Case No. EWFC-57

51.The police’s investigation of the parents’ mobile ‘phones has led to the discovery of a number of videos and photos, all of which I have viewed. The majority show B looking like a happy, well-cared for and loved baby, often with A being the person who is both videoing and touching and coo-ing to her baby with obvious affection. But there are a few that are not so endearing. 52.In one particular video, C can be seen behind the wheel of his car, without his seatbelt on (this factor being observable, but also you can hear the warning light continually beeping), with B lain across his lap, completely unrestrained. A is taking the video, and she can be heard laughing and chatting with C. She told me that she had passed B to the father when he collected them from the bus stop, and I was left with no understanding of why she allowed C to drive off. During her evidence, she accepted that she was enjoying the moment with her husband but was critical after the event. Both parents now accept that this was completely unacceptable but there was an air of defensiveness from both of them when making that admission, such that I was left with the impression that they both still struggled to understand why professionals have been so concerned at their behaviour. A said that, in India, where she grew up, this would not be considered to be unusual. 53.As I indicated to A during her evidence, at a point at which she appeared to become irritated at the questioning, this incident demonstrates, at the very least, incredibly poor decision making by both adults, who preferred to have a ‘special moment’ for themselves, rather than consider the physical safety of their child. A momentary lapse in C’s concentration, even at a relatively slow speed, may have been fatal for so small a baby. This incident placed B at risk of significant harm. It also tells me a great deal about the dynamic between the parents, and A’s ability to protect her child. 54.In another video, B is shown lying on the back seat of the car, whilst the vehicle is clearly moving (despite both parents denying this), without any means of restraint, save that her mother is sitting next to her and has her hand on her chest. Again, this behaviour was irresponsible and dangerous. Both of these videos show handling that falls below that to be expected of a reasonable parent. 55.Reliance is also placed on some of the photographs that have been extracted. In three particular photos, C is shown holding A (who is tiny) up on the roof of the car (which is parked). He told me in evidence that he was very proud, not only of his daughter, but the fact that he had just purchased the car, and he is the first in his family ever to do this. I infer from his evidence that the photo was intended to show his pride in how far his life had come. I would note that although these photos have a slightly bizarre feel to them, I am not persuaded that they show C holding B in a way that was deliberately harmful or neglectful. There is also a photo in which the father is placing his thumbs in the middle of B’s cheeks, in which he says that he is rubbing her cheeks. It doesn’t look very comfortable. All of the ‘concerning’ photos relied upon by the local authority have an air of carelessness about them but I am not persuaded that they demonstrate parenting that falls below that expected of a reasonable parent. But they do tell me a little about the ‘kind’ of parent the father was. 56.On the night at about the time of the Queen’s Jubilee (2/3/4/June), the father has said that he was responsible for caring for B, as A was feeling very unwell. A told me that she was really poorly, with the ‘chills’. Despite the fact that she was breast-feeding her baby, she told me that she was so poorly that she took the decision to ‘miss’ a feed and allow C to offer expressed milk to B whilst she had a rest in the spare room. C told me that he went to bed and went to sleep. 57.A’s written evidence was that she knew nothing at all about any incident having occurred that night until after they had both been interviewed by the police, when her husband told her that B had fallen from the bed whilst in his care. Her statement said, “B slept in a cot next to our bed and there are no railings on one side of the cot so it could be attached to our bed. I was in a bed in the spare room asleep when this happened. I wasn’t very well. I had chills and a fever and so C was completing the night feeds and bottle feeding B to help me rest and get better. C told me that B did not cry out when this happened and she didn’t seem like she was in pain or hurt. It didn’t wake me up and I think that it would have done if she had cried out, even though I was in a different room.” In fact, she goes on to agree with her husband that, had she known about this incident at the time, she would have ‘panicked.’58.She was explicit in this statement that she did not even hear B cry out. However, during cross-examination, she told me that, in fact, she had heard B cry out, and was able to describe this as a ‘normal’ cry. She asked her husband what was going on and he said that there was nothing to be worried about. She continued to tell me that she knew nothing about B having fallen until later on. She seemed somewhat ‘detached’ when asked her feelings about having been misled by her husband. 59.The mother’s oral account to me was more in keeping with the written evidence of the father. In his first statement, he says,“7.I then went to my wife and tried to get her to eat something. The door to the room my wife is in is next to the door to the main bedroom where B was, at right angles to each other so if I stand facing the door to the room my wife was in, the door to the main bedroom is directly to my right. I heard a noise from the main bedroom and turned around and saw that B had rolled out of her cot and landed on the carpeted floor. 8.I immediately went to her and picked her up, comforted her and then put her back in the cot. 9.My wife asked “what is happening” but I just said B was hungry because I did not want her to worry as she was poorly and I could manage. B cried for a moment but settled when I picked her up and was not distressed or hurt, as far as I could see. I didn’t tell my wife about this until about 1 or 2 days after the police interview.”60.However, in his oral evidence, there was a different account again from C. In fact, I found the father’s oral evidence in relation to that evening almost incomprehensible, and the impression I formed was that he was ‘making it up as he went along.’ 61.I do accept that there is a video which appears to show that B was able to roll very early on in her development, and Dr Ward was happy to accept that it is possible for very young babies to develop this skill. So, there is no mechanical reason that the account of the fall could not be true. But I am sure that it is not. 62.As I have already said, the incident in which B lay on her father’s lap was nothing short of dangerous. But they also provide me valuable information about the way in which these two adults related to each other and behave as parents. My impression of the mother is that she was willing to allow the father to handle B in a way that she may have known he should not, or at least, with hindsight can see he should not, because of her love for him and her desire for them to be the family that she has always wanted. She was pleased and proud that her partner was taking such ‘pleasure’ in their daughter. As a consequence, she has found it very difficult to be critical of him, and there continued to be an element of her evidence that struggled to accept that the father’s behaviour was poor. For example, both of the parents tried to tell me that there was something about the mother’s tone of voice during the ‘car’ video that indicated that she was disapproving, but that is not what the video shows. The mother is laughing and nothing about her tone is remotely critical. They have subsequently felt the need to say that they reflected on their actions, because that is what is expected of them. But it was not true at the time. 63.Equally, whilst the other photos and the videos may not demonstrate neglectful or harmful parenting in themselves, they do show that the father was careless with his daughter, and was capable of acting in ways that were focused on meeting his own needs (for a cuddle, to show off his car) without thinking through the consequences of his actions for B. The mother had done nothing to intervene. She was the photographer. 64.I am in no doubt at all that both parents are lying to me about the events of the Queen’s Jubilee. A is an incredibly attentive mother, who was worried about her child’s feeding, such that she told me that it was on her mind all of the time. She has been determined to be able to feed her herself. She is a worrier and she panics, that much is clearly true. A told me that her husband had never fed their daughter unsupervised (by her) before the night that she was poorly. In truth, B had barely had a bottle feed. Throughout her daughter’s short life, the mother has always engaged well with medical professionals, and I have formed the view of her that she has been honest when asked questions about her health and development. She was horrified when she was told that her baby had rib fractures by hospital staff. It is inconceivable to my mind that, once A was told about the injuries, and she had been aware that there had been an occasion that B had fallen off a bed, A would not have told the doctors about it immediately. But more than that, had she heard her baby cry out on the night in question, as she would have done had she fallen from a bed, this is a mother who would have jumped out of bed, no matter how ill she was feeling.65.Equally unbelievable is the evidence of C, when he asks me to accept that, knowing that his daughter had fallen, and knowing that she had fractured ribs, he did not think to tell the staff at the hospital about it. The first time that this ‘fall’ is ever mentioned by anyone, is at the start of the father’s police interview, in a pre-prepared statement in which he said, “Some time after the Queen’s Jubilee I understand that the baby had rolled from the cot and fell on the carpet in the bedroom. I immediately checked the baby and she seemed fine and calmed down. This is the only time she fell.”66.C made no mention of his wife being ill in this account. In the account given to the court which I set out above, he makes no reference to feeding his baby, despite accepting in oral evidence that it was a significant feed. He also told me in evidence that B had been somewhat ‘troublesome’ during that feed, trying to fall asleep, and ‘fretting.’ That much would be expected of a child who was so used to being fed at the breast by her mother. 67.I do not accept that A was aware of B suffering from a fall on a night around the time of the Queens Jubilee. She did not know that C was going to recount such an event in his police interview until after the interview had taken place. But she has subsequently presented her husband’s account as being truthful when she knows that it is not. I am afraid that I have formed the view that whatever went on over the weekend of the Queen’s Jubilee, both A and C are lying about it. 68.I must now go on to consider the relevance of that lie in terms of the central issue that I must determine. 69.Firstly, I must determine what relevance the fact that B was diagnosed as being Vitamin D insufficient has to the probable cause of her fracture, that her mother was the same, and that A had also suffered with gestational diabetes. What might have been the effect on the structure of her bones, their strength and their propensity to fracture? These are complex questions that have been the subject of medical and legal debate for many years and in many cases. Dr Ward, Dr Olsen and Professor Greene provided me with a number of research studies in order to demonstrate the extent of the medico-legal debate. All of them sought to give me as much assistance as possible, but all acknowledged certain unknowns that underlie what conclusions they are able to reach. 70.No-one knows through experimentation the precise level of force it takes to break the rib of a six-week-old baby, for obvious ethical reasons. However, it is possible to extrapolate from the fact that rib fractures are not sustained through everyday activity and handling, something outwith the usual must have occurred. We do know that lots of those children have chest x-rays (for example in relation to breathing difficulties) and no fractures are seen. 71.However, Professor Greene also reminded me that there is no available data on the mechanical function of the bones of children who suffer from a Vitamin D deficiency or insufficiency. Professor Greene was prepared to accept that this uncertainty extends to whether, in respect of bones to which there is an underlying mechanism which may affect their viability, there was an associated greater risk of fracture. Again, what we do know is that there are vast numbers of children in the UK who are low in Vitamin D, and those children are not presenting with fractures, either through unknown cause or reduced levels of force having been applied. Professor Greene (having considered the research) told me that he did not consider that there is a proven relationship between an increased risk of fracture and vitamin D insufficiency/deficiency. That was the case even if one included the possible impact of A’s gestational diabetes.72.There is simply no data on the impact of low levels of Vitamin D on bone strength or the force required to break a bone. Professor Greene was prepared to say that there is an inevitable range as described in the arrow below (my creation).73.At either end of the range, there is a greater degree of medical certainty. Children with entirely normal bone structure require a significant force to be applied to their chest in order to fracture a bone. Children with observable rickets on an x-ray can and do sustain fractures of their bones without a significant force having been applied. 74.In the middle of that range, there will be children who have a Vitamin D deficiency, whose bone density cannot be observed by x-ray (Dr Olsen and Professor Greene both being in complete agreement that x-rays are not sensitive to changes in bone density until they become significant), but whose bone density is ‘suboptimal,’ who have a degree of poor bone growth that might have an impact on the degree of force, but that impact is wholly speculative. B’s ‘suboptimal bone structure’ put her somewhere on that line, but it is not possible to say where she was, or to directly infer from that suboptimal bone structure that it there was a resulting impact upon her bone strength or her propensity to fracture. It would be right to conclude that the fact that her mother was similarly deficient, combined with her being breast fed, and her poor feeding up until her admission to hospital, are likely to indicate that she was becoming more insufficient as time went on. 75.Professor Greene left this valuable and detailed discussion with this conclusion. That, in his clear view, a force that one would not expect to see in normal handling is most likely to have been applied to B’s ribs, even in the context of her Vitamin D insufficiency. 76.Dr Ward agreed with this analysis and reminded me that the group of children who appear in the middle of that arrow is very large indeed (where B is), and that very many children in the UK today will have insufficient Vitamin D, and yet rib fractures are still very rare. We simply do not know at what stage bones become more susceptible to fracture, save from the knowledge that we gain from our day to day experience. It is also accepted medical opinion that the bones of children have a degree of elasticity which is not present once a child is fully grown. Everyday accidental falls do not cause rib fractures. Serious RTAs can. And fractures in a child of this age are very rare, whatever the cause. 77.It will be apparent from this discussion that despite being asked extensive questions on the subject, none of the experts, in fact, diverted from their original conclusions, which Dr Ward set out with admirable clarity in her report as follows, “Prof Greene referred to the limited evidence from studies and case reports and consensus from expert groups which lacks absolute clarity, though he referred to a global consensus on rickets in 2016 which concluded that fractures only occurred in those who were mobile and had severe radiographic evidence of rickets. They suggested that simple vitamin D deficiency without radiological or biochemical signs of rickets has not been associated with increased fracture risk in infants and children. The radiological opinion has not changed i.e. no radiological evidence of rickets, and biochemical changes of insufficient 25OH vitamin D with mild elevation of PTH and alkaline phosphatase was modest has not changed. I have not seen further opinion from Prof Greene. B was not mobile in terms of crawling, cruising or walking. The statement of Dr H simply repeats information from the records. Therefore I would not wish to change my opinion that although there was a potential risk of bone fragility associated with vitamin D insufficiency, there is no confirmed radiological evidence of rickets which would predispose to fractures. One cannot be more specific in relation to risk of fractures on the basis of current research.”78.I accept the opinion of all three experts that a force must have been applied to B’s ribs in order for them to fracture, and I accept Dr Olsen’s clear view that the appearance of the 4th rib (in terms of the stage of healing that could be observed) was different to that observed in relation to the 5th and 6th. Therefore, I am entitled to conclude that there have been two incidents during which inappropriate force has been applied to B’s ribs. That force was sufficient to characterise it as being outside of normal handling (which does not cause rib fractures), and it would be obvious to an observer that the handing was inappropriate. 79.Dr Ward was equally clear in her view that the bruise seen to B’s cheek was as a result of inappropriate handling, there being no evidence that B had a tendency to bruise. She did not consider that it was probable that the cheek being rubbed against the strap of the car seat was the cause. The presence of the small lump inside her mouth has no relevance at all to the causation of the bruise. 80.As I have already set out, everything that I have come to know about the parents from the evidence indicates that A is an attentive, warm and caring mother. She showed remarkable determination in her desire to feed B herself, and she dedicated herself to the care of her child, with very little else in her life at that time. I also accept her evidence that she first observed the bruise to B’s face at about 11pm, when she fed B. The bruise had not been visible to her before or immediately after C had bathed her that night. A immediately sought medical attention for her daughter, and I do not accept the father’s evidence that she sought his consent before she did so. It is improbable in my view that A would have taken her child to hospital in the way that she did if she had any suspicion that the bruise had been deliberately inflicted or her child had previously sustained rib fractures. 81.The father’s evidence was implausible. He answered every question put to him with complete confidence, but seemingly without any appreciation of the inconsistencies in his account. He spoke with a high degree of confidence and did not accept that any of his parenting could have been better, even when challenged about the car video. He is invested in this relationship, having already ‘lost’ his relationship with his older child. It is my clear determination that A did, indeed, go to bed because she was unwell on an evening around the Queens Jubilee. I consider that it is most probable that the father struggled to feed B and that he was too rough with her and broke her 4th rib. It is highly probable that he squeezed her chest too hard. I also find that there was another incident in which the father similarly broke B’s 5th and 6th ribs in a similar way. I consider that it is most probable that C bruised B’s face by a poke or a prod when he was bathing her on the night of the 29th June. 82.I am afraid that, despite all of the positive things that I have been able to say about the mother as a parent, she has lied about what she knows, in an effort to protect her husband and to conceal the truth about how B’s ribs were broken. I accept that she would not have known about the bruise being caused, but she would have heard B cry out in an unusual and painful way on two occasions, when B was in the hands of her father, and she has concealed those from professionals and from the court. Whilst she has, quite properly, sought to explore whether B suffered from any underlying medical issues that were relevant to the causation of her fractures, by the time she gave her own evidence, she knew that this was unlikely, and she failed to tell the court the truth.