Prosecution of parents over baby’s death raises controversy over diagnosing child abuse

Parents whose baby son died after a fractured skull and bleeding into the brain have won the right to keep their second child after a clash of experts in the family court.

The case of Jayden Wray, who, unknown to his parents and doctors, had severe congenital rickets when he died aged 4 and a half months, has focused new attention on the controversy over the classic “triad” of encephalopathy and subdural and retinal haemorrhages and the extent to which it is diagnostic of trauma.

His parents, Rohan Wray and Chana Al-Alas, were cleared of murdering him at the Old Bailey last December after a six week trial. Experts disagreed over whether the parents were to blame, and the judge directed the jury to acquit them.

But the London Borough of Islington took their second child, a daughter, into care at birth in October 2010, when they were awaiting trial. Last week a High Court judge, Lucy Theis, ruled that she should be returned to her parents after a four week trial in which the court’s Family Division heard evidence from the same experts.

At the end of a 67 page judgment, the judge said: “I have reached the conclusion that even though the presence of the subdural haemorrhage points towards Jayden’s injuries being caused by trauma, the balance of the evidence points the other way.”

The post mortem examination of Jayden showed encephalopathy, subdural and retinal haemorrhages, and numerous bone fractures. The paediatric pathologist Irene Scheimberg, who conducted the procedure for the coroner with a consultant forensic pathologist, concluded that the cause of death was “hypoxic ischaemic encephalopathy and multiple fractures in a background of congenital rickets.” The forensic pathologist Nathaniel Cary, who observed the post mortem examination for the police, thought that the cause was head injury.

The judge said that the evidence was that shaking or shaking with impact injury causing the damage in Jayden’s brain would have resulted in immediate collapse and that there was no evidence of any contemporaneous injury. The parents took Jayden to their GP complaining that he was not making any noise and not opening his mouth, that his tongue appeared stuck to his mouth, and that he was having fit-like signs, jerking a little.

The GP noted that Jayden was “alert” and said that there were no indications that he had a life threatening condition. He told the parents to take him to the paediatric walk-in clinic at University College Hospital, where they went by bus. CCTV footage shows him sitting on his mother’s knee. In the footage, the parents were behaving normally, and Jayden appeared awake and not stiff and posturing.

The judge said that the care at the hospital, where Jayden was having seizures, was “sub-optimal.” There was no proper management of his carbon dioxide levels, and the handover of records to Great Ormond Street Hospital for Children, where he was taken next, was “chaotic.” The radiologist at Great Ormond Street was unaware that the University College Hospital radiologist had raised a question about rickets.

It was only on post mortem examination that Jayden was shown to have had severe rickets. He had been born deficient in vitamin D and was breast fed by his mother, who also had vitamin D deficiency. The severity of his condition and its manifestation in the bones was “effectively outside the clinical experience of any of the medical witnesses,” the judge said.

She called for research “in relation to the different aspects of the triad and the impact of vitamin D deficiency and rickets on babies under 6 months.”

A spokesman for Great Ormond Street said, “Our priority when Jayden arrived in the hospital was to try to save his life.” An independent review by a senior radiologist experienced in the radiology of non-accidental injury concluded that it would have been best practice to raise the possibility of an underlying bone disease but added: “This is not a typical case of rickets.”

A University College Hospital spokesman said that its clinicians regretted that they were unable to reverse Jayden’s deteriorating condition during his short stay at the hospital.