Non-Accidental Head Injury in Young Children: Medical, Legal and Social Responses

194 Pages·2006·0.75 MB·English

by  Cathy Cobley

Non-Accidental Head Injury
in Young Children
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Non-Accidental Head Injury
in Young Children
Medical, Legal and Social Responses
Cathy Cobley and Tom Sanders
Jessica Kingsley Publishers
London and Philadelphia
Firstpublishedin2007
byJessicaKingsleyPublishers
116PentonvilleRoad
LondonN19JB,UK
and
400MarketStreet,Suite400
Philadelphia,PA19106,USA
www.jkp.com
Copyright©CathyCobleyandTomSanders2007
TherightofCathyCobleyandTomSanderstobeidentifiedasauthorsofthisworkhasbeenasserted
bytheminaccordancewiththeCopyright,DesignsandPatentsAct1988.
Allrightsreserved.Nopartofthispublicationmaybereproducedinanymaterialform(including
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Warning:Thedoingofanunauthorisedactinrelationtoacopyrightworkmayresultinbothacivil
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LibraryofCongressCataloginginPublicationData
Cobley,Cathy.
Non-accidentalheadinjuryinyoungchildren:medical,legaland
socialresponses/CathyCobleyandTomSanders;forewordbyThe
Rt.Hon.LordJusticeWall.
p.;cm.
Includesbibliographicalreferencesandindex.
ISBN-13:978-1-84310-360-8(alk.paper)
ISBN-10:1-84310-360-5(alk.paper)
1.Shakenbabysyndrome--GreatBritain. 2.Shakenbabysyndrome
--Lawandlegislation--GreatBritain. I.Sanders,Tom,1968- .
II.Title.
[DNLM: 1.ChildAbuse--legislation&jurisprudence--GreatBritain.
2.Child--GreatBritain. 3.CraniocerebralTrauma--GreatBritain.
4.ShakenBabySyndrome--GreatBritain. WA33FA1C656n2007]
RJ375.C632007
617.10083--dc22
2006033262
BritishLibraryCataloguinginPublicationData
ACIPcataloguerecordforthisbookisavailablefromtheBritishLibrary
ISBN-13:9781843103608
ISBN-10:1843103605
ISBNpdfeBook:1846425727
PrintedandboundinGreatBritainby
AthenaeumPress,Gateshead,TyneandWear
Contents
Foreword 7
TheRt.Hon.LordJusticeWall
INTRODUCTION 9
Chapter1 TheProblemof ChildAbuse:Recognition,Responses
andRe-evaluations 13
Chapter2 ConstructingandDeconstructingShakenBabySyndrome:
ChangingCulturalDefinitionsandMedicalPractice 36
Chapter3 ClinicalIdentificationof Non-AccidentalHeadInjury:
Examiningthe‘Social’RiskFactors 56
Chapter4 ProvingNon-AccidentalHeadInjury:FromMere
SuspiciontoProof BeyondAllReasonableDoubt 78
Chapter5 Causation,ScientificEvidenceandShakenBaby
Syndrome:AnExampleof aMedicalControversy 113
Chapter6 RespondingtoNon-AccidentalHeadInjury:Changes
andChallenges 144
APPENDIX:THERESEARCHPROJECT 166
REFERENCES 177
CASES 185
SUBJECTINDEX 186
AUTHORINDEX 191
List of figures
1.1 Theprocessof recognitionof childabuse 14
1.2 Theiceburgof childabuse 29
4.1 Thespectrumof proof 83
4.2 ProvingNAHI:theattritionof casesinthestudycohort 87
4.3 ProvingNAHI 90
A.1 Progressof casesthrpoughthechildprotectionsystem 175
A.2 Progressof casesthrpoughthecriminaljusticesystem 176
List of tables
3.1 Socialhistoryof carers(54referrals) 67
3.2 Considerationof NAI(54referrals) 68
3.3 Confirmedclinicaldiagnosisatadmission
(14non-referrals) 69
3.4 Possiblenon-accidentalcausesof SDH(14non-referrals) 71
3.5 Ageandsexof 14non-referrals 71
3.6 Maritalstatusof themother 73
4.1 Suspects,arrestsandcharges 96
4.2 Initialchargesbroughtbypolice 103
4.3 Charges,indictmentsandoutcomesof caseswhich
proceededtotrial 104
5.1 Medicalopinionastocausation 117
Foreword
Forallthedisciplinesengagedinthepracticeandstudyofbothfamilylaw
and the criminal law, non-accidental head injuries in young children pose
some of the greatest difficulties and give rise to the most rigorous chal-
lenges. It is a subject on which there remains a divergence of responsible
medicalopinion;wherethesymptomatologyisitselfcontroversial;whereit
isverydifficulttobecertainofthetimingoftheinjuriesandthenumberof
incidentsinvolved; andinwhichtheinterpretationofscans(whetherCTor
MRI) requires highly specialist expertise. Add to that already complex
cocktailthefactthatperpetratorsrarelyifevergiveatrueaccountofwhat
has occurred, and the difficulties of establishing precisely what has hap-
penedtotheinjuredchildareself-evident.Yetfewareasofchildabusehave
moresignificantlongtermconsequencesforthechildreninvolved–thatis,
of course, where they survive.
The minefields in the forensic context are legion, and in the criminal
contexthavehadfar-reachingconsequences.Eveninthefamilyjusticesys-
tem, where proceedings involving non-accidental head injury are rigor-
ouslyexaminedbyaspecialistjudiciary,careproceedingsinwhichallthe
professionalsineverydisciplineareofunimpeachablecompetencecanstill
carrythedangerofamiscarriageofjustice,asinWvOldhamMBC[2006]1
FLR 543, a decision of the civil division of the Court of Appeal which,
rightly, has not escaped the authors’ notice.
Againstthatbackground,Iwelcomethisuser-friendlybook,whichnot
onlyprovidesahelpfulandbalancedtourd’horizon,butalsoputsthesubject
both in its historical context and in the context of the authors’ own
well-focused and interesting research.
Child abuse, of which non-accidental head injury is a significant
element, is an all-too-prevalent social evil. To combat it effectively, we
mustunderstandit.Thisbookisausefulcontributiontothatprocess,andI
commendittoreadersfromallthedisciplinesengagedinthecriminaland
family justice systems.
TheRt.Hon.LordJusticeWall
7