W (A Child), Re

In child-injury fact-finding, the court may assess the cumulative force of several significant injuries. It is not necessary to prove that every injury, considered separately, was non-accidental where the explanations, taken together, are implausible and leave the series of injuries unexplained.

An underlying medical condition remains a possibility to be evaluated, not a conclusion which the evidence compels. Appellate courts may uphold a finding supported by an alternative permissible basis where the trial judge’s principal reasoning was imperfect, provided the parties understand the essential reasoning and no material unfairness results. Serious injuries may also justify a finding that carers should have sought medical attention, even where their timing or mechanism is uncertain.

A and his parents appealed findings made by His Honour Judge Brown in Leicester County Court following a fact-finding hearing on the local authority’s care-order application. The judge found that A had suffered non-accidental injuries, including mouth and forehead injuries, a skull fracture and a vertebral fracture. He concluded that one parent had inflicted the injuries, that the other knew more than was disclosed, and that both parents had failed to obtain timely medical attention.

The appeals challenged the evaluation of accidental explanations, the possibility of bone fragility, the cumulative approach to the evidence, and the findings concerning medical assistance. The central issues were whether the findings were adequately reasoned and whether they were properly supported by the evidence.

1. Appeal dismissed. The Court of Appeal upheld the judge’s findings that A’s injuries were non-accidental and that neither parent had obtained timely medical attention.
2. The reasoning concerning the duration of A’s distress after the mouth injury was unsatisfactory. A was sleeping separately from his parents, and the evidence did not establish how long he had cried before they awoke. Nevertheless, the finding could properly be supported on an alternative basis: the account that a non-toddling baby had fallen from a sitting position onto a toy with sufficient force to cause substantial injury was implausible.
3. The forehead bruises were also properly treated as non-accidental. Although a child might accidentally strike himself with a toy, the explanation required two separate impacts, each sufficiently forceful to cause bruising, and was inherently unlikely.
4. The possibility of an underlying bone disorder had been properly explored. The medical evidence was inconclusive. That such a condition was possible did not compel a finding that it existed, and the judge had not ignored or misunderstood the evidence supporting bone fragility.
5. The decisive consideration was cumulative. A baby who could not walk or stand had suffered five significant sets of injury while dependent on his parents. The explanations offered for the individual injuries did not sensibly account for the series as a whole. The medical evidence and the inherent improbability of the proposed mechanism entitled the judge to reject the parents’ account.
6. The judge was also entitled to find a failure to seek medical help. Two fractures would have caused significant distress for at least some period, and the parents should have appreciated that medical attention was required. On the mother’s own account, blood was visible on A’s mouth during the night, yet neither parent properly checked him or sought assistance. The judge’s ex tempore reasons were adequate because the parents understood that he disbelieved them and preferred the medical evidence.

1. Court of Appeal (Civil Division): On 8 May 2013 the court dismissed the parents’ appeals and upheld the findings of fact.
2. Leicester County Court: His Honour Judge Brown conducted a fact-finding hearing and on 18 January 2013 found that A’s injuries were non-accidental and that the parents had failed to obtain timely medical attention.