L and M (Children), Re

Factual and Procedural Background

On 3rd August 2011, a six-month-old girl, referred to as M, was taken by her father to a GP due to concerns about swelling on her head. The GP observed a clicking sound and a bruise on her chest, leading to a hospital referral. Hospital investigations revealed multiple skull fractures and rib fractures of different ages. This triggered care proceedings concerning M and her older brother, L.

In May 2012, HHJ Marshall found that M's injuries were inflicted non-accidentally in the care of her parents. The parents successfully appealed this finding, resulting in an order for a retrial before a Family Division judge. This judgment follows the conclusion of that retrial, conducted with strict anonymity for the family.

The father, aged 33, originally from Sri Lanka, is a serving soldier. The mother, aged 30, and father married in 2004. They have two children, L born in 2008 and M born in 2011, with a prior stillbirth in 2010.

The family faced various stresses including disputes with a neighbour, mental health concerns for the mother, and the tragic loss of a baby in 2010. The father was posted away for military exercises, leaving the mother to care for the children alone for several weeks. During this time, M exhibited some health issues such as colic and constipation.

On 2nd August 2011, the father reported dropping M onto a coffee table and then the floor, an incident he did not initially disclose to the mother or medical professionals. The following day, swelling on M's head was noticed, prompting medical examination. Subsequent hospital investigations confirmed multiple fractures, and M was detained for six days.

Care proceedings were initiated on 25th August 2011, with interim care orders placing M and L with their maternal grandmother. Contact with the parents has been supervised. The initial fact-finding hearing was held in June 2012 before HHJ Marshall, who found the injuries were non-accidental but could not identify the perpetrator. The parents appealed, and the Court of Appeal ordered a retrial due to insufficient explanation of the judge's conclusions.

The retrial involved extensive expert medical evidence, including new neuroimaging and expert reports, and detailed oral evidence from medical specialists, family members, social workers, and the parents. The court received comprehensive submissions from counsel representing all parties.

Legal Issues Presented

1. Whether the injuries sustained by M were inflicted non-accidentally while in the care of her parents.
2. Whether the parents’ accounts of the incidents leading to the injuries are credible and truthful.
3. The identification of the likely perpetrator(s) of the non-accidental injuries.
4. The interpretation and significance of complex medical evidence relating to the nature, timing, and cause of M's injuries.

Arguments of the Parties

Local Authority's Arguments

• The local authority contended that M’s skull and rib fractures were non-accidental injuries sustained while in the care of her parents.
• They challenged the credibility of the parents’ explanations, highlighting inconsistencies and omissions, including failure to seek medical attention after incidents.
• They emphasized the improbability of the injuries resulting from the described accidents, given expert medical evidence on fracture timing and mechanism.
• They submitted that both parents remain in the pool of possible perpetrators, but one likely caused the injuries while the other conceals information.

Parents' Arguments

• The parents provided accounts attributing some fractures to accidental incidents: the mother described slipping in the bath and gripping M tightly, possibly causing earlier rib fractures; the father described dropping M onto a coffee table and floor, accounting for later injuries.
• They asserted that M was a well-cared-for, much-loved child, and that the injuries occurred during a relatively stress-free period.
• The parents' counsel argued that inconsistencies in their accounts were minor and understandable in the human context, including grief and distress.
• They challenged the assumption that the injuries must be non-accidental, given the unusual clinical picture and evolving medical understanding.

Table of Precedents Cited

Court's Reasoning and Analysis

The court carefully examined the extensive medical evidence, including radiological and neuroradiological reports, expert opinions, and the parents' accounts. It applied established legal principles requiring the local authority to prove non-accidental injury on the balance of probabilities, with careful assessment of all evidence and credibility of witnesses.

The court resolved a key medical conundrum identified in earlier proceedings regarding the nature and extent of M’s skull fractures. The instruction of a paediatric neuroradiologist led to the conclusion that several previously identified fractures were actually accessory sutures or fissures, reducing the number of fractures and explaining the lack of expected brain injury and clinical symptoms.

The court accepted the expert evidence that M had sustained four skull fractures and rib fractures of different ages, likely caused by compressive forces and impact. The timing of the posterior 8th rib fracture was determined to be no later than 1st August 2011, inconsistent with the father's account of the 2nd August incident. It was also unlikely that the 8th rib fracture could be caused by a fall as described by the father.

The court found the parents’ explanations for the injuries to be inconsistent, implausible, and marked by omissions and falsehoods, including failure to seek medical attention and concealment of incidents. The court noted the improbability that the father would conceal dropping M if it had occurred as described and found inconsistencies in the duration and severity of M’s distress following the alleged incidents.

Despite recognizing the parents as devoted and caring in other respects, the court concluded that the parents had not told the truth about the circumstances of M’s injuries. It found that the local authority had established on the balance of probabilities that the injuries were non-accidental and sustained in their care, but it could not determine which parent inflicted them. One parent is likely responsible, with the other knowingly withholding information.

The court also reflected on the evolving nature of medical understanding in such cases, the necessity of expert evidence, and the importance of rigorous but careful analysis of all evidence presented.

Holding and Implications

The court FINDS that M sustained four skull fractures and a posterior 8th rib fracture non-accidentally while in the care of one or both parents. The local authority has discharged the burden of proof on the balance of probabilities that these injuries were inflicted non-accidentally.

Neither parent was identified as more likely than the other to have caused the injuries; both remain in the pool of possible perpetrators. The court finds that each parent has given false and misleading accounts and is concealing information, with one likely responsible for the injuries and the other protecting the perpetrator.

The court expresses regret and reluctance in making these findings, acknowledging the parents’ devotion and the family’s hardships, including the loss of a previous child. It emphasizes the importance of the children being brought up by their parents where safely possible and urges the parents to be frank to facilitate the safe return of M and L.

No new legal precedent is established; the decision primarily affects the parties by affirming the non-accidental nature of the injuries and the need for ongoing protective measures and further cooperation.