Missed chances to save baby from abuse

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LESSONS must be learnt from the case of a nine-month-old Wigan boy who was clearly attacked on several occasions before health and social services came to his rescue, a report concludes.

When concerns were finally raised about one apparent injury the youngster had suffered, he was given a thorough examination and medics concluded that he had been the victim of serious serial abuse.

Old injuries hitherto undetected by the medical or social care experts included a fractured right arm, broken collar bone and a haemorrhage to the back of his eye which was thought to have been caused either by a blow or shaking. It was also medically concluded that they were inflicted at different times.

The unnamed youngster, who was put into foster care after the alarm was raised, had also been taken to hospitals and GPs with other injuries including bleeding from his mouth on two occasions and, just the day before the inquiry was launched, an eye injury.

A criminal investigation was launched. But while suspicions were high that either the mother or her new partner was responsible and the “non-perpetrator” knew what had happened but covered up for the abuser, the authorities were unable to prove beyond reasonable doubt who the assailant(s) was. This was not helped by their not being able to pinpoint the exact timing of the older injuries. As result the Crown Prosecution Service concluded that there was not enough evidence to bring any one person to justice.

Wigan Safeguarding Children’s Board has since carried out a serious case review, calling the youngster Child D to protect his identity, and concluded that there were at least three missed opportunities where “possible non-accidental injuries could have been identified before the final presentations.”

A general criticism is a lack of reporting individual incidents to other people in the medical and social care chain.

On average a child under four accesses a GP practice seven times a year but while Child D visited regular and out-of-hours GPs 15 times in nine months, no-one thought to raise concerns. In all he made 26 contacts with health services outside of routine checks.

The report says the mother had been trying for a baby, but after falling pregnant, split up with the biological father and sought a late termination. The pregnancy was too advanced and so she decided to continue with it and keep the baby.

Late booking for pregnancy is, the report adds, known to be associated with “poor outcomes” and the mother and unborn child should have been identified as vulnerable but neither GPs nor midwives did this.

Once born there were instances when the mother reported he had been projectile vomiting, a common sign of a mother over-feeding which in itself is a sign of not coping. But no concerns were raised. She had herself complained of feeling anxious and depressed and the report says that had she been tested properly by health visitors the results would have triggered closer scrutiny of her and the baby’s wellbeing.

Medical staff were also criticised for taking family explanations for the boy’s injuries at face value and there was no mechanism in Wigan for health visitors to update records on the arrival of a new male partner on the scene after a child’s birth.

A lack of general communication comes under fire. The report reads: “No one health service held the full picture of the attendances and contacts made by Child D. This meant that no practitioner could see the developing information and all the ‘warning flags’ which the attendances showed.