KB-2023-001305 - [2025] EWHC 2488 (KB)

Sidney was born on 2 November 2014 following an uncomplicated pregnancy and delivery. He experienced no significant health problems in the early weeks of his life. On 13 November 2014, when he was eleven days old, his weight was 3.56 kg (on the 50th centile), his length was 54 cm (between the 50th and 75th centiles) and his head circumference was 37 cm (between the 50th and 75th centiles).

In this context, the centile measurements indicate where, in the population of babies of any given age, any given measurement falls. For example, a head circumference measurement on the 75^th centile indicates that 25% of all other babies of that age would be expected to have a longer measurement and 75% would be expected to have a shorter measurement. And so on.

On 17 December 2014, Sidney was seen at the GP surgery for his 6-8 week check. His head circumference was on the 75^th centile but his weight had dropped to the 9^th centile. The plan, in particular in the light of the drop in weight centile, was for close monitoring at home by the health visitor. I note again that, at this stage, there is no evidence that any parental abuse had yet taken place.

It was on or around 31 December, that Sidney first became the victim of abusive head trauma (“AHT”) inflicted by his mother. No one else, and that includes Sidney’s father, knew about, or even suspected, this at the time.

On 2 January 2015, Sidney’s parents brought him into the GP surgery with a report of his vomiting during the previous week. The doctor identified no urgent features for concern on examination. They were advised to get him re-weighed by, and to discuss their concerns with, the health visitor. Sidney’s mother’s consistent and credible presentation of innocent concern served entirely to camouflage her sinister involvement in his medical presentation.

In the event, Sidney’s symptoms did not settle within the next few days and, on Tuesday 6 January 2015, the health visitor advised that he should be taken to hospital. At 5.35pm, he was seen in the Accident and Emergency Department (“A&E”) at Yeovil Hospital. The nursing notes record:

“Vomiting since 31/12/14 after feeds. Saw GP – reflux. So far progressively worse. ↓ feeding. Parents report lethargic and drowsy. ↓ wet nappies (3 today). Today only had two feeds, vomited after both. Pt alert and orientated. BNO [bowels not open] for 2 days. PMH [past medical history]: normally well. Med: None”.

At around 7pm, Sidney was seen by a doctor in A&E. The notes record:

“HPC [history of presenting complaint]: Projectile vomiting for 7/7 – getting worse. Is still hungry after feeds. ↓ PO [oral] intake – normally has 6 bottles/24o, recently has only had 2. Last weight 06/01/15 4.78kg. Started on 25th centile + has dropped to 9th but following 9th centile curve. Irritable, not sleeping at night. Milky vomit, no bile. Doesn’t look in pain, not drawing up legs. ↓ wet nappies – only 3 in last 24 hrs, normally 6-7. BNO for 2/7, prior to this was normal, loose stool. No one else unwell”.

At around 11pm on the same evening, Sidney was seen by a consultant paediatrician, Dr Oliver. She recorded:

“Problem vomiting falling off centiles.

History as previously documented. Baby well until NYE. 7 days of vomiting poor feed since then. Mostly milk. Takes small amounts of feed only. More lethargic. Losing weight. No temp. No rash. No apparent pain. B/O [bowels opened] 2/7 ago - Yellow. PU OK – reduced last 24 [hours]. Family members well…

No FHx [family history] pyloric stenosis.

O/E [on examination]: Pink. Alert. Cool peripheries. Skin – reduced turgor. Cool peripheries, mottled. Mucous membranes moist. Active movements, not jittery…

OFC [occipitofrontal circumference] 41.5 cm – 98th centile.

Imp[ression]: Susp[ected] pyloric stenosis – moderate dehydration. Also, macrocephaly. ?? Intracranial o/a OFC [on account of occipitofrontal circumference, i.e. increase in head circumference]. Alert and active. Fontanelle level.

Plan: IVF [intravenous fluid] maintenance + @ 150 mls/kg/d. NGT [nasogastric tube] + free drainage. Replace Na [sodium] losses ml for ml. USS [ultrasound scan] mane [next day] Abdo +/- Cranial. Repeat gas.”

It can be seen that Dr Oliver considered the possibility of an intracranial cause for Sidney’s symptoms. This was in addition to her primary concern which was of an abdominal pathology in the form of pyloric stenosis (a very different condition caused, as I have already noted, by a narrowing of the opening between the stomach and the small intestine). The plan was for an USS of the abdomen and, perhaps, of the head (“+/- cranial”) to be carried out on the following day.

In fact, however, following the ward round of Dr Heaton, consultant paediatrician at Yeovil the next morning, it appears that Dr Oliver’s tentative suggestion for the carrying out of an USS head scan there and then was not pursued. An abdominal scan was, however, undertaken, which was reported upon as follows:

“No convincing evidence of pyloric stenosis although false -ve [negatives] occur + the length of the pylorus is suspicious (long)”.

A decision was taken to transfer Sidney to the care of the paediatric surgeons in Bristol Hospital for further investigation of the possibility of pyloric stenosis. At 3.15pm on Wednesday, 7 January 2015, Bristol indicated that they were happy to take Sidney but that there were no beds available. He therefore remained at Yeovil for a further two days, until the transfer finally took place at 14:50 on Friday 9 January 2015. No USS of Sindey’s head was carried out during this period. The decision not to carry out such a scan over this period had originally been criticised by the claimant’s expert consultant paediatrician Dr Conway but he later changed his mind on the issue and this allegation was dropped.

The discharge summary from Yeovil stated:

“1/52 history of post-prandial vomiting. Fall in centiles from 25th to 9th. BNO for 2/7. VBG pH 7.485, Cl 100 BE 3.6 initially. USS non-thickened pylorus but suspiciously long. Pt discussed with paeds surgeons at BCH who have kindly accepted to r/v. Pt was also noted to have a soft systolic murmur and poor head and neck control and head circumference of 91st centile o/e. Therefore we will follow up in Dr Zabarowski’s OPA for an echo and r/v of development and head circumference in 1/12 time”.

The abdominal scan undertaken at Bristol on Friday, 9 January 2015 showed no evidence of pyloric stenosis. Sidney was seen thereafter by Ms Cusick (consultant paediatric surgeon) on her morning ward round of 10 January 2015. Her notes record:

“Hx reviewed, 10 day history of vomiting. Fed well o/night. Imp/[ression] possible GORD [gastro-oesophageal reflux disease] P[lan] observe today → aim for d/c [discharge] tomorrow. If further vomiting, consider anti-reflux medication”.

At 6pm on the same day, Sidney was seen by Dr Sage, an ST3 (Specialty Training year 3) in paediatrics and a member of the paediatric surgical team. Dr Sage recorded that the issue of Sidney’s head circumference had been discussed with the Medical Registrar (i.e. a doctor on the paediatric, rather than surgical, team), and that Sidney needed:

“follow up with Yeovil which may need to be sooner than one month but would need to remain an inpatient. P/HV [health visitor] to monitor wt and HC in 1-2 weeks. D/C [discharge] summary copied to notify paediatrician in Yeovil”.

At the centre of Sidney’s case, as finally articulated, is the contention that no reasonable practitioner in the position of the unnamed Medical Registrar would have advocated this course. He or she ought to have recommended that an USS of the head be performed very soon.

In the event, Sidney was discharged home on the evening of Saturday 10 January 2015. While there, he was the victim of another incident of AHT at the hands of his mother. On Sunday 11 January 2015, he was taken to hospital by ambulance following a cardiac arrest. He was taken to the Paediatric Intensive Care Unit at Southampton Children’s Hospital where he underwent a CT scan of his head. The scan showed skull fractures with bilateral large subdural haematomas. There was electrical evidence of seizure activity. There were bilateral retinal haemorrhages.

Sidney has been left with permanent and significant disabilities including developmental delay and neurodisability, visual impairment, and a history of limb spasticity and epilepsy.