“A has suffered fractures of the posterior right 9th and 10th ribs which, in my opinion, are no older than 11 days of age on [a date] 2025”
“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. The fractures would not have occurred from normal domestic handling, over-exuberant play or rough inexperienced parenting. Rib fractures are typically the result of severe excessive squeezing compressive force applied to the chest. The amount of force required to cause these fractures is unknown, but in my opinion, it is significant…. In my opinion, the level of force required to cause the rib fractures is beyond that of rough heavy handedness. I note that the father has commented that he was relatively heavy handed with A. In my opinion, there needs to be severe excessive inappropriate squeezing of the chest to cause the rib fractures. This action with this level of force has not been described. I have not been provided with any suitable explanation of significant force applied to A’s chest to account for the fractures which he has sustained. In the absence of any suitable history, unexplained fractures of this nature in a child of his age raises 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.”
“Radiologically there is no evidence of any underlying bone disorder… It Is my understanding that EDS alone does not increase bone fragility. Children with cIEDS and hypermobility can have an increased propensity to fracture, but these fractures occur as a result of significant events. They do not occur as a result of lesser forces being applied to the bone.”
“The degree of force required to cause fractures in a three week infant is unknown, however, during cardiac compressions, when the infant's chest is compressed to around 30% of its normal anterior/posterior diameter, fractures are rarely reported. Force therefore at least equivalent to that used during cardiac compressions, must have been used to cause the rib fractures in A. Such force is not used in normal or even rough handling.”
“Following initial assessment and review, I was concerned of multiple unexplained bruising seen on the child along with concerns of infection. I discussed my concerns with the on-call consultant and suggested for referral to social care and for a child protection medical to be undertaken along with initial blood investigation and a septic screen as described above. Medical photography was performed and documented as above and in body charts as attached. I remained concerned because of how unsettled the child was, and I could not exclude non-accidental injury despite my assessment occurring prior to radio imaging and their significant findings.”