“as each child is an individual it is not possible to be specific. As discussed in my first report fractures are painful when they occur, and I would expect a child to cry out and be distressed... Each child is an individual and they show their distress in many ways from facial grimacing, crying, screaming, wriggling, refusing feeds etc. Many parents identify and learn their child's cues and begin to distinguish a hungry cry from a pain cry but not all parents can do this. If a child was otherwise normally a settled or quiet baby, then I would expect that any signs of distress would have been noted as unusual or a change in behaviour and that a parent or carer would have therefore realised that something was wrong, but they may not have realised that this specifically meant pain.... It is not possible to state how B might have specifically presented... I described the general features of rib fractures i.e that a child may breathe more shallowly or be distressed when being handled. This might take the form of B crying each time she was being handled or be more fussy or unsettled. It is not possible to say how long this might last for.”
“so it's the change in behaviour. So she might not cry out in distress, she might just be more grisly than normal or whimpering or not as happy as she had been previously. This might be the only thing that apparent, a carer would pick up; that change of behaviour and I think I've already said that actually it's really difficult for professionals, particularly when we don't know the babies too, and when we clinically examine them, to be able to identify that there are rib fractures there.”
“not necessarily, no we're talking about quite a difficult area to feel too, even as paediatricians, when we clinically examine babies we often can't feel rib fractures. That's why we do skeletal surveys in many ways because there's often no external signs that we can pick up.”
‘I’m trying to give you a plausible answer’ and ‘I think you’re trying to get at the old [father’s name] being a bad parent’ and ‘you’re trying to get me to say I agree with you’