A & Ors (Children : care proceedings), Re (Rev 1)

In disputed child-injury fact-finding proceedings, a medical consensus that inflicted trauma is the likely explanation does not make that explanation inevitable or conclusive. The court must assess the whole evidential picture on the balance of probabilities, including whether the cause may remain unknown. Medical findings, expert opinion, the carer’s account and surrounding circumstances must be evaluated together. Stress factors have no independent probative value, but may reinforce other findings where consistent with them. In assessing a witness’s account, the court should consider consistency, external support, internal coherence and demeanour, while applying the caution in R v Lucas [1981] 1 QB 720 that a lie on one issue does not necessarily destroy the remainder of the evidence.

The local authority commenced care proceedings concerning three children after MA suffered a subdural haemorrhage, extensive bilateral retinal haemorrhages, encephalopathic illness and right-sided weakness. The mother described an unwitnessed fall or collapse at home. The medical experts considered alternative explanations, including a low-level fall, pre-existing subdural bleeding, metabolic or coagulation disorders and vaccination-related injury, but ultimately regarded an inflicted shaking or acceleration/deceleration injury as the most likely explanation.

The central questions were whether the mother’s account was reliable, whether the medical evidence established inflicted trauma on the balance of probabilities, and how the family’s circumstances and identified stress factors should be evaluated.

1. Fact-finding approach. The court found that the likely explanation for MA’s presentation was an inflicted shaking injury, probably followed by a throw, and rejected the mother’s account. The finding was reached on the balance of probabilities after considering the medical and lay evidence together.
2. Medical evidence and unknown causation. The triad of subdural haemorrhage, encephalopathy and retinal haemorrhages was not treated as diagnostic. Even where recognised alternative causes have been excluded, the cause may remain unknown. That possibility affects the evaluative assessment but does not alter the burden or standard of proof. The approach in Re: R (A child) [2011] EWHC 1715, drawing on Henderson & Ors [2010] EWCA Crim 1269 and Cannings, was adopted.
3. Assessment of the mother’s evidence. The court considered whether the account was consistent, externally supported, internally coherent and credible in light of the mother’s demeanour. Applying the caution in R v Lucas [1981] 1 QB 720, a lie on one issue did not automatically destroy the remainder of a witness’s evidence. Here, however, the mother’s changing account and the false retraction by her brother materially undermined the central explanation.
4. Stress factors. The parents’ isolation, workload and difficulties managing the older child had no independent probative value. They could nevertheless reinforce other findings where consistent with them. In this case, the evidence supported the conclusion that the mother had momentarily lost control.