Part 25 Applications for Experts in Non-Accidental Injury Cases

You have your first non-accidental injury case and you have reached a stage in proceedings where an expert is required, but you’re unsure about which expert to instruct and what questions to ask. Don’t panic! Hopefully, this blog will provide some guidance. This is not an exhaustive list of injuries or questions to ask, but a starting point when considering some of the most common allegations.

The decision about which expert to instruct will be guided by the child’s injury and the mechanism put forward by the carer/s and/or person who had care of the child during the time window when the injury happened.

For almost any injury a paediatrician will be required. Questions to ask of this expert can include:

• How would the child have reacted when the injury was sustained?
• Would the person who was caring for the child been aware of the injury?
• Does the explanation offered by x account for the injury?
• In your opinion what is the likely cause of this injury?
• Are there any underlying disorders or genetic conditions that has predisposed this child to this injury?

Bruising and clotting

In cases where there is bruising and there is abnormal clotting, a haematologist will be required. The haematologist should be asked whether the abnormal clotting results and/or clotting disorder would cause the child to bruise from normal handling and if not, to comment on whether the force needed to cause bruising to the child would be less than normal.

Fractures

Suspected non-accidental injuries that involve at least one fracture will require a radiologist. An important point to note is that a radiologist will never see the patient and therefore they can only comment on the scans that have been performed and the information that has been passed on to them by the treating clinicians. Questions to ask of a radiologist will include:

• Can you provide a timeframe for the occurrence of this fracture?
• Does the explanation offered by x account for this fracture?
• In your opinion what is the likely mechanism for this fracture?
• Do you see any abnormalities of the bone density noted on the scan/s?
• Are there any abnormalities of the bone that you see on the radiographs that might pre-dispose this child to weaker and/or more brittle bones? If so, is there any outstanding test you would recommend for this child?

There are several diseases that can make bones more brittle and therefore susceptible to fractures. Although rare, osteogenesis imperfecta (also known colloquially as brittle bone disease), is a genetic condition that causes brittle bones. This diagnosis should be considered in a child with multiple fractures. If there is either confirmed or suspected osteogenesis imperfecta, an expert will be required that specializes in treating these children. The type of doctor who treats this condition might vary depending on the geographical location of the child. However, a paediatrician with expertise of osteogenesis imperfecta can be used as an expert. If the diagnosis has been confirmed with genetic testing then a geneticist should be considered.   

A paediatric endocrinologist is required for any suspected or confirmed underlying bone disorder due to mineral deficiencies or hormone imbalances. The exact questions asked will depend on the abnormal results of the blood tests and the condition which the child has, but ultimately questions need to be asked about what effect the condition has had on the child’s bones and whether the child would have a higher chance of sustaining fractures through normal handling/a lesser force.

Head injuries

Head injuries will require a paediatric neuro-radiologist or a radiologist who has expertise in paediatric neuroradiology and possibly a paediatric neurosurgeon. These specialists normally work together when children present with such injuries to determine treatment. Both will be able to comment on the scans. The paediatric neuroradiologist can be asked what the likely mechanism of injury is and how likely they think a certain explanation put forward by one of the carers, if there is an explanation offered, would have caused the injury. The paediatric neurosurgeon will be able to comment on treatment, prognosis and effects of the injury on the child.

Often, head injuries are seen in tandem with retinal haemorrhages. An ophthalmologist will be required in instances where retinal haemorrhages are present and where there is injury to the eye.

Other injuries

For any other injury, a good rule of thumb if you’re unsure about the experts will be that the experts will be from the medical specialties that have been involved in the treatment of the injury. 

Dr Maia Love is a former doctor who specialises in family law, with a particular interest in cases where there are allegations of non-accidental injury and forensic examination of medical records and examination of medical experts is required.