment on the likely force that would be required to cause the injuries insofar as you are able to do so (appreciating that it is difficult to quantify force in such cases). Each fracture is the result of significant force applied to the bone. The amount of force required to cause these fractures is unknown, but in my opinion, it is significant, excessive and greater than that used in the normal care and handling of a child. These fractures would not have occurred from normal domestic handling, over-exuberant play or rough inexperienced parenting. 11. In your view, could any of the identified injuries/lesions be caused by way of normal handling of a child? See question 10. 12. Would you be assisted in your replies with input from other medical disciplines or any further medical investigations. If so, please advise. From a radiological perspective, no further tests are indicated.” Answers to Specific Instructions See question 1 From a radiological perspective, no further tests are indicated.”

See question 1

[74]There is an addendum report from Dr Johnson and there is an email. I do not think anything in particular turns on that. Dr Johnson was not called to give evidence.[75]The third jointly instructed is the consultant paediatrician, Dr Birch. Dr Birch produced a lengthy, detailed, comprehensive and clear report. She received the court bundle and T’s medical records. She sets out a very detailed chronology of events. She sets out a very detailed summary of the child protection medicals, to which I have referred. She sets out a number of photographs that she has been provided with. She sets out a very detailed account of the bruises and she then sets out, over a number of paragraphs, a very detailed account of the fractures and bony injuries. Obviously I have read all of that with care.[76]That background leads her to provide a number of opinions to the court. “29. Naturally it is important to distinguish non-accidental bruises from accidental bruises. In inflicted abusive bruising, the face was the most frequently injured (41%) part of the body, with the cheek being the most common site for the injury. These bruises although often small can be regarded as warning signs that the child is in need of protection.30. Bruises over soft tissue are of concern when considering the likelihood of non-accidental injury.31. Accidental bruises are less common in non-ambulant children but nevertheless when babies are examined routinely they do often show small bruises. A study reported that 12% of normal babies are found to have undiagnosed bruising 4 bruises were found on the front of the body and were located over bony prominences of the bruises the majority (78%) were on the face and head. However the accidental bruising is over hard bony areas and not the soft part of the cheek. There was a highly significant increase in bruises with increase in mobility.32. In T’s case the facial bruising is almost exclusively over soft tissue and the cheek bruising is over the baby ‘fat pad’ or ‘sucking pad’ which is not bruised accidentally.33. In distinguishing accidental from non-accidental bruising it is important to note the context of the bruising – for example are there multiple bruises, are there bruises of varying ages and is the explanation absent or not credible. Often one cannot be certain from the view of the bruise alone but the presence of other bruises or injuries which are regarded as indicative of abuse can raise one’s threshold of suspicion with respect to dubious marks. When abuse is suspected, bruising must be assessed in the context of medical, social, and developmental history, the explanation given, and the patterns of non-abusive bruising.34. The Systematic review on Bruising published by the Royal College of Paediatrics and Child Health in 2019 gives characteristics associated with bruising indicative of abuse; Bruising in children who are not independently mobile; Bruising in babies; Bruises that are seen away from bony prominences; Bruises to the face, abdomen, arms, buttocks, ears, neck, and hands; Multiple bruises in clusters; Multiple bruises of uniform shape; Bruises that carry the imprint of implement used or a ligature; Bruises that are accompanied by petechiae, in the absence of underlying bleeding disorders.35. In this case we have lack of mobility, she is a baby, she has bruises away from bony prominences, she has bruising on her face and cluster of bruising on the trunk and she has a bruise on the neck under her chin – all of which add up to a picture of suspected non-accidental injury.36. In terms of the bruising, from the history we can confirm that this is recent although bruising appears to have appeared piecemeal over a period of some days. It is very difficult to date bruising from photographs (see appendix dating of bruises and marks).37. The pattern of bruising seen here is very likely to be caused by non-accidental injury whereby excessive force has been used in handling the child and causing injury.38. The level of force would be such as to exceed normal or rough handling and the perpetrator would know that they were causing T harm. AT the time of the injuries she is likely to have felt pain and cried but she would likely settle relatively quickly such that a non witnessing carer might not realise that anything was wrong.39. T has no underlying medical condition which would predispose her to easy bruising and apart from her injuries she is otherwise a healthy baby.” She then sets out her conclusions in respect of the fractures and bony injuries and provides her opinion to the court at paragraphs 44 to 51:
“44. Metaphseal fractures in infants are very often associated with non accidental injury – they can be relatively silent and cause pain when first acquired but then this can settle fairly quickly so that a non witnessing carer might not realise that the child has fractures. The child might just be a bit fractious, not their usual selves, have discomfort on being handled but not show overt signs of fracture. 45. The injury typically occurs when the child might be picked up and held by the lower leg and swung round – hence providing a pulling force and a torsion force or twist. Considerable force is required for this injury and it would not be likely to occur if say an adult was picking up a child which accidentally slipped from their grasp so that they grabbed for the leg to catch the child. The weight of the child alone would be insufficient to cause this type of injury which usually also involves a degree of swinging the baby and thus increasing the gravitational force. 46. Metaphyseal fractures of the ankle can possibly occur when the baby gripped around the chest and the lower part of the body shaken - the flailing about of the lower leg on the upper can be responsible. If the shaking had been of sufficient force to injure the legs other concomitant injuries occur for example cranial injury encephalopathy and cranial bleeds which fortunately were not seen in T’s case – she had a negative CT Scan, Nevertheless we do see grip marks on T’s chest. 47. T is a healthy little girl who has no underlying condition which would predispose her to fractures. She is a non-ambulant infant who has sustained multiple injury – not only extensive bruising but also four or possibly five fractures. 48. She has no propensity to fracturing or bruising, standard blood tests have been normal and her xrays showed normal bone density and no signs of any metabolic disorder. Of course this does not entirely rule out a bleeding disorder – for the bruising – but this is very unlikely and a bleeding disorder would not show up with the sort of bruising seen which is a pattern of non accidental injury. The family history is of increased propensity to clotting – not bleeding – fractures would not relate to a bleeding disorder – so for all these reasons further testing is contraindicated. 49. T has metaphyseal fractures only – these are very rare in birth injuries and are also not a feature of Osteogenesis imperfecta. T also has no other signs of OI or any bone disorder. Genetic testing is therefore not clinically indicated. 50. It is possible that all the fractures occurred during one event whereby she was grasped by the chest and her legs were swung about but it is more likely that more than one incident occurred to produce the numerous fractures. 51. We can see from the diagram above that the left knee fractures are close together and could have been produced at the same time by a twisting pulling action at the knee but the other fractures are likely to have required separate applications of force – so probably three or possibly four events (if number 5 is indeed a fracture).”
Her conclusion is clear at paragraph 55:
“In conclusion, on balance of probabilities, T at the tender age of just four weeks, has been subject to repeated acts of physical abuse at the hands of an adult who has caused significant widespread bruising and four or possibly five metaphyseal fractures.”
[77]She provided an addendum report. She helpfully sets out to the court in that report the caution that is required in respect of bruises and how long they persist in infants. She is warning the court to be careful in respect of how long bruises persist because that is dependent on the severity and the depth, the colours, blood supplies and other issues. She sets out in answer to a number of questions, whether areas which sustain bruising are liable to bruise more easily in the days or weeks following the original cause. Her answer was, no, this would be very unusual. She says in the case of an infant sustaining bruising such as the forceps bruising, this would not have any permanent effect on the facial tissues and would not predispose to further episodes of bruising. She then sets out evidence regarding conditions which easily and readily cause bruising. I need not add to this lengthy judgment because none of those matters have been pursued, as I understand the case put.[78]There is a further addendum report. That was in response to issues raised by Mother and I think all of those lines of enquiry have been discounted and I do not understand matters to be pursued on what is covered in that report.[79]There is a third addendum report, in which consideration is given to whether it is necessary, in the light of what the consultant obstetrician Mr Brocklesby says about whether there should be an expert in haemolytic anaemia, to comment on nitrofurantoin. Her clear evidence is, no, that is not required. There is no evidence T ever had G6PD deficiency.[80]She also gave oral evidence and I found her a clear, straightforward and robust witness, as I did Mr Brocklesby. She was asked questions about the quality of the photographs that were taken early in the morning of the child protection medical. It is clear that she has relied on some of those and the point was made by Mr Bowe KC that the child protection medical did not think these were of good quality but she had relied on them. She took the view that this did not undermine her opinions in any way. She was asked a number of questions about whether they were tracking bruises but she was very clear that the bruising that she was concerned with, the photographs of day 25 post birth and later, were unrelated to the forceps bruising and these were not tracked bruises and she was of the view that tracking comes down the face and not up.[81]In answer to a detailed series of questions by Mr Bowe KC about the quality of the photographs, she felt some of the photographs which showed the chin bruising were better and she really could not say what the medical view was about whether that photograph accurately captured what the doctor at the time was seeing. When asked about whether the late month one bruising could be related to a forceps delivery she was clear that it was not related to the forceps. When it was pointed out that there were aspects of the delivery, on the mother’s case, that were unclear because of the notes, she remained of the same view. I think she accepted that the marks demonstrated two sides of a forcep used. When asked questions about the colours of bruises and whether this denoted healing in an ordinary bruise, she was clear you could not rely on colour to do so. She was clear that the forcep bruising had cleared up. When she was asked about you could not exclude the fact that the bruising shown in late month one was from the forceps, she said, “No, you would not expect it to appear a month later. That is a different bruise. That is not a resolving bruise. That bruise is a lot worse than the forceps bruise. It is not a resolving bruise.” When asked whether it was a tracking of the bruise, she said it was not.[82]She was asked some questions about the fractures to the legs and whether this could have taken place changing the child. She said you do not normally fracture a leg when changing. She said that excessive force had been used. She said that pulling force and torsion were both required. It is not related to normal handling.[83]In answer to questions from Mr Howell-Jones, she was of the view that T was not susceptible to further bruising. She said, “No, not really.” She said the blood vessels become normal and there would not be any scarring. When asked if it had not healed was T more susceptible, she said, “Yes, but the healing definitely would not take a month.” When asked if the bruise under the chin could be caused by falling asleep with a dummy, she said it was possible. She accepted that some fractures could be asymptomatic.[84]I turn now to chapter 6, the mobile phone and other Evidence Matters evidence.

PART 6 – EVIDENCE MATTERS – FORENSIC EVIDENCE FROM DEVICES

[85]It has been extremely helpful to the court and I am very grateful to Miss Lattimer and Miss Mahmood for having taken the time, and it must have taken a lot of time, to put together the first and second appendices to their written document. I am very grateful to them for the forensic skill they have shown in drafting those documents and assisting the court.[86]The analysis of those documents provides a lot of insight and evidence into what was actually going on in the family home between T, the mother and the father. That evidence casts significantly more light than the witness statements and oral evidence of Mr and Mother. It also shows a lot of photographs of T which helps the court to piece together what may have happened. It is not possible in this judgment to summarise all of the messages or all the photographs but I have carefully looked through those appendices. There are a number of helpful points that flow from it.[87]First of all, it is clear that Mother very much enjoyed taking pictures of T, understandably so because there are many pictures of her beautiful baby girl. It is clear from the contemporaneous messages that T was bruised by the forceps and that can also be seen in some of the early pictures. It seems to me, from looking through the appendices without going through the huge amount of documentation in the bundle, which is nearly 3,000 pages, that from the day of T’s birth to day 20 post birth pictures of T were taken by the mother every day, I think with the exception of day 14. No pictures by Mother were taken on day 21, 22, 23 or 24, although I note that Father took two pictures on day 21. The pictures on day 25 show a very large concerning bruise on T’s left cheek. Mother messages the father on the morning of day 25, saying:
“Be cute without the fuck off bruise xxxx.”
There is very little other introduction or explanation for that text message. Pictures are then taken again on day 25, 26, 27 post birth and days 28, 30, 31 and 32 post birth.[88]The messages generally, up until around when Father returns to work on day 16 post birth are pleasant to read and evidence Mother’s, in particular, pleasure in being a new mother with the normal emotions one would get with a new mother or feeling at times a little lonely or emotional and, indeed, being nervous with the care of a newborn. But from around the day 18 post birth, the messages seem to indicate that there are some difficulties. For example, at 11.50 on day 18 post birth, the mother explains that the dog “has been sick a million times and so has T.” She has “literally been up all night dealing with both”. She says at 12.13:
“Can’t even walk shop to get a redbull today because T just screams and the pet throws everything everywhere.”
On day 19 post birth at 16.42 she says:
“Trust it all to happen when ‘Father’ goes back to work. It’s the first time I’ve sat here today and just thought ‘why did we do this’ Thank you for being so understanding, I feel awful I keep changing when. But Sunday 100%.”
[89]There are also positive messages. She says at 16.53 on day 19 post birth :
“She’s an absolute angel, it’s just seems this shitty colic is really upsetting her! I love this baby stage, the little scrunch and smile, but definitely don’t love this stage. I don’t know how you managed 3!”
She explains later that day she is just very tired. On day 20 post birth she says that T has colic and has not settled in days. She says:
“… I am majorly sleep deprived”
. She explains later on day 20 post birth that the week has caught up with her and she says:
“It makes me feel guilty because I just sometimes think life was so easy before.”
[90]On day 23 post birth she says:
“Didn’t get sleep, feel fucking shit.”
On day 24 post birth she says:
“ideally I want to get my ovaries tied!” and “Just trying to settle T, been crying since 4. Tried everything, bottle, nappy, moses, crib, sleepyhead holding her blanket, no blanket, swaddle and absolutely nothing is working. Don’t know what’s the matter xx.”
The father says, at 19.41 on day 24 post birth :
“Tired girl, bless her ours is crying none stop for 2 days now xxxx”
. On day 26 post birth the mother says:
“If I ever wanted to scream, today is the day” and “Literally just crying xxxx”
. She says later that day:
“Please remind me why I became a mum”
. She says she is “Going to ring the doctors tomorrow” complaining that “the colic and constipation is unreal.”[91]There are a lot of other messages and I cannot go through all of them. As I have referenced, the forensic evidence also shows that the mother searched about bruising on babies on the evening of day 21 post birth. There are also voice notes from the father and, very helpfully, they have been transcribed for me. There is a voice note from the father on day 25 post birth to his cousin, that says this:
“No idea what was up with her. She’s been like it for two days. No idea. Dunno if she’s had some sort of belly ache or I don’t really know. She kept doing this like weird cough and it would like wake her up. She would go to sleep for five minutes, do this like weird little coughy thing and then start squealing, so we don’t know if, I dunno, it just seemed to be hurting her whenever she did this little cough thing. But she’s alright again now so g’god knows.”
His voice note to Mother on day 24 post birth also makes clear that there were difficulties between them, the stress of managing T.

PART 7 – THE LAW

[92]I need to do nothing further than add to this judgment the helpful agreed summary of the law, without further comment or amendment. A. “FINDING OF FACT HEARINGS – GENERAL LEGAL PRINCIPLES

B. IDENTIFYING A PERPETRATOR

[1]In the matter of A Local Authority v W (No. 2) (Finding of Fact Hearing) [2020] EWFC 68, MacDonald J has set out the legal principles that are engaged when the court is determining questions of fact. At paragraph 48 they are summarised as follows: 48. The legal principles that apply when the court is determining questions of fact are now well established and can be summarised as follows: i) The burden of proving the facts pleaded rests with the local authority. In cases of alleged non-accidental injury, it is for the local authority to establish on the balance of probabilities that the injuries were inflicted. There is no requirement on the parents to show that injuries resulted from some other cause. Where a respondent parent seeks to prove an alternative explanation but does not prove that alternative explanation, that failure does not, of itself, establish the local authority’s case, which must still be proved to the requisite standard (see The Popi M, Rhesa Shipping Co SA v Edmunds, Rhesa Shipping Co SA v Fenton Insurance Co Ltd [1985] 1 WLR 948 at 955-6). ii) The standard to which the local authority must satisfy the court is the simple balance of probabilities. The inherent probability or improbability of an event remains a matter to be taken into account when weighing the probabilities and deciding whether, on balance, the event occurred (Re B [2008] UKHL 35 at [15]). I examine the topic of inherent probabilities further below. iii) Within this context, there is no room for a finding by the court that something might have happened. The court may decide that it did or that it did not (Re B [2008] UKHL 35 at [2]). iv) Findings of fact must be based on evidence not on speculation. The decision on whether the facts in issue have been proved to the requisite standard must be based on all of the available evidence and should have regard to the wide context of social, emotional, ethical and moral factors (A County Council v A Mother, A Father and X, Y and Z [2005] EWHC 31 (Fam)). v) In determining whether the local authority has discharged the burden upon it the court looks at what has been described as ‘the broad canvas’ of the evidence before it. The role of the court is to consider the evidence in its totality and to make findings on the balance of probabilities accordingly. Within this context, the court must consider each piece of evidence in the context of all of the other evidence (Re T [2004] 2 FLR 838 at [33]). However, the concept of the canvas is not an excuse for forensic laxity. Wide as it is, the canvas surveyed must still be comprised of threads of relevant admissible evidence. vi) In this context, and self-evidently, I am not limited to considering the expert evidence before me. Rather, I must take account of a wide range of matters that includes the expert evidence but that also includes, for example, my assessment of the credibility of the witnesses and inferences that can be properly drawn from the evidence. Accordingly, the opinions of the medical experts need to be considered in the context of all of the other evidence. vii) When considering the medical evidence with respect to the child’s presentation, the court must bear in mind, to the extent appropriate in the given case, the possibility of an unknown cause for that presentation (R v Henderson and Butler and Others [2010] EWCA Crim 126 and Re R (Care Proceedings: Causation) [2011] EWHC 1715 Fam). As observed by Dame Elizabeth Butler-Sloss P in Re U, Re B (Serious Injury: Standard of Proof [2004] EWCA Civ 567:
“The judge in care proceedings must never forget that today's medical certainty may be discarded by the next generation of experts or that scientific research would throw a light into corners that are at present dark.” viii) The evidence of the parents and carers is of utmost importance and it is essential that the court forms a clear assessment of their credibility and reliability. The court is likely to place considerable reliability and weight on the evidence and impression it forms of them. In this regard, it is important to bear in mind the observations of Peter Jackson J in Lancashire County Council v M and F [2014] EWHC 3 (Fam) that: “To these matters I would only add that in cases where repeated accounts are given of events surrounding injury and death, the court must think carefully about the significance or otherwise of any reported discrepancies. They may arise for a number of reasons. One possibility is of course that they are lies designed to hide culpability. Another is that they are lies told for other reasons. Further possibilities include faulty recollection or confusion at times of stress or when the importance of accuracy is not fully appreciated, or there may be inaccuracy or mistake in the record keeping or recollection of the person hearing or relaying the account. The possible effects of delay and repeated questioning upon memory should also be considered, as should the effect on one person of hearing accounts given by others. As memory fades, a desire to iron out wrinkles may not be unnatural – a process that might inelegantly be described as “story-creep” may occur without any necessary inference of bad faith.” ix) It is also important when considering its decision as to the findings sought that the Court take into account the presence or absence of any risk factors and any protective factors which are apparent on the evidence (see Re BR [2015] EWFC 41). These, however, cannot be determinative by themselves. x) It is in the public interest that those who cause injury to children be identified (Re K (Non-accidental Injuries: Perpetrator: New Evidence) [2005] 1 FLR 285). The court should accordingly endeavour to identify on the simple balance of probabilities the person or persons responsible for inflicting the injuries in question where it is possible to do so. xi) The Court should not, however, ‘strain’ the evidence before it in order to identify on the simple balance of probabilities the individual or individuals who inflicted the injuries. If it is clear that it is not possible on the evidence before the court for the court to conclude on the balance of probabilities who the perpetrator of the injuries is, or perpetrators of the injuries are and the court remains genuinely uncertain, then the court should reach that conclusion (Re D (Care Proceedings: Preliminary Hearing) [2009] 2 FLR 668). xii) Where it is not possible to identify which parent inflicted injuries found to be non-accidental, it is open to the court to conclude in respect of each parent that the local authority has demonstrated that there is a likelihood or real possibility that they inflicted the injuries and to proceed to the welfare stage on the basis that one or other or both parents caused the injuries in question (see Lancashire County Council v B [2000] UKHL 16, O and N (Minors); Re B (Minors) [2003] UKHL 18 and Re B (Children: Uncertain Perpetrator) [2019] EWCA Civ 575 B. IDENTIFYING A PERPETRATOR Re B (Children: Uncertain Perpetrator) [2019] EWCA Civ 575 Jackson LJ: “The concept of the pool of perpetrators should, therefore, as was said in Lancashire, encroach only to the minimum extent necessary upon the general principles underpinning s.31(2). Centrally, it does not alter the general rule on the burden of proof. Where there are a number of people who might have caused the harm, it is for the local authority to show that in relation to each of them there is a real possibility that they did it. No one can be placed into the pool unless that has been shown. This is why it is always misleading to refer to ‘exclusion from the pool’. Approaching matters in that way risks, as Baroness Hale said, reversing the burden of proof. To guard against that risk, I would suggest that a change of language may be helpful. The Court should first consider whether there is a ‘list’ of people who had the opportunity to cause the injury. It should then consider whether it can identify the actual perpetrator on the balance of probability and should seek, but not strain to do so … only if it cannot identify the perpetrator to the civil standard should it go on to ask in respect of those on the list: ‘Is there a likelihood or real possibility that A or B or C was the perpetrator or a perpetrator of the inflicted injuries?’ Only if there is, should A or B or C be placed into the ‘pool.’”
[2]Re A [2022] EWCA Civ 1348 King LJ:
“I suggest … that in future cases judges should no longer address themselves on the necessity of avoiding ‘straining to identify a perpetrator.’ The unvarnished test is clear: following a consideration of all the available evidence and applying the simple balance of probabilities, a judge either can, or cannot, identify perpetrator. If he or she cannot do so, then, in accordance with Re B (2019), he or she should consider whether there is a real possibility that each individual on the list inflicted the injury in question.”

C. FAILURE TO PROTECT

[1]Re L-W [2019] EWCA Civ 159 King LJ:
“Failure to protect comes in innumerable guises. It often relates to a mother who has covered up for a partner who has physically or sexually abused her child or, one who has failed to get medical help for her child in order to protect a partner, sometimes with tragic results. It is also a finding made in cases where continuing to live with a person (often in a toxic atmosphere, frequently marked with domestic violence) is having a serious and obvious deleterious effect on the children in the household. The harm, emotional rather than physical, can be equally significant and damaging to the child…A finding of failing to protect can lead the Court to conclude that the children’s best interests will not be served by remaining with, or returning to, the care of that parent, even though that parent may have been wholly exonerated from having caused any physical injuries. Any Court conducting a finding of fact hearing should be alert to the danger of such a serious finding becoming ‘a bolt on’ to the central issue of perpetration or of falling into the trap of assuming too easily that, if a person was living in the same household as the perpetrator, such a finding is almost inevitable. As Aikens LJ observed in Re J, ‘nearly all parents will be imperfect in some way or another’. Many households operate under considerable stress and men go to prison for serious crimes, including crimes of violence, and are allowed to return home by their long-suffering partners upon their release. That does not mean that for that for that reason alone, that parent has failed to protect her children in allowing her errant partner home, unless, by reason of one of the facts connected with his offending, or some other relevant behaviour on his part, those children are put at risk of suffering significant harm.”

D. RISK FACTORS AND PROTECTIVE FACTORS

[2]Re BR (Proof of Facts) [2015] EWFC 41 99. Jackson J:
“18. On behalf of the Children's Guardian, Mr Clive Baker has assembled the following analysis from material produced by the NSPCC, the Common Assessment Framework and the Patient UK Guidance for Health Professionals. Risk factors o Physical or mental disability in children that may increase caregiver burden o Social isolation of families o Parents' lack of understanding of children's needs and child development o Parents' history of domestic abuse o History of physical or sexual abuse (as a child) o Past physical or sexual abuse of a child o Poverty and other socioeconomic disadvantage o Family disorganization, dissolution, and violence, including intimate partner violence o Lack of family cohesion o Substance abuse in family o Parental immaturity o Single or non-biological parents o Poor parent-child relationships and negative interactions o Parental thoughts and emotions supporting maltreatment behaviours o Parental stress and distress, including depression or other mental health conditions o Community violence Protective factors o Supportive family environment o Nurturing parenting skills o Stable family relationships o Household rules and monitoring of the child o Adequate parental finances o Adequate housing o Access to health care and social services o Caring adults who can serve as role models or mentors o Community support 19. In itself, the presence or absence of a particular factor proves nothing. Children can of course be well cared for in disadvantaged homes and abused in otherwise fortunate ones. As emphasised above, each case turns on its facts. The above analysis may nonetheless provide a helpful framework within which the evidence can be assessed and the facts established.”
Risk factors o Physical or mental disability in children that may increase caregiver burden o Social isolation of families o Parents' lack of understanding of children's needs and child development o Parents' history of domestic abuse o History of physical or sexual abuse (as a child) o Past physical or sexual abuse of a child o Poverty and other socioeconomic disadvantage o Family disorganization, dissolution, and violence, including intimate partner violence o Lack of family cohesion o Substance abuse in family o Parental immaturity o Single or non-biological parents o Poor parent-child relationships and negative interactions o Parental thoughts and emotions supporting maltreatment behaviours o Parental stress and distress, including depression or other mental health conditions o Community violence Protective factors o Supportive family environment o Nurturing parenting skills o Stable family relationships o Household rules and monitoring of the child o Adequate parental finances o Adequate housing o Access to health care and social services o Caring adults who can serve as role models or mentors o Community support[3]Re BR had similar application in Derbyshire County Council v Parents & Anor [2025] EWFC 336 (B) (18 July 2025)

E. LIES – LUCAS DIRECTION

[1]The rule of R v Lucas [1981] QB 720 was adopted in the family courts in A County Council v K, D and L [2005] EWHC 144 (Fam).[2]The general principle is that if the court concludes that a witness has lied about one matter it does not follow that he has lied about everything. A witness may lie for many reasons, for example out of shame, humiliation, misplaced loyalty, panic, fear, distress, confusion and emotional pressure.[3]In the criminal courts a lie can only be used to bolster evidence against a defendant if the fact-finder is satisfied that the lie is deliberate, relates to a material issue and there is no innocent explanation for the lie.[4]The court should be cautious when evaluating the evidence of a dishonest witness; see R v Lucas [1981] QB 720 – “If a court concludes that a witness has lied about a matter, it does not follow that he has lied about everything. A witness may lie for many reasons. For example, out of shame, humiliation, misplaced loyalty, panic, fear, distress, confusion and emotional pressure...The jury should in appropriate cases be reminded that people sometimes lie, for example, in an attempt to bolster up a just case, or out of shame or out of a wish to conceal disgraceful behaviour from their family.”[5]As McFarlane LJ (as he then was) observed in Re H-C (Children) [2016] EWCA Civ 136 at paragraph 97: 97. … A family court, in common with a criminal court, can rely upon a finding that a witness has lied as evidence in support of a primary positive allegation. The well-known authority is the case of R v Lucas (R) [1981] QB 720 in which the Court of Appeal Criminal Division, after stressing that people sometimes tell lies for reasons other than a belief that the lie is necessary to conceal guilt, held that four conditions must be satisfied before a defendant’s lie could be seen as supporting the prosecution case as explained in the judgment of the court given by Lord Lane CJ:
“To be capable of amounting to corroboration the lie told out of court must first of all be deliberate. Secondly it must relate to a material issue. Thirdly the motive for the lie must be a realisation of guilt and a fear of the truth. The jury should in appropriate cases be reminded that people sometimes lie, for example, in an attempt to bolster up a just cause, or out of shame or out of a wish to conceal disgraceful behaviour from their family. Fourthly the statement must be clearly shown to be a lie by evidence other than that of the accomplice who is to be corroborated, that is to say by admission or by evidence from an independent witness.” 98. The decision in R v Lucas has been the subject of a number of further decisions of the Court of Appeal Criminal Division over the years, however the core conditions set out by Lord Lane remain authoritative. The approach in R v Lucas is not confined, as it was on the facts of Lucas itself, to a statement made out of court and can apply to a “lie” made in the course of the court proceedings and the approach is not limited solely to evidence concerning accomplices. 99. In the Family Court in an appropriate case a judge will not infrequently directly refer to the authority of R v Lucas in giving a judicial self-direction as to the approach to be taken to an apparent lie. Where the “lie” has a prominent or central relevance to the case such a self-direction is plainly sensible and good practice. 100. One highly important aspect of the Lucas decision, and indeed the approach to lies generally in the criminal jurisdiction, needs to be borne fully in mind by family judges. It is this: in the criminal jurisdiction the “lie” is never taken, of itself, as direct proof of guilt. As is plain from the passage quoted from Lord Lane’s judgment in Lucas, where the relevant conditions are satisfied the lie is “capable of amounting to a corroboration”
. In recent times the point has been most clearly made in the Court of Appeal Criminal Division in the case of R v Middleton [2001] Crim.L.R. 251. In my view there should be no distinction between the approach taken by the criminal court on the issue of lies to that adopted in the family court. Judges should therefore take care to ensure that they do not rely upon a conclusion that an individual has lied on a material issue as direct proof of guilt.”[6]The then McFarlane LJ went on to confirm that there should be no distinction between the approach taken by the criminal court on the issue of lies to that adopted in the family court. The correct approach therefore is that judges should therefore take care to ensure that they do not rely upon a conclusion that an individual has lied on a material issue as direct proof of guilt.[7]Keehan J (having taken into account the foregoing authority) gave himself a revised Lucas direction in Hertfordshire CC v Ms T & Mr J [2018] EWHC 2796 (Fam) in the following terms:
“I should only take account of any lies found to have been told if there is no good reason or other established reason for the person to have lied.”
[8]Most recently in Re A, B and C (Children) [2021] EWCA Civ 451, Macur LJ indicated:
“58. That a tribunal’s Lucas self-direction is formulaic, and incomplete is unlikely to determine an appeal, but the danger lies in its potential to distract from the proper application of its principles. In these circumstances, I venture to suggest that it would be good practice when the tribunal is invited to proceed on the basis, or itself determines, that such a direction is called for, to seek Counsel’s submissions to identify: (i) the deliberate lie(s) upon which they seek to rely; (ii) the significant issue to which it/they relate(s), and (iii) on what basis it can be determined that the only explanation for the lie(s) is guilt. The principles of the direction will remain the same, but they must be tailored to the facts and circumstances of the witness before the court.”

F. CREDIBILITY, MEMORY, RECALL AND RECONSTRUCTION

[1]The evidence of the lay parties and the explanations given by them are of the utmost importance and a clear assessment of their credibility and reliability must be made by the court. In the context of the consideration of a wide canvas of material in reaching the factual decisions in the case, investigations of fact should have regard to the wider context of social, emotional, ethical and moral factors. The assessment of credibility generally involves wider difficulties than mere ‘demeanour’, which is mostly concerned with whether the witness appears to be telling the truth as he or she now believes it to be. With every day that passes the memory becomes fainter and the imagination becomes more active. The human capacity for honestly believing something which bears no relation to what actually happened is unlimited. Therefore, contemporary documents are always of the utmost importance.[2]Every time a court has to assess ‘memory’ and ‘credibility’ it is faced with a difficult process and a sometimes almost impossibly difficult problem. In Gestmin SGPS v Credit Suisse (UK) Ltd [2013] EWHC 3560 Leggatt J (as he then was), confirmed the importance of a proper approach to memory and eyewitness testimony:
“16. While everyone knows that memory is fallible, I do not believe that the legal system has sufficiently absorbed the lessons of a century of psychological research into the nature of memory and the unreliability of eyewitness testimony. One of the most important lessons of such research is that in everyday life we are not aware of the extent to which our own and other people's memories are unreliable and believe our memories to be more faithful than they are. Two common (and related) errors are to suppose: (1) that the stronger and more vivid is our feeling or experience of recollection, the more likely the recollection is to be accurate; and (2) that the more confident another person is in their recollection, the more likely their recollection is to be accurate. 17. Underlying both these errors is a faulty model of memory as a mental record which is fixed at the time of experience of an event and then fades (more or less slowly) over time. In fact, psychological research has demonstrated that memories are fluid and malleable, being constantly rewritten whenever they are retrieved. This is true even of so-called 'flashbulb' memories, that is memories of experiencing or learning of a particularly shocking or traumatic event. (The very description 'flashbulb' memory is in fact misleading, reflecting as it does the misconception that memory operates like a camera or other device that makes a fixed record of an experience.) External information can intrude into a witness's memory, as can his or her own thoughts and beliefs, and both can cause dramatic changes in recollection. Events can come to be recalled as memories which did not happen at all or which happened to someone else (referred to in the literature as a failure of source memory). 18. Memory is especially unreliable when it comes to recalling past beliefs. Our memories of past beliefs are revised to make them more consistent with our present beliefs. Studies have also shown that memory is particularly vulnerable to interference and alteration when a person is presented with new information or suggestions about an event in circumstances where his or her memory of it is already weak due to the passage of time. 19. The process of civil litigation itself subjects the memories of witnesses to powerful biases. The nature of litigation is such that witnesses often have a stake in a particular version of events. This is obvious where the witness is a party or has a tie of loyalty (such as an employment relationship) to a party to the proceedings. Other, more subtle influences include allegiances created by the process of preparing a witness statement and of coming to court to give evidence for one side in the dispute. A desire to assist, or at least not to prejudice, the party who has called the witness or that party's lawyers, as well as a natural desire to give a good impression in a public forum, can be significant motivating forces. 20. Considerable interference with memory is also introduced in civil litigation by the procedure of preparing for trial. A witness is asked to make a statement, often (as in the present case) when a long time has already elapsed since the relevant events. The statement is usually drafted for the witness by a lawyer who is inevitably conscious of the significance for the issues in the case of what the witness does nor does not say. The statement is made after the witness's memory has been "refreshed" by reading documents. The documents considered often include statements of case and other argumentative material as well as documents which the witness did not see at the time or which came into existence after the events which he or she is being asked to recall. The statement may go through several iterations before it is finalised. Then, usually months later, the witness will be asked to re-read his or her statement and review documents again before giving evidence in court. The effect of this process is to establish in the mind of the witness the matters recorded in his or her own statement and other written material, whether they be true or false, and to cause the witness's memory of events to be based increasingly on this material and later interpretations of it rather than on the original experience of the events. 21. It is not uncommon (and the present case was no exception) for witnesses to be asked in cross-examination if they understand the difference between recollection and reconstruction or whether their evidence is a genuine recollection or a reconstruction of events. Such questions are misguided in at least two ways. First, they erroneously presuppose that there is a clear distinction between recollection and reconstruction, when all remembering of distant events involves reconstructive processes. Second, such questions disregard the fact that such processes are largely unconscious and that the strength, vividness and apparent authenticity of memories is not a reliable measure of their truth.”
[3]The same Judge (now in the Court of Appeal) recently made the following observations as to demeanour in R (on the application of SS) (Sri Lanka) v The Secretary of State for the Home Department [2018] EWCA Civ 1391: “36. Generally speaking, it is no longer considered that inability to assess the demeanour of witnesses puts appellate judges "in a permanent position of disadvantage as against the trial judge". That is because it has increasingly been recognised that it is usually unreliable and often dangerous to draw a conclusion from a witness's demeanour as to the likelihood that the witness is telling the truth. The reasons for this were explained by MacKenna J in words which Lord Devlin later adopted in their entirety and Lord Bingham quoted with approval: "I question whether the respect given to our findings of fact based on the demeanour of the witnesses is always deserved. I doubt my own ability, and sometimes that of other judges, to discern from a witness's demeanour, or the tone of his voice, whether he is telling the truth. He speaks hesitantly. Is that the mark of a cautious man, whose statements are for that reason to be respected, or is he taking time to fabricate? Is the emphatic witness putting on an act to deceive me, or is he speaking from the fullness of his heart, knowing that he is right? Is he likely to be more truthful if he looks me straight in the face than if he casts his eyes on the ground perhaps from shyness or a natural timidity? For my part I rely on these considerations as little as I can help." "Discretion" (1973) 9 Irish Jurist (New Series) 1, 10, quoted in Devlin, The Judge (1979) p63 and Bingham, "The Judge as Juror: The Judicial Determination of Factual Issues" (1985) 38 Current Legal Problems 1 (reprinted in Bingham, The Business of Judging p9). …….39. … empirical studies confirm that the distinguished judges from whom I have quoted were right to distrust inferences based on demeanour. The consistent findings of psychological research have been summarised in an American law journal as follows: "Psychologists and other students of human communication have investigated many aspects of deceptive behavior and its detection. As part of this investigation, they have attempted to determine experimentally whether ordinary people can effectively use nonverbal indicia to determine whether another person is lying. In effect, social scientists have tested the legal premise concerning demeanor as a scientific hypothesis. With impressive consistency, the experimental results indicate that this legal premise is erroneous. According to the empirical evidence, ordinary people cannot make effective use of demeanor in deciding whether to believe a witness. On the contrary, there is some evidence that the observation of demeanor diminishes rather than enhances the accuracy of credibility judgments." OG Wellborn, "Demeanor" (1991) 76 Cornell LR 1075. See further Law Commission Report No 245 (1997) "Evidence in Criminal Proceedings", paras 3.9–3.12. While the studies mentioned involved ordinary people, there is no reason to suppose that judges have any extraordinary power of perception which other people lack in this respect.40. This is not to say that judges (or jurors) lack the ability to tell whether witnesses are lying. Still less does it follow that there is no value in oral evidence. But research confirms that people do not in fact generally rely on demeanour to detect deception but on the fact that liars are more likely to tell stories that are illogical, implausible, internally inconsistent and contain fewer details than persons telling the truth: see Minzner, "Detecting Lies Using Demeanor, Bias and Context" (2008) 29 Cardozo LR 2557. One of the main potential benefits of cross-examination is that skilful questioning can expose inconsistencies in false stories.41. No doubt it is impossible, and perhaps undesirable, to ignore altogether the impression created by the demeanour of a witness giving evidence. But to attach any significant weight to such impressions in assessing credibility risks making judgments which at best have no rational basis and at worst reflect conscious or unconscious biases and prejudices. One of the most important qualities expected of a judge is that they will strive to avoid being influenced by personal biases and prejudices in their decision-making. That requires eschewing judgments based on the appearance of a witness or on their tone, manner or other aspects of their behaviour in answering questions. Rather than attempting to assess whether testimony is truthful from the manner in which it is given, the only objective and reliable approach is to focus on the content of the testimony and to consider whether it is consistent with other evidence (including evidence of what the witness has said on other occasions) and with known or probable facts.” "I question whether the respect given to our findings of fact based on the demeanour of the witnesses is always deserved. I doubt my own ability, and sometimes that of other judges, to discern from a witness's demeanour, or the tone of his voice, whether he is telling the truth. He speaks hesitantly. Is that the mark of a cautious man, whose statements are for that reason to be respected, or is he taking time to fabricate? Is the emphatic witness putting on an act to deceive me, or is he speaking from the fullness of his heart, knowing that he is right? Is he likely to be more truthful if he looks me straight in the face than if he casts his eyes on the ground perhaps from shyness or a natural timidity? For my part I rely on these considerations as little as I can help." "Discretion" (1973) 9 Irish Jurist (New Series) 1, 10, quoted in Devlin, The Judge (1979) p63 and Bingham, "The Judge as Juror: The Judicial Determination of Factual Issues" (1985) 38 Current Legal Problems 1 (reprinted in Bingham, The Business of Judging p9). ……. "Psychologists and other students of human communication have investigated many aspects of deceptive behavior and its detection. As part of this investigation, they have attempted to determine experimentally whether ordinary people can effectively use nonverbal indicia to determine whether another person is lying. In effect, social scientists have tested the legal premise concerning demeanor as a scientific hypothesis. With impressive consistency, the experimental results indicate that this legal premise is erroneous. According to the empirical evidence, ordinary people cannot make effective use of demeanor in deciding whether to believe a witness. On the contrary, there is some evidence that the observation of demeanor diminishes rather than enhances the accuracy of credibility judgments." OG Wellborn, "Demeanor" (1991) 76 Cornell LR 1075. See further Law Commission Report No 245 (1997) "Evidence in Criminal Proceedings", paras 3.9–3.12. While the studies mentioned involved ordinary people, there is no reason to suppose that judges have any extraordinary power of perception which other people lack in this respect.

G. THE ASSESSMENT OF WITNESSES

[1]Re M (Children) [2013] EWCA 1147 Macur LJ:
“Any judge appraising witnesses in the emotionally charged atmosphere of a contested family dispute should warn themselves to guard against an assessment solely by virtue of their behaviour in the witness box and to expressly indicate that they have done so.”

PART 8 – THE PARTIES’ SUBMISSIONS

[93]Miss Lattimer and Miss Mahmood have provided a helpful closing note. They emphasise that in respect of the fractures, that the window of 2 to 4 weeks from day 33 post birth is really not an exact science and they note Dr Johnson could not exclude the fractures taking place at birth but, in their submission, Mr Brocklesby’s evidence does exclude the birth injuries as an explanation. In their submission, in cephalic births, the legs are not touched by the surgeon. They also point out that in twenty-five years Mr Brocklesby had only ever experienced single fractures, not multiple ones and this was reflected in the literature. They point out the cephalic nature of the procedure and that the only unusual thing was the use of the forcep blade. There is no mention of any manipulation of the legs. The procedure took only a few minutes which Mr Brocklesby said was pretty standard. The clinical team had no recollection of any difficulties when T was delivered.[94]They point out that the radiological window identified by Dr Johnson overlaps with the local authority’s period in which the developing crisis was impacting on Mr and Mother. They rely on Dr Birch’s evidence in respect of bruises and her very clear evidence and they summarise Dr Birch’s evidence. They summarise from the messages which I have just set out the developing difficulties in the household. They make particular reference to the voice message of the father, noting that the mother had been crying the night before and that they had slept separately.[95]They say it is clear T’s presentation was worsening. The mother was searching about bruises on the evening of day 21 post birth . There were further internet searches about babies crying excessively on day 24 post birth . They make the submission that Father’s message to his cousin talks of “squealing” but made no mention of bruising to his cousin, and that T had been like that for two days. They say that, for the reasons set out in respect of the way in which the message of day 25 post birth was discussed in Father and Mother’s evidence, they could not really remember how it came about that the facial bruising that was not fresh on the morning of day 25 post birth . The local authority say that the parents’ evidence is striking inasmuch as they have no clear memory of when they saw the day 25 post birth bruise for the first time. The mother’s evidence about when she discussed it with the father was unsatisfactory. The father had no recollection. Neither could account for the lack of photos around day 20 to day 22 post birth and shortly thereafter. Neither could account for not obtaining prompt medical attention, either after the unusual presentation described by the father in the voice note on day 23 post birth or after the bruising on day 25 post birth . Mother could not properly account for her internet searches and Father could not account for his false explanation to his cousin on the evening of day 28 post birth that T had fallen asleep on her dummy.[96]In short, the local authority’s submission is that these injuries, the bruises and fractures, were caused in the family home at some stage after day 16 post birth, when the father returned to work and the pressures became too much. They say the dates of days 21, 23 and 24 are significant; day 21 because the father had sole care of T for an hour and a half when the mother was at a beauty parlour. They say day 23 and 24 post birth are significant because of what the father describes to his cousin. It is clear the bruising was significant on day 25 post birth. They say that neither parent provides a truthful event of those periods or a reliable account. They rely on the evidence of Dr Johnson and Dr Birch that there must have been multiple applications of force and they submit, on the balance of probabilities, looking at all the evidence, there was more than one incident with days 21 and day 23 being the standout likely focal points. Both parents had care of T. Both were under significant strain and that neither parent has been truthful to professionals or the court. They say that the court should try to identify a perpetrator if it can but the local authority submits that this is a case where the lack of honesty on the part of both parents leaves us without sufficient reliable evidence upon which to do so, beyond saying that it was one or other of the parents, the other person being in the pool.[97]Mr Bowe KC and Mr Howell-Jones and their learned juniors make common cause. Their submission is that the injuries could have been caused at birth. Mr Bowe KC referred me to the decision of Peter Jackson J (as he then was), and it is right to make the submission that risk factors are really absent from Father and Mother and protective factors are present.[98]They point out what Dr Birch says about the timing and reliability and the nature of bruises, and how it is difficult to be clear about when bruises are caused. They make the submission that Dr Birch relied on photographs (which the child protection medical were not comfortable with) in arriving at her view that these were not accidental injuries. They said the evidence around the bruising on the chin is particularly poor. As for the left cheek bruise, their submission is it is clear that the bruising was sustained at birth, that forceps were used and that that bruising persisted throughout some of month one post birth, that the fact that the mother had searched for bruises in month one post birth does not really mean anything because they were naturally playing on the mind of the mother and she wanted to have an understanding of how they had been caused. It was reasonable that she was curious about the causation of the bruises and the potential role of blood disorders.[99]Mr Bowe KC particularly makes the point that the mother really persisted after day 25 post birth in seeking medical attention and effectively when dismissed on day 30 post birth made significant efforts to see a doctor again on day 31 post birth and raised issues regarding bruising with the professionals. She was happy to do what was needed. She handed over her phone. She cooperated. Again he points out to further bruising that took place in the hospital around day 36 post birth , that again it was the mother that was pointing this out and was concerned and wanting a proper investigation having been told that this was a tracking bruise.[100]Again, in respect of injuries to the back, the bruising, the point is made that Dr Birch’s conclusions are undermined by the poor quality photographic evidence from the child protection medical. In respect of the leg fractures, it is pointed out that the radiologist cannot exclude the window going back to birth and that long bone fractures are possible in childbirth whether vaginal or otherwise, and aging is very subjective as regards to the timing of those. Mr Bowe KC points out that there were plainly difficulties and that is why the caesarean section was planned. He says it was pretty much medical necessity. It is clear that there were concerns and she was moved up the list. He repeats his points that there were deficits in the notes. There is no explanation as to why the mother was moved up the list, what complications were expected, that there were difficulties with the pregnancy, that the use of the forceps is problematic regarding the body map and the bruising of the left cheek, only mention of one blade. The body map does not reflect the extension of the bruising. There is no proper explanation of the types of forceps used. So all of that is put forward by the parents that the court must be cautious in respect of accepting the local authority’s case and that there is an alternative explanation for how these injuries were caused.[101]In terms of failure to protect, the point is made that there is no evidence that there were risk factors in respect of the other parent. This would be an inappropriate bolt-on finding to make.[102]Mr Howell-Jones makes very similar submissions regarding the bruising, the fractures and the radiological evidence and asks me to focus particularly on the father’s evidence about his love for his daughter and this was not a child who was hidden away. There was engagement with the police and medics and, again, there is no failure to protect.[103]The Guardian’s submissions I read, whilst being cautious about the role of fact-finding for a Guardian, effectively say some of the following. On the causation of the bruising it is submitted by Mr Adams and Mr Rank that there would appear to be an overwhelming weight of evidence to suggest that none of the bruises which the authority asserts were inflicted relates to the birth process and that each of those marks are an inflicted injury which arose as a consequence of the use of inappropriate force.[104]It is said in respect of the fractures, Mr Brocklesby gave evidence on the probability of injuries having occurred in that way. He was properly challenged on the deficiencies in the clinical notes but was clear in his evidence that he could see nothing that was suggestive of a birth injury or circumstances where fractures of this kind would be likely to occur during a cephalic injury. The court may feel the weight of the evidence suggests that birth injury can be excluded as a realistic possibility.[105]In respect of the perpetrators, it is said that the court may feel that the telephone disclosure provides a compelling insight into a situation of escalating stress and tension within the household in the second half of month one post birth. From the Guardian’s perspective one of the most troubling features of the hearing this week has been the complete failure of either parent to provide any kind of a meaningful insight into the events which led to T’s injuries, despite the fact that key factors of concern were put to them fairly and straightforwardly in cross-examination. The question of whether the parents have colluded in a decision to conceal what they know in relation to those events is one which the court will be bound to consider.[106]The Guardian, and those acting for the child, recognise that the factual determinations in this matter are for the court but it has considered the evidence carefully and given thought to the question of whether the court should be invited to identify a single perpetrator of injury. Whilst there are relevant pointers in respect of each parent, it will not be submitted that the evidence supports such a finding.[107]Then it is said that whilst these and other aspects of the evidence may point to each of the parents individually as a potential perpetrator of injury, the court may feel that one of the difficulties in going beyond an uncertain perpetrator finding, is that the parents have revealed so little in evidence about the dynamic of the household at the relevant time, whilst the broad context does not urge from the evidence, it may be difficult for a conclusion to be reached about that a single, specific perpetrator can be identified in relation to any or all of the injuries and so little insight has been given by mother and father into the key events that we recognise this is ultimately a matter for the court.[108]The very large new bruises to T’s left eye were clearly apparent on day 25 post birth and it may have arisen before that. It is a striking and significant mark in a non-ambulant child, yet no medical assistance was sought until day 30 post birth and no satisfactory explanation has been given by either parent, as to whether there was even any discussion about whether or not a medic should be consulted at that point or that the injury had arisen. Then the court is asked to consider whether the evidence points to the fact that both parents must have had knowledge of what occurred and(a) chose not to act in response to that over a period of at least five days, thereby failing to prioritise the needs of T, and(b) subsequently make a decision which continues to endure to present an account which was not truthful and which actively conceals what has really taken place.

PART 9 – ANALYSIS AND FINDINGS

[109]I remind myself that the burden of proof remains with the local authority and the parents need not prove anything. Whilst the parents’ explanation is that they did not cause the injuries and they must have been caused during the birth, the burden is not on them.[110]I remind myself that I must consider the broad canvass of the evidence and to consider the totality of it holistically. I must try to fit the individual pieces of the evidence together. I must not overly focus or place undue prominence or importance on the expert evidence. Crucially, for me, the evidence of the parents is of the utmost importance and it is essential I form a view on their credibility and reliability.[111]I agree with Mr Bowe KC that I should apply Re BR and consider the risk and protective factors. I also further agree that Father and Mother, on the evidence before me, present with very few, if any, risk factors and they present as having many of the protective factors. But ultimately, I further agree with Peter Jackson J (as he then was) that each case must turn on its own facts and that the presence or absence of the risk or protective factors proves nothing in any individual case.[112]I remind myself in this sad and tragic set of proceedings that Father and Mother had tried to conceive for nine years, that T is the baby that they had longed for, for many years, and that it is absolutely clear from the evidence of their delight as a new mother and father. The photographs show T surrounded by love from her mother, her father and the wider family. Father and Mother are both employed. They appears to have resources and a nice home, a wide support network of family and friends. There is no evidence of alcohol or drug use. There is no evidence of domestic abuse. This appears to have been a successful, happy, committed married couple who longed for a baby. I take all that into account as I consider the factual findings.[113]It has been helpful to trace back the chronology of events from the day of T’s birth to day 32 post birth and to consider the responses of the parents. I will explain in a moment why I consider it more likely than not that the bruises and fractures took place at some stage between around day 19, day 24 or day 25 post birth, but it is clear that during that period T was in the sole care of her mother and father. Either the injuries were caused by one of them or, as the parents submit, they were caused at birth. There is no other explanation put before this court. It is not suggested that a neighbour or a grandparent or the pet caused the injuries. There have been investigations taking place into genetic conditions like anaemia and susceptibility to bruising. None of those issues have been advanced at this final hearing. It is to some extent a relatively straightforward issue and my reasons will be now quite succinct. I have tried to evaluate the evidence carefully and holistically as I have listened during the week.[114]To assess how these injuries were caused, if not at birth, during the late month one period, the court required open, transparent and clear evidence from Mother and Father. They were the two adults who cared for T during the latter part of month one period. Their evidence fell very far short of the openness and the candour that the court required.[115]Father’s witness statement effectively said nothing about what took place on the material days. It effectively said on each relevant day that I have been thinking about carefully this week that nothing took place. I find that this is not true. I find that he almost certainly knew that when he signed his witness statement. It was put to him by Miss Lattimer in the witness box that his written evidence, backed by a statement of truth, was untrue. He effectively denied this and obfuscated before answering most of the questions that he just could not remember. I do not find that credible. When he said he did not remember, I do not find that he was telling the truth. He is more likely than not to have remembered the circumstances by which his first and only newly born, beautiful baby daughter suffered such a large bruise on her face in late month one post birth. He was sufficiently worried that he was communicating with his cousin He was describing T coughing and squealing in pain for two days, up to day 24 post birth. Despite that openness, which betrays his concern, it is curious that he omitted to tell his cousin about the bruise and then attempted to explain the bruise later, on day 27, as being caused by the dummy. Aside from his disclosures to his cousin, fundamentally he failed to put any proper description about the events in his witness statement and then said nothing very much was happening. I find, as I say, that this was untrue and he failed to provide an honest account of what took place.[116]Mother’s evidence was also not candid. She failed to give the court a clear explanation and account for the circumstances of how she and Father became aware of the “fuck off bruise”. She claimed not to recall when that took place when she was directly questioned about it by Miss Lattimer. She could not recall the circumstances of that discussion with Father. It appears her evidence was that first they discussed it when she sent a photograph on the text message on day 25 post birth and they must have discussed it when he returned home from work. I do not accept that the first time she sent the picture with the message about the “fuck off bruise” was the first time that Mr and Mother had discussed that bruise. I do not accept that explanation. It is not truthful. It is not credible.[117]I also find Father and Mother failed to provide a proper account as to the lack of photographs taken between days 20 and 24 post birth given the repeat pattern of photographs being taken both before and up to and then thereafter on day 25 post birth and following. More concerning, however, the failure to take T to the GP until day 30 post birth is a matter of very significant concern and no proper account has been given. I find that Father’s voice note to his cousin describing two days of screaming prior to 8am on day 24 post birth, therefore back to the morning of day 22 post birth, is almost certainly what took place. If one dates that back then to the morning of day 22 up to day 30 post birth, that provides a window of eight days in the life of a tiny newborn baby in which it was clear to Father and Mother that T was injured and in pain. She was bruised and unsettled. This was a newborn couple who were nervous, so nervous at one stage that Mother did not want to take a picture of T in a bath. But they did not take her to the doctor for eight days. I do not see sufficient evidence that Mother’s family members recalled in their witness statement her contacting them for help or assistance as mother says. That is not what their statements say although I accept I have not gone through all of the call records but I have gone on the basis of their witness statements.[118]I therefore find that both Father and Mother have failed to provide a candid, honest and open account of what took place or a proper explanation of why T was not taken to the doctor. The conclusion I find is that their evidence to this court was not credible. It follows that I find that their evidence was not reliable.[119]I have given myself a Lucas direction, although not addressed specifically by counsel on this point, but I have taken on board that their lies about not remembering, whilst they are untrue, they both may have lied for a variety of reasons and I must approach what I have found to be those untruthful lies and their evidence with caution. But it does not mean that they have lied about everything and I remind myself that just because they have lied about going to the GP and the circumstances of the bruise, this does not mean that they inflicted the injuries. I must consider all the evidence holistically and carefully.[120]So my role is to consider the various parts of the evidence. The evidence of the professional witnesses of fact, the evidence gained forensically from the devices, the evidence of the three highly professional expert witnesses and the evidence of Father and Mother which, as I say, is not credible.[121]I consider first the bruising, the two bruises to the face, the bruise to the chin and the multiple bruises to the back. I am entirely clear in my fact-finding that the forceps bruising was to the face and head. This was evidenced in the body map and the pictures taken at the time. That bruising was not elsewhere and T was seen on multiple occasions by professionals thereafter. There was no bruising from forceps under the chin or on the back. Health professionals saw T naked on days 11 and day 17 post birth. They did not note bruises to the chin or the back. It is also the case that the health professionals who saw T on days 11 and day 17 do not recall seeing any forceps bruising but clearly had previously been there on T’s cheek. But I am absolutely clear that the facial bruising, at the very latest, had plainly resolved by day 19 post birth. Miss Lattimer took the witnesses to very clear pictures of T naked in the bath on this day. When questioned, Father and Mother accepted that T’s face was unblemished at this time. There were no bruises on day 19 post birth.[122]I also accept the evidence of the child protection medical. These were two doctors who saw T proximate to the events described. They examined her with detail and care on days 32 and 33 post birth. They could see the bruising. They are experienced and they are witnesses of fact close to the incidents. They were clearly of the view that these were non-accidental injuries.[123]In addition to the witnesses of fact at the time, I had the detailed, thorough and comprehensive reports of Dr Birch. I have set out her evidence above. I accept her evidence. These were bruises caused by inflicted injuries. These were not accidental injuries for the reasons she provides. These were not track bruises, as was sought to be advanced in cross-examination. These were bruises caused at some stage after probably day 19 post birth. They were not caused during the birth process and the local authority is correct that these are inflicted injuries and they are injuries that took place when T was in the care of her parents.[124]As I consider the parents’ evidence, which is crucial, and I find it not to be credible, and I holistically consider it with the witnesses of fact, the photographic evidence and the expert evidence, I am in little doubt that these injuries were not caused during the birth process. The only other explanation put forward to the court is that those injuries took place in the care of the parents at some stage, as I say, in late month one post birth.[125]Given the failure of the parents to provide a candid and honest account, it is not possible for the court to conclude on the balance of probabilities whether the bruises were caused by Mother or Father. Applying the case law, it is clear that the pool of perpetrators consists only of Mother or Father and nobody else. But it is not possible to say which parent has caused the injuries. One of them did and there is a real possibility that each individual, namely Mother and/or Father, did so. This is clear to me because the bruises took place when T was in the sole care of her parents. This was a time of tension. The mother, in particular, was stressed, tired and struggling. The parents were arguing. But in addition, they failed to take their daughter to a doctor long past when it was obvious that she needed medical attention. They stopped taking pictures. Looking at all the evidence together, therefore, there is a real possibility that each of the mother and/or the father inflicted the bruises.[126]Of course, I have assessed the evidence in respect of the fractures alongside the evidence in respect of the bruises. The evidence of the fractures and the bruises is corroborative of the other injuries effectively. They are not viewed in isolation. I have, in a similar fashion, triangulated the professional evidence of the witnesses of fact, the parents’ own evidence, which I do not find credible, the documentary and photographic evidence and, of course, the evidence of the three expert witnesses. I have little hesitation in concluding that the fractures were not caused by the birth process. There is no dispute that T was delivered by caesarean section in the cephalic position, namely head-down. She was not a breech baby. I find her head left the stomach first, then her body and then her legs. I find her legs were not manipulated.[127]Mr Brocklesby’s evidence was entirely clear, even when politely but robustly challenged by mother and father’s counsel. He was clear that in twenty-five years he had never seen multiple fractures. He told me when a limb was fractured he felt it. It is simply, on the balance of probabilities, is not likely that the multiple professionals who delivered T would have failed to notice three significant applications of force to the legs which would have caused the injuries. Nor was there anything in T’s presentation on the day of her birth and on days 1 and 2 post birth that would have supported the likely pain from fractures. There is, for example, nothing that corresponds with the periods of pain and squealing that the father describes on days 22 and 23 post birth in the period immediately post-birth that would provide support that these injuries were caused in the birthing process.[128]I find, therefore, that the fractures took place when T was in the care of her mother and her father. As I have said, they have not provided an honest and candid account. One of them caused the fractures and there is a real possibility that each individual, namely Mother or Father, did so. This is because the fractures took place when T was in the sole care of her parents. This was a time of tension. As I have already said, Mother, in particular, was stressed, tired and struggling. The parents were arguing. Again, I repeat they failed to take their daughter to the doctor long past when it was obvious she needed medical attention. They stopped taking pictures. They provided accounts which were not correct to a family member, father’s cousin. Therefore there is a real possibility that each of the mother and father inflicted the fractures.[129]I therefore make the findings as set out in the disputed threshold document. I do so in agreement with the local authority’s submissions and for the reasons set out in their closing document with the support of T’s Guardian.[130]I have not overlooked the points made on behalf of the parents. I accept the parents’ evidence that they perceived that there were risk factors with the pregnancy and that the mother therefore had an elective caesarean section. They considered there were issues which placed them at the top of the surgical list. They felt they experienced a traumatic birth with force, but Mr Brocklesby’s evidence was clear on issues of fundal pressure. He was equally clear on the use of forceps, that whilst unusual would not account for the injuries I am concerned with.[131]I have also considered everything they have said about the notes being inaccurate at the time of the delivery of T and maybe it can be inferred it is suggested more went on during the caesarean section than was documented, but these suggestions are not supported by the witnesses of fact who have given statements to the court, or emails, nor is it supported in any way by the expert evidence. Whatever omissions there are from the notes cannot evidentially or logically account for the injuries caused to T.[132]I accept Dr Birch relied on photographs from the child protection medical that were said by the child protection medical professionals to be of poor quality. That, however, is not materially relevant because there was a variety of pictures for Dr Birch to consider in the context of much further evidence and in the context, of course, that the child protection medical clinicians felt that the injuries were very likely to be non-accidental. The photographs do not detract from the opinions of Dr Birch, which I accept.[133]I also take into account the fact that the mother pursued medical assessments on and after day 30 post birth. She cooperated to an extent. But I have not found Mother and Father to be frank and candid in explaining what happened to T. Mother was often pushing an explanation regarding genetic susceptibility to bruising. This has been ruled out. The fact that there was some level of cooperation does not support sufficiently the suggestion that she or Father are not responsible for these injuries and, therefore, they must have taken place in the birth process. I have considered those submissions and the points made not just individually but holistically and together but they find no basis for me to conclude the injuries were sustained at birth.[134]I therefore find the injuries at paragraph 1 of the disputed schedule were inflicted. I accept the timing of the findings of the bruises and the fractures as per the local authority schedule. It follows, therefore, that I also accept paragraphs 9 and 10 of the local authority’s disputed threshold document.[135]Lastly, I turn to the issue of failure to protect. I accept the argument made that neither parent effectively can be blamed because the other parent does not have risk factors suggestive of likelihood of harm. Paragraph 11 of the local authority’s disputed threshold states that if the other parent was present when a given injury was caused, the other parent has failed to protect T. The Guardian makes a slightly different case, which is a failure to prioritise T’s needs by parents choosing not to act to take her to the doctor for at least five days and by failing by continuing to present an untruthful case which conceals what happened.[136]The evidence does not permit me to find that the other parent was present when the injuries were inflicted. Because of the way in which the mother and father presented their case, I just do not know exactly what was inflicted on T, when and who else was there, if anyone. But I do know from the voice message that from almost certainly day 22 post birth, both parents knew that T was seriously in pain and discomfort. She was squealing and crying. She was unsettled for days. The parents knew this. They knew of the bruise from at least the day 25 post birth if not before. It was a huge bruise. In my judgment, they failed to protect T by failing to take her to the GP or otherwise seek appropriate medical care during the period of around eight days until day 30 post birth. This is, in my judgment, a serious omission. I have re-read what King LJ says in the matter of LW. She specifically cites a partner who fails to get medical help for a child as an example of a failure to protect. That departs slightly from the pleaded disputed threshold document but I am entirely satisfied that that issue was well within the ambit of the evidence and was a matter on which all parties could give evidence and make submissions. There was, therefore, a failure to protect T by her parents.[137]Those are my reasons for making findings of fact today and finding, with that one amendment, the disputed facts as set out in the disputed threshold document are found.