“A is an eight-month-old girl who has an unexplained left parietal skull fracture. It is possible that she has fallen and hit her head accidentally, but the height and force of such a fall from a seated position is unlikely to be enough to cause a skull fracture. If she had accidentally fallen and sustained the skull fracture then I would expect there to have been a period of distress and crying following this, which a reasonable care giver would be able to recall. A’s mum has appropriately sought medical attention when she noticed the swelling on A’s head and has been appropriate in her concerns and care for A while on the ward. She has co-operated fully with the Child Protection medical process, and there seems to be a very good attachment between Mother and A. In summary, A has an unexplained left parietal skull fracture, and from the history given I am unable to exclude non-accidental injury as a cause of this.”
“Erm, she was asleep on the bed, I stood up, opened the wardrobe, tried to take clothes, what to dress of the day. Was dressing, and I remember I was pulling my jeans up when I just heard, like, erm, like, she hit the floor, erm, and she started the cry. Erm, I pick her up straightaway, I was shocked that she fell. When I pick her up she cried, erm, I walk with her, I tried to, like, rock her. I walked with her outside her room to our spare room, I walk all the way back, I stay there maybe a minute and she stopped, she settled, she was looking at me and she was, like, fine, she looked really fine. I check her, I check her head, I check, like, for anything, like, if she injured, there was no blood, erm, there was no, erm, redness or anything like that.”
“Six months old fell off bed and three feet in centimetres”
“Six months old fell off bed. Six months old fell off bed.”
“Q. Yeah, and how was, like, how was she positioned? A. Just sitting up. Q. Sitting up? A. Yeah. Q. Propped against anything? A. No, sitting up. Q. Okay. Erm did you leave her at any point? A. Like, as I’ve just glanced up at the TV, she’s, like, fell backwards. Q. Okay. A. And I, if you imagine a baby falling backwards. Q. Yeah. A. Like I said it’s, it, it was just, she was crying like she was hurt to be fair, but it wasn’t, I couldn’t see it being that.”
“Oh no, it’s all right, just a little fall back.”
“Erm, I think when I got up for work, I think she was crying, but I’m not sure.”
“We have a temperature so she’s been crying so much. It’s much better now. She finally went to sleep. I hope Nurofen is working.”
“Could it be from the fall on Tuesday”
“We have a sore on the head. I don’t know whether it’s bad or not. She has a lump on the left side above her ear.”
“Did she hit herself?”
“Yes the day before yesterday but I’m not sure because she has a bump only now. It’s as big as when you join the index finger and the thumb. It doesn’t have any colour, nothing, just a bump.”
“So she had to hit herself today.”
“No she didn’t hit herself today. She slept with us at night and then from 6.00 in the cot and now she woke up and I see a bump.”
“I was picking her up off the floor and as I grabbed her she’s thrown herself back and hit the carpet and I thought nothing of it put her to bed and she wouldn’t sleep.”
“Please comment upon A’s likely presentation at the time immediately after she sustained the injuries. A would have cried or screamed out in pain and would have continued to cry for several minutes before settling on comforting. Following the injury, the associated swelling would have occurred within a few hours and would have reached maximum size within a day. Bathing or attending to care would have identified the swelling. A fall from the bed may account for both the scalp and the skull injury. Other accidental mechanisms may include a fall from height or being dropped from a height. An impact to the head with an object or hitting the child’s head against a hard surface may lead to such non-accidental injuries. At this stage both accidental and non-accidental injuries have to be considered.”
“The majority of swellings would be visible within a few hours. It is very unlikely that it would take up to 72 hours to become visible. The majority of swellings would reach the maximum size within a day. It is very unlikely that it would take up to 72 hours to reach the maximum size.”
“On the afternoon/evening of26th October 2023 father has given an account of A falling backwards from a seated position and knocking her head in the floor. Might this incident have exacerbated a pre-existing injury, skull fracture, provoking an inflammatory response causing visible or more greatly visible swelling to appear within the 12 to 16 hours thereafter?”
“The soft tissue injury noted at the medical of27th October 2023 was a 5x4cm boggy swelling over the left parietal region. An undisplaced left parietal fracture was noted on her head CT scan. Children fall backwards from a sitting position frequently. This type of fall is very unlikely to generate forces that would lead to either a fracture or a scalp swelling. Scalp swelling is due to accumulation of blood and not due to inflammation. Therefore, this proposal is not relevant. A would have cried or screamed out in pain and would have continued to cry for several minutes before settling on comforting. All the children who sustain this type of injury are very likely to respond in the way that I have already described. The duration it would take them to settle down may vary.”
“Substance Misuse. Since A’s birth the father has misused controlled substances. This includes cocaine, cannabis, MDMA, and a prescription drug, Tramadol, that was not prescribed to him. The mother has misused MDMA, cocaine and alcohol. Both parents have sought to conceal their substance misused, denying any misuse during the police interview on2nd November 2023 .”
“If I say something I was thinking I’m going straight to prison and never going to see her, so I didn’t. I didn’t say the full truth to them there.”
“During the course of the mother’s evidence she attempted to minimise or avoid giving any matters that she feared could paint her or the father in a negative light. This included their respective alcohol and drug misuse, both now and in the past, the suggestion of co-sleeping, A’s reaction to whatever happened in the living room while she was cooking, and where the father was when she went to investigate what happened.”
“Do you take drugs?”
“This is not a typical care case. The parents in this case were unknown to the local authority until A’s admission to hospital, and observations of their care since demonstrates that they present as loving appropriate child focused parents. For the most part, the parents do not appear to present with many of the risk factors for non-accidental injury identified by the NSPCC, and present with many of the protective factors identified. However, as Peter Jackson J cautioned in Re BR: “The presence of absence of a particular factor proves nothing. Children can be well cared for in disadvantaged homes and abused in otherwise fortunate ones”
“Like I said it’s, it, it was just, she was crying like she was hurt to be fair, but it wasn’t, I couldn’t see it being that.”
“Q. So, do you think she fell onto anything? A. I can’t say for sure.”
“I can’t give you an exact memory’s, not. I don’t have the best yeah … Yeah, I’ve just been sat on the floor, yeah, doing it, like, in front of the TV, and the kitchen, like, to the back, and I think Mother was in the kitchen. And I think she’s just, I think she said something along the lines of, “What’s, what’s wrong with…”
“Q. So what happened when you got up for work? A. I think when I got up for work I think she was crying, but I’m not sure.”
“I had my back against the larger of the settees. I could have possibly to the armchair at one point but not when she fell. I was looking at watching TV. She was simply going back onto the carpet. It is actually a mat not a carpet. She was on the lefthand side where the heart is.”
“Nobody every asked.”
“The father to PGM: “Mother doesn’t know the full story yet as I haven’t had an opportunity to tell her”
“Have yous had the second opinion yet?”
“Yeah it’s back. Not sure on the results though. Should be okay.”
“Yeah surely it can’t be any different.”
“Exactly so I’m gonna hold my ground for now.”
“Okay keep us informed.”
“I’m torn massively but seeing as she has said that I think it’s the right decision.”
“Have yous had the second opinion yet?”
“Yeah it’s back. Not sure on the results though. Should be okay.”
“Yeah surely it can’t be any different.”
“Exactly so I’m gonna hold my ground for now.”
“Okay keep us informed.”
“I think she might fall in living room on the carpet near the fireplace as there are tiles but I put pillows round but she’s learning to crawl so she falls every now and then. I can’t wait to buy playpen so she can be safer. It’s just scary thinking they think we did something bad and to be honest first day here they made me feel horrible. I cried all day and night. Now it’s better and I know she’s okay so will be will be okay soon. Also my phone broke the other day so I’m using tablet now.”
“I was in the kitchen cooking dinner. I did hear A cry out so came into the doorway to check on her. Father was already comforting her and said she had fallen backwards from being sat upright on the floor. The cry was enough for me to come out of the kitchen to investigate, but she settled quickly and when we checked we could not see anything of concern.”
“I went into the kitchen shortly after to prepare dinner and Father was with A in the living room. The living room and kitchen are very close together with a clear line of sight. At one point I recall hearing A cry. It was not a significant or a bad cry. I went to the door of the living room to ask if she was okay. Father assured me that it was okay so I returned to cooking dinner.”
“I had a little bit of suspicion it could be in dad’s care” but when asked about what the father had said to J she said: “Yes, but he kind of explained it”
“The mother fully accepts with shame and regret that she was dishonest about the incident when A rolled off the bed on 24th October, withholding potentially vital information from treating clinicians.”
“The mother accepts that she has failed over the last year to show insight into the father’s role in causing A harm. She has failed to challenge the father when evidence clearly pointed to 26th October, and that she initially did not tell professionals that A had rolled off the bed. The court may conclude that the mother is not a particularly insightful or analytical individual. Her views have clearly been clouded by her admiration and love for the father.”