A Local Authority v Mother & Ors

This case concerns the application by the Local Authority (“LA”), for a care order in respect of P, a child born 2024. P’s mother is the First Respondent (“the M”) and P’s father is the Second Respondent (“the F”). P’s maternal grandparents, maternal grandmother (“MGM”) and maternal grandfather (“MGF”), are the First and Second Intervenors. P’s paternal aunt, (“PA”), is the Third Intervenor.

The LA was represented by Mr Christopher Adams. The M was represented by Ms Kate Burnell KC and Ms Nicola Brown, the F was represented by Mr Richard Hadley KC and Mr Christopher Rank, and the Children’s Guardian was represented by Ms Kate Hughes KC and Mr George Smith. MGM and MGF were represented by Mr Adeo Fraser and PA attended as part of the hearing but was not represented.

The background to this matter is that on 8 May 2024, when P was approximately 11 weeks old, the F made a 999 call saying that P had become unconscious. P was taken to hospital and subsequent examinations found that he had a subdural haemorrhage and a number of other very concerning injuries. Happily, P has survived those injuries but he is currently in foster care.

Both the M and the F denied causing P any injuries, although the F’s position became slightly nuanced during the hearing. MGM and MGF had care of P at various times before 8 May. Further, M and MGF have put themselves forward to care for P if he cannot return to the care of the parents. In those circumstances they were joined as Intervenors in this matter. PA is P’s paternal aunt. She too had care for P at various times before his injuries occurred and it was determined that it was appropriate for her to be joined as an Intervenor. No party by the end of the hearing sought any findings against PA. The LA did not seek findings of fact of failing to protect against M and MGF but did ask me to set out the issues that arise in relation to their evidence in this judgment.

In setting out the facts I will refer to the relevant parts of the evidence in the narrative, rather than recounting all the evidence separately.

The M and F’s relationship began in early 2023 having known each other previously at school. The M became pregnant in May 2023 and they moved to their current property in December of that year. It is highly relevant that this is a fairly small three bedroom property, with a living room and kitchen downstairs and three bedrooms upstairs. The M and F both agreed that the walls and ceilings are thin and if someone is downstairs talking on the phone they can be heard upstairs (albeit not the words). This means that if P was crying in one room, it is extremely likely that a parent somewhere else in the house would have heard.

On 6 February 2024 there is a Facebook message from the M to a friend, KK, in which the M indicates that the F has practically stopped drinking and been out less. The M says that the F had said that he didn’t realise how much it affected his “attitude and anger”. The F in his evidence said that he had stopped drinking for a while but started going to the pub again shortly after P was born. This is a fairly constant cause of tension between the M and the F in the many electronic communications.

There is also a running theme of worries about money, which both the M and the F accepted.

P was born in 2024 with no resuscitation required and good Apgar scores. It is clear that the birth itself was quite traumatic but there is no evidence of any birth related injuries. P’s newborn infant physical examination indicated no abnormality apart from a possible posterior tongue tie.

There were a series of visits to healthcare professionals in which no concerns were raised about P’s presentation. I do not need to set these all out because by the end of the hearing all parties accepted that P had a number of injuries, which had no organic or otherwise explicable cause other than non-accidental injuries.

On 5 March there is a Snapchat message between the M and the F where the F apologises to the M for “making her feel shit” and there is reference to the parents arguing.

From 8 March onwards there are a series of photographs of P, to which I will refer below. It should be noted that photos, particularly when not taken in a controlled and professional manner, can be misleading and need careful interpretation. I take this fully into account when commenting on the photos.

On 9 March there is a WhatsApp message from the M to F where it is clear that the M is very tired and somewhat struggling. Throughout this period there are references to M seeing P and having no concerns. Similarly, PA saw P regularly and also says she had no concerns.

On 11 March P went to a postnatal clinic. On 15 March he was seen by Dr H because of constipation.

On 16 March there is a message which appears to indicate that the F was caring for P alone whilst the M was out. The F says “fed him winding him he cried. Sat here now he’s crying. Idk what to do and its pissing me off x”.

On 18 March there is the first of a long series of concerning photographs of P. This photograph appears to show abrasions on his face and lips, including quite a deep scratch to the left of his mouth. The M said the scratch happened when P was in the bath and he scratched himself with his nail. The F agreed with the M. Professor Fleming said that he was surprised if a baby’s fingernail could cause a scratch this deep. The M said the photo was misleading and there had been a scab which fell off and then the scratch bled again.

On 19 March there are photographs and a video of P’s mouth. They show a bruise/abrasion on P’s left upper lip and the video shows a great deal of blood in P’s mouth that appears to be coming from more than one place.

In her statement of 27 June 2024 the M said that the mouth bleed had probably been caused by P putting his hand in his mouth. However, in a subsequent statement, the M said she thought it was from P’s frenulum being torn when the F was feeding him. The M said in oral evidence that she was in the kitchen and had made up a bottle for the F to feed P in the sitting room. The F was struggling to get P to latch on, so the M went through to the sitting room, helped P to latch on and then she went back to the kitchen. The F again called for help and she then saw the blood in P’s mouth and took the video with the torch on to try to see what was happening in his mouth. She was wiping the blood off the outside and inside of P’s mouth.

The M said that when the F brought P back through she was “panicking” and “teary”. Despite the blood inside P’s mouth and the very clear bruise/abrasion on his lip she said she never thought the F had hurt him and had not thought the F had forced the bottle into his mouth.

Professor Fleming’s view was that the photos and videos indicate significant force-feeding, by pushing the bottle too far into the P’s mouth, injuring the inside of the mouth and the lip. I have no hesitation in agreeing with Professor Fleming. It is entirely obvious that the feeding was far too forceful and had injured P’s mouth quite seriously.

I have to say that I found this part of the M’s evidence fairly extraordinary. She was in the next room throughout and saw the clearest possible evidence that the F had forced the bottle into P’s mouth far too roughly. Yet she did not, or says she did not, reach the obvious conclusion. I note that the account that she gave orally to the court of three attempts to feed P is not the account that she gave in her earlier statement.

The F, after a number of questions, accepted that he might have been “a little too aggressive” in giving P the bottle. I take this as effectively a concession that he caused the mouth injuries, albeit without intending to.

The M said that she told the GP and the health visitor that P’s frenulum had been bleeding. It is accepted that there is no reference to this in the medical notes.

On 22 March there are further photographs which appear to show a mark higher up on P’s left cheek.

On 23 March there are photographs which appear to show a mark on P’s left eyelid and possibly his forehead. Professor Fleming thought P could have caused these to himself. On 25 March there are photographs which appear to show marks to the left side of P’s face. The M said P had dry skin and I accept that these photos are not determinative of there being injuries.

On 31 March there are photos that show a clear bruise below P’s left eye. The M had no explanation for this. She said she had never seen anything dropping on P’s head or face. She said in response to this photo and many others, that she had asked the F whenever she saw a bruise and the F always said he didn’t know how the injury had been caused. Professor Fleming thought it unlikely that P could have done this to himself.

On 4 April health visitor MH saw the M and P at the 6 to 8 week check.

On the same day there is an argument in the messages between the M and the F because the F is gaming and the M says he is not helping.

5 April is the earliest date on which the fractures to P’s left ribs, his left radius, the lower end of his left shin bone, and the two fractures to his left foot could have occurred.

On 10 April there is a photograph which shows a faint bruise by P’s left eye/on his cheek. The M had no explanation for this but said that whenever there was a bruise there had been a red mark before. She thought P might have caught himself or rubbed his eyes and his cheek.

I note that in respect to a number of the bruises, Professor Fleming said that in his experience babies of this age do not flail their arms around in a way that causes them bruises as shown in the many photographs.

On 14 April there was a photograph which appears to show a bruise on top of P’s forehead on the left side.

On 16 April P was taken by the M to the GP clinic for his immunisations and 8 week examination.

Between 16 and 20 April there are a series of photographs in the photograph bundle which appear to show scratches to the left side of P’s nose and cheek and bruises to his left cheekbone and forehead. The M said she did not cause them and she had no explanation for them. She did accept during cross examination that she was starting to have doubts in her mind that the F’s explanations “didn’t make sense”. She said “I thought maybe he wasn’t handling him as gently as he should have been”. The M suggested that from about this time onwards she started asking the F to do less with P.

There are also photos of blood on a muslin cloth. The M said P’s frenulum had split again when the F fed him. She said the GP had told her it had healed, but again there is no record of that in the notes. The M said in cross examination that she thought the F had put the bottle in too hard, but “he didn’t do it purposefully or out of frustration”. The M said that whenever she raised her concerns with the F he said that she was “overthinking”, that it was merely her anxiety and that she was insinuating that he had deliberately harmed P.

The F accepted that he may again have been “too forceful” in feeding P.

In my view, from at least 16-20 April the M knew that the F was injuring P through his rough and inappropriate handling. That is the only sensible interpretation of what the M said in evidence and the photos.

On 19 April M cared for P for a couple of hours as the M had an eyelash appointment. M indicated that discolouration could be seen but it was not as significant as the photographs would suggest.

From around 17 April the family were all unwell with flu. On 19 April there are messages from the M to the F in which she indicates that she is ill and identifies a number of matters which are making her unhappy. She says “I feel like shit I don’t have the energy to do anything. Just want to smoke a joint and drown myself in the bath.” The F is in the pub in the late afternoon and an argument develops about his reluctance to come home. The M states that she is “genuinely at the end of my tether with life in general because I prioritise every fucker else and put other people first and nobody does the same for me”. The F says that he does care but that he has “just had a few pints after work to sort me and my mental health out a little bit”. The M posts an Instagram message about her, the F and P being unwell.

On 21 April there are a further series of photographs that show a significant bruise or lump at the centre of P’s forehead and bruising to the left cheekbone. The F’s story as to how these injuries occurred has varied. On 21 April the F told the M that P had picked up the Firestick remote (a light electronic device) and dropped it on his own head. I therefore will call this the “Firestick incident”. On the evening of the second day of the hearing, after hearing Professor Fleming, the F told the M and PA that he had dropped the X-Box controller on P. Professor Fleming made clear that the nature of the head injuries meant that it was virtually impossible that the Firestick incident could be true. I will set out the original course of events and explanations and then return to the X-Box.

A video probably filmed at 10.08am appears to show a cut/bruising to P’s lip and P crying. The F said that P caught his lip on his nail. It is not entirely clear when this happened or whether the M was still in the house. At 10.24am the M Facebook messages PA to ask if she can come over, she says “please don’t tell F.”“I feel like I’m losing my head, I’ve had to walk out of the house”. It seems that there had been a significant argument about a family party. The M says that when she left the house P was uninjured and asleep on the sofa. She was out of the house from 10.24am until about 2.41pm. The F accepted this was the longest period when he had cared for P alone. Both the M and the F agree that there had been a major argument that morning when the F said that he would not go to the M’s grandmother’s 80th birthday. At some point, possibly during this argument, the F suggested to the M that P may not be his biological child.

It is not entirely clear where the M was this day after she left PA before lunch. She said she did not go for a walk with a friend, but there seems to be a couple of hours unaccounted for. Ultimately this is not critical for the issues I have to decide, save that the M was out of the house for about four hours when she was fully aware that the F posed a serious risk to P.

The F sent the M the photo of the significant bruising at around 2.30pm. At this point she speaks to the F and texts PA at the same time. The F initially said the bruising “had just appeared”. The M pushed the F on this and he then said that P had dropped the Firestick on his head. The M said in evidence that she went home, but only after about another 25-30 minutes. She said when she got home she had suggested taking P to the doctor but the F had persuaded her not to. The M decided to wait till the next day and then there was no swelling.

There is an exchange with PA from 14.27pm in which the M says that the F has asked her where she is and “is making out like I'm cheating on him”. The exchange continues and the M says “I genuinely can’t cope anymore. Sat on Morrison’s car park crying.” She also says “He’s just sent me this picture of [P]. I know he wouldn’t lay a finger on him however he didn’t have them this morning and he’s never smacked himself in the face that hard.”“They just appeared”. There is then a discussion between the M and PA about P whacking or boxing himself.

The M said that when she got home she suggested taking P to the doctor but the F dissuaded her, and suggested waiting till the next morning. The swelling had then gone down so they decided he did not need to go to the doctor.

The F maintained the Firestick incident story until the evening of the second day of the trial. His oral evidence then changed to saying that he had placed P on the sofa and had got up to make him a bottle and dropped the X-Box controller, forgetting that P was on the sofa. The F said he was embarrassed by what he had done and therefore made up the Firestick incident.

The F’s story seems unlikely. Firstly, I am doubtful that dropping the X-Box controller would have caused these two separate head injuries, although I accept it is possible. Secondly, although the F might have been embarrassed, it seems more than odd to make up the unlikely story of the Firestick incident and then stay with it once the police and social services became involved. I think that the F changed his story because he heard Professor Fleming’s evidence and realised his original story was unsustainable. I also conclude that the F, with the at least tacit collusion of the M, decided not to take P to the doctor in case awkward questions were asked.

On 25 April there are a number of deeply concerning photographs. These appear to show a number of bruises to the left side of P’s face extending from just below the left eye to under his chin, together with discolouration to the left eyelid and scratches to the left nostril. The M says that she left the house three times that day. The M says that she wasn’t planning on leaving the F alone with P but her cat was ill and had to be taken to the vet urgently.

The F called her when she was shopping in Sainsburys and told her that P had injured his eye whilst being changed. The M went straight home. She said that when she saw the bruises she didn’t think P could have done them to himself but when she asked the F he insisted that was what had happened. The M’s plan was to take P to the doctor next morning, but the bruises had faded by then.

These bruises are important because the bruising below the jawline are ones where it is impossible to see how a non-ambulant baby could have caused them to himself, and they fairly clearly show finger marks. They are therefore very strongly suggestive of very rough handling around P’s jawline. Professor Fleming said that he could not believe they were self-inflicted and they were characteristic of forceful holding whilst forcing a baby to feed.

The F had no explanation for these marks. He said he might have held P “too firmly” and “harder than I assumed I was”.

On the F’s phone the police found a photo on Snapchat which appears to show a baby with a bite mark. The date on Snapchat is 25 April. The image is slightly unclear, but Professor Fleming thought that it was probably a bite mark. In my view it is a bite mark. The F denies ever seeing the photo but has no explanation as to how it is on his phone. The M denies seeing a bite mark. I will deal with the bite mark in my conclusions.

On 8 May both the M and the F say that P was well. The F was working in the morning, he came home and changed P. The F came home early from work and he, the M, his brother’s girlfriend Sophie, and P went to a football match. They came home between 7pm and 8pm.

At around 8pm the M went out to buy cannabis to ease her period pains. When she left the house P was asleep or falling asleep, and she said that she was not anticipating that the F was going to put P to bed, she was going to do it on her return.

At 8:38pm the F made a 999 call. He described P as being in and out of consciousness and his eyes kept rolling back. The operator heard a baby screaming.

The F’s evidence was that he decided to take P to bed because he was starting to fall asleep downstairs. This was the first time that he would have done so on his own. He took P upstairs and put him on the changing mat. The F took P’s clothes off to change his nappy and P was “a bit agitated” and was flailing his arms around but not crying. The F went to pick P up to feed him and he noticed that P’s breathing was very irregular. The F picked P up and he was floppy and his limbs had no control.

Under cross examination the F said that when he picked P up and his breathing was irregular “I may have shaken him to see if it would rectify the situation.” He said he was “in a bit of a panic” and went back and forth, once or twice, to see if P “would return to normal”.

The F accepted that he had never said before that he had shaken P. He said he had been unsure whether he did or did not, but he was now clear that he had done so. He said that he only shook P after P had gone floppy. The F denied losing his temper with P or shaking him out of frustration because he was crying.

I am confident that the F was lying in this evidence. I deal with this in my conclusions.

The F was clear in his evidence that the M was an excellent and loving mother and would never have harmed P.

A large number of medical experts were appointed to report in this case. I set out below a brief summary of their evidence. I permitted four of those experts, Professor Saggar, Mr Jalloh, Dr Hogarth and Professor Fleming to give oral evidence and be cross examined. I will comment on the case management aspects of that decision in a separate ancillary judgment. The day before Dr Hogarth was due to give evidence, counsel for the M and counsel for the F indicated that they no longer wished to cross-examine him. He was therefore stood down.

Dr Olsen identifies 13 fracture injuries and details and explains those as follows:

The fractures therefore resulted from multiple applications of force, unless a severe underlying condition associated with bone fragility existed.

Dr Hogarth describes the presence on CT scans taken on 8 May 2024 of fresh subdural bleeds mainly over the right cerebral hemisphere and the presence on a subsequent MRI scan on 10 May 2024 of fresh subdural bleeds over both hemispheres and a thrombosed bridging vein. There was also evidence of hypoxic-ischaemic injury to the right cerebral hemisphere.

The fresh subdural haematoma seen on the CT scan was no older than 29 April 2024 and the SDH seen on the MRI scan could be dated between 7 and 9 May 2024.

The time determined by the Court as the time when P was last seen well may be the best indicator of when the causative event occurred.

If P does not suffer from any relevant underlying medical condition, the most likely cause of the identified injuries is inflicted trauma by a shaking mechanism.

A single event could account for the findings on the neuroimaging. The possibility that there was more than one event cannot be excluded, but it is not required to explain the neuroradiological findings.

Mr Jalloh indicates that P suffered a brain and spine injury characterised by subdural bleeds on both sides of the head, diffuse hypoxic-ischaemic injury, vertebral body fractures in the spine and possible subdural blood in the spine.

In the absence of any relevant underlying disorder, the injuries would have been caused by an episode of trauma and probably a mechanism that involves shaking.

The traumatic episode that caused the injuries would have probably been painful or distressing and, accordingly, P would have displayed an immediate change in behaviour, such as crying or irritability. However, this might not represent a significant change in behaviour if he was already crying and/or unsettled. Sometimes a crying infant will become quiet or be rendered unconscious following an episode of trauma. The evolution of symptoms after a traumatic event depends on the degree of encephalopathy, ranging from irritability, lethargy, and vomiting to seizures, apnoea, reduced consciousness and possible life-threatening collapse. P’s presentation was consistent with encephalopathy. Although an infant suffering encephalopathy would be unlikely to behave entirely normally, the signs can be relatively non-specific and a caregiver who has not witnessed an episode of trauma would not reasonably be expected to attribute the signs to a brain injury.

The likelihood is that P sustained an episode of trauma after the point at which the Court can determine that he was last completely well and, on balance, shortly before his presentation on 8 May 2024. No evidence could be found of a previous brain injury that might coincide with earlier episodes of trauma that caused fractures or bruising, but this does not preclude this possibility.

All the lesions on the brain imaging are consistent with a single episode of trauma.

Mr Jalloh was cross examined. He was asked whether the vertebral fracture could have been the result of P’s seizures, as has been recorded in some research papers. He said that this would only occur in adults because adults have much stronger muscle bulk and so the force generated by seizures is much greater.

He was absolutely clear that the brain injuries were not consistent with a birth related subdural haemorrhage. The MRI scan showed an acute change which would have occurred within 3-7 days of the “insult” and would be very unlikely to be birth related. Further there was no evidence that even if P had had birth related subdural bleeding that would then create a vulnerability for later haemorrhage. For any such mechanism there would have to be a subdural fluid collection and there is no evidence that that occurred.

Mr Jalloh’s conclusions therefore remained precisely the same as they had been in his written report.

Professor Saggar identifies a family of history of hypermobile spectrum disorder (“HSD”) in the F and some evidence also in the M.

There is very limited evidence to suggest that P has inherited this and the connective tissue panel for the different types of EDS and brittle bone disease genes was normal.

From the combination of clinical features and the gene test results, there is no evidence that P has a significant vascular fragility disorder or that he has OI. The residual risk that P may have a rare vascular fragility disorder with no identifiable gene mutation is less than 1%.

There is very little evidence that P has inherited hypermobility syndrome HSD from his parents. The clinical features and examination findings suggest that the current degree to which P manifests any features of HSD would not explain the bleeding in the brain and/or the fractures.

No further gene testing is required. Forces that are considered plausible and precipitant require identification to explain the full presentation of this child.

Professor Saggar in cross examination accepted that statistically there was a 75% chance that P had inherited HSD from his parents, and that there was a known link between that condition and susceptibility to bruising. However, P was currently showing no signs of hypermobility, having a Beighton Score of 2/9 where only above 6/9 would show HSD. He accepted it was hard to diagnose hypermobility in a young infant because of their high intrinsic level of joint flexibility.

He accepted that P was showing a lot of bruising before the index occurrence, and such bruising could be an indicator of HSD. However he thought it was relevant that P had shown no tendency to bruise after he moved to foster care.

He was clear that HSD would give no propensity to subdural haemorrhages or fractures.

Following all relevant testing, no blood clotting disorder can be identified.

Only mild platelet function disorders have not been specifically tested for and therefore not diagnosed or excluded. It is recommended that the test for mild platelet function disorder is not used in children under one year of age and, in any event, mild platelet function disorder is very rare and could not cause the bleeding seen in P.

The bruising and bleeding observed in P should be considered to have occurred, on the balance of probabilities, in a child with a normal blood clotting system.

Professor Fleming gave oral evidence. I have set out much of his evidence in respect of the bruising above.

Professor Fleming identifies no predisposition in P to injury and defers to the other experts in relation to their areas of speciality.

In the absence of an identified episode of significant and complex trauma, or the presence of an underlying abnormality of bone fragility, the combination of multiple bilateral rib fractures, spinal fractures, lower limb and upper limb fractures is strongly suggestive of non-accidental injury.

The subdural haemorrhages, the encephalopathy described by the paramedics and the acute acidosis on admission to hospital were highly likely to have arisen as a result of an acute hypoxic-ischaemic episode shortly before the 999 calls. The CT scan and MRI findings are also strongly suggestive of a recent hypoxic-ischaemic episode. In the absence of a relevant reported accidental episode or any evidence of pre-existing vulnerability, what is described is highly likely to be a consequence of imposed, non-accidental injury.

The episodes leading to the fracture injuries are highly likely to have been accompanied by a period of significant distress, although the duration may have been relatively brief and a person not present at the time the bony injuries were inflicted might not recognise that significant injury has occurred. He therefore accepted that if the M was not present for the incident when the fractures occurred she might not have realised anything had happened.

The most commonly described mechanism leading to the combination of rib fractures, acute encephalopathy and subdural haemorrhage is vigorous shaking, which may also be responsible for spinal compression injuries and metaphyseal fractures, such as the one to P’s left tibia.

It is not possible to state, on clinical grounds, whether the fractures were caused by one, or more than one, episode of injury. All of the reported bony injuries, with the exception of the fractured clavicle, are compatible with one or more episodes of vigorous shaking, with or without impact, and shaking is also the most likely mechanism for the subdural haemorrhage.

The fracture to the left collarbone could have arisen at the time of birth. Professor Fleming notes factors that are both indicative and contra-indicative of that possibility. He said in oral evidence that clavicle fractures were often missed at birth and only showed up later on in x-rays. In the light of this evidence I think it is appropriate to discount the clavicle fracture.

A photographic image dated 25 April 2024 and taken from the F’s phone indicates a lesion to P’s right flank. Professor Fleming acknowledges that he is not an expert on the interpretation of possible human bite marks, but indicates that he is able to say from his own experience that this appears to be the most likely explanation for this lesion. In the absence of any follow-up images, or any visible item with which to assess the exact size of the lesion, he states that it is not possible to state with certainty whether the lesion was inflicted by an adult or a child, and if this question needed to be determined, suggests that it should be put to an expert in forensic odontology.

I suggested to Professor Fleming that this photograph was much more likely to be of the area just below P’s neck, than his flank. He agreed that this was quite possible.

In his final report, dated 14 February 2025, Professor Fleming responds to the schedule of photographic evidence in the bundle. He expresses the view that ‘the lesions listed above are strongly suggestive of repeated inappropriate, very rough violent handling and are not compatible with self-inflicted injuries in an infant of less than three months of age’. He comments particularly on the bleeding from P’s upper lip and the bruising to his cheeks and concludes that ‘there is very clear evidence of recurrent inappropriate or violent handling of P over the preceding weeks’. Professor Fleming also reiterates his view that ‘in my opinion by far the most likely explanation of P’s collapse on May 8 was an episode of imposed hypoxic-ischaemic injury, probably caused by an episode of violent shaking or shaking plus impact by his father whilst alone with P shortly before the 999 call’.

The M made a number of statements and gave oral evidence for a day. I have summarised the key parts of her narrative evidence above.

In my assessment, she was largely truthful on primary facts. However, there was a very consistent theme of her seeking to minimise her responsibility, find excuses for her choices and to paint herself in a favourable light.

The M was absolutely clear that she had never injured P and, in her written evidence, that she had never seen the F injuring P. She also said that she had never seen P do something which then led to a corresponding bruise. The M had said to the police that she did not think P could hit himself hard enough to cause a bruise.

Throughout her written evidence the M had not accepted that the F had injured P. However, on the third day of the trial, when the F changed his story about the Firestick incident on 21 April, the M changed her position and said that she thought the F had shaken P. She said that she wanted to hear the oral evidence of the experts to see if they changed their evidence. The M said she had believed the F’s explanation because he seemed so sure. She said she felt “betrayed and angry” because she had given the F ample opportunity to be open and honest with her. The M said that she and the F had separated that evening, and she was no longer in a relationship with him.

I have to say that this change of position came astonishingly late, given the overwhelming evidence that the F had caused P’s injuries, which must have been even more overwhelming to the M who was in the house.

It was a feature of the M’s evidence that she seemed considerably more concerned about the fact that the F had lied to her, rather than her failure to protect P and having left him in a situation where he could easily have died.

It was clear from the M’s evidence that she knew that the F became frustrated with P. She accepted that sometimes P’s crying “overwhelmed him”. On at least one occasion the M accepted hearing the F swear at P and she had said to him that P “was not purposefully being annoying”. The M had said to the police that it got to the point where “she didn’t want to go upstairs” because “there was something there”. On one occasion the M had heard what she thought was the F slapping P, but when the F denied it she said she believed him.

The M said when she challenged the F about the injuries, he would get defensive and ask her what she was insinuating. One of the oddities about her evidence was that she seemed to feel that if the F was not deliberately harming P then that was what really mattered. The extremely obvious fact that the F was harming P, whether deliberately or not, seems to have been something that she was not prepared to accept until exceptionally late in the day.

The most obvious example of at best wilful blindness on the M’s behalf was the mouth injury on 19 March, which I set out in detail above. The M was in the kitchen and must have heard P crying and twice went and helped put the bottle in his mouth. She said she was “panicking and teary”, but she said there was no moment when she thought the F had been rough with P. The M said she had never thought that the F had injured P by over vigorous force feeding. She said in her June 2024 statement that she thought the injuries had been caused by P putting his hand in his mouth. In my judgement the M knew that the F had caused those injuries by forcing the bottle into P’s mouth. Whether she “forgave” that because she thought he did not do it deliberately, is largely irrelevant. The M knew the child was at risk of serious injury. Further, the M chose not to take P to the doctor, even though he had been bleeding copiously from his mouth.

The M said that she had not realised until she saw the photos how often P had injuries. But she then sought to minimise the photos, or at least her responsibility, by saying that they did not show a true picture. When asked about each bruise the M said she hadn’t caused them and she didn’t know how they had been caused.

The M accepted that by 19 April she was starting to have doubts in her mind about the F’s explanations not making sense. She said she had started to ask the F to do less with P. The M accepted that she had never seen P’s arms flailing and him bruising himself. On 18 April, when there was an injury to P’s mouth when the F was feeding him, she said she thought the F had put the bottle in too hard but didn’t think that he had done so purposely or out of frustration.

I asked the M what she had done at this stage to protect P. Her answer was that she didn’t think that she was not protecting him. I note that in the closing submissions Ms Burnell said the M accepted that she “grossly failed to protect P”, but that is not what the M herself said in evidence.

After the Firestick incident on 21 April, the M said she had started to question the entirety of the F’s explanations, but the F was very angry with her for asking questions.

The F was not an impressive witness. He struggled to make eye contact and fell back quite quickly on saying he could not remember particular incidents.

The F accepted that he had struggled to come to terms with the idea that he would be a father and he was not fully prepared for the reality.

The F accepted that once P was born he would sometimes find it hard to settle him, and the F found that upsetting and would sometimes ask the M to come home because he was worried he couldn’t get P to settle. Although the F accepted these points, I think that he was minimising these difficulties. The text messages suggest a higher level of frustration and difficulty with the F coping with P than he was prepared to accept.

The F accepted that he was selfish in making choices to go the pub after work rather than go home and help the M.

The F said that he had never seen the M getting cross or angry with P and he had never seen her harming P in any way.

The F was asked a large number of questions about the mouth injuries on 19 March. As I have said above, he eventually accepted that he had been too aggressive in giving P the bottle. In my view he only said this because, having heard Professor Fleming’s evidence, he had no realistic alternative.

The F was very unclear about how all the bruises were caused, save for referring to P’s arms flailing around. He did however say that once or twice he might have handled P “in the wrong way”.

I have set out above the F’s version of events in respect to the Firestick incident.

The F said that the M had challenged him on a number of occasions about the injuries but it did not change anything, and P continued at times to be left in his sole care.

The F’s evidence in respect to the 8 May index injury was that the M had gone out to get cannabis at about 8pm. He decided, for the first time ever, to take P upstairs and put him to bed whilst the M was out. He lay P on the bed at which point he went floppy and his eyes rolled back. In oral evidence the F said he then picked P up and might have shaken him, perhaps once, in order to bring him back into full consciousness. This was the first time that the F had admitted to shaking P, but said that it was after P became ill.

The F’s evidence was not believable. The medical evidence is clear that there was no reason for P to have become ill that evening other than that he was shaken. The F has now accepted that he did shake P. What really happened that evening is not possible to know.

PA, gave oral evidence. The LA did not proceed with its case that she had failed to protect P. She had known that there were problems in the parents’ relationship. However, she had had no idea that P was being injured. Although she saw P on occasions, she did not notice bruises on him. I accept she was a truthful witness and she had no reason to realise what was happening in the household.

MGM, gave evidence for a day. Nobody suggests that she caused any of the injuries. She cared for P about once per week after the first two weeks when the F was on paternity leave, normally on a Thursday or Friday. She was also in very frequent electronic communication with the M.

MGM said that the M never spoke to her about the problems the parents were having in the relationship; nor about the money worries; nor the degree to which the M was struggling with the F’s lack of help with P.

MGM said that throughout the period from P’s birth to the index injury, she was also having to help her elderly parents, and particularly her father who was unwell. She suggested, and I accept this, that that may form part of the reason why she did not pick up how very badly things were going wrong between the M and the F, and the signs of P being injured. She suggested that it may have been why the M didn’t confide in her, not wanting to place additional burdens on MGM. I note that M and MGF were at pains to excuse the M’s failure to seek support from them. They both said this was the M trying to protect them, rather than acknowledging that the M was actively deceiving them, whilst leaving P to be injured by the F.

MGM said that although she had seen various injuries, including the video of P’s mouth on 19 March, a number of bruises and the photo of the bruising following the Firestick incident, she always accepted the M’s explanations. This included accepting that P was bruising himself, despite the fact that she had never seen this happen.

The MGF, also gave written and oral evidence. He had seen much less of P than his wife, and he said that he had no suspicions that P was being mistreated by either of the parents. He said that he had no idea that there were problems in the parents’ relationship, or that the M was as stressed and unhappy as was truly the case.

He accepted that he and M had failed to protect P but said that he had nothing to alert him to what was really happening in the household.

I will return to his and MGM’s evidence in my conclusions.

There is no dispute between the parties on the legal principles and the case law that should be applied in this case. The summary set out below is an appropriate analysis of the relevant caselaw, and it is not necessary to set out the various cases that lie behind this summary.

The burden of proof is on the LA. There is no obligation on the parents to provide explanations for injuries or ‘memorable events’ although the court is entitled to weigh the absence of such explanation alongside all the other evidence in the case. The civil standard of proof applies, namely the balance of probabilities. If the LA proves that it is more probable than not that a disputed event occurred, then it becomes an established fact for the purposes of these proceedings. If the event in question is not proved, it is treated as having not occurred. That is the binary system that operates in the Family Court.

The court must reach decisions in relation to disputed allegations on evidence, not speculation or rumour. It may, however, draw logical inferences from evidence that it has accepted.

The court must reach a conclusion in respect of each separate allegation but must also take care not to compartmentalise its analysis – the entire canvas of evidence must be surveyed and each piece of evidence must be considered in the context of the other evidence.

The role of the judge and the expert are very different. The responsibility for making decisions always rests with the judge and not the expert - the expert advises, and the court decides. It is important that the expert evidence in this case is considered as part of the overall evidence in the case and not analysed in isolation.

When considering the expert evidence, the court must keep the following firmly in mind.

The answer to the issues or an allegation in this case cannot be provided by the expert opinion alone. The expert medical evidence must always be combined with the factual evidence before a proper conclusion can be reached by the court and inevitably the parents’ accounts will be an important part of its analysis. It is important that each expert keeps within the bounds of their own expertise and defers, where appropriate, to the expertise of others. Recurrence of injury is not in itself probative.

If the court disagrees with an expert’s conclusions or recommendations an explanation from the court is always required.

The court will be mindful of the fallibility of memory, particularly in a case where multiple accounts have been given, and the fact that it is now 13 months since P sustained the brain injury. The court will acknowledge the dangers of inferring that because a parent has not explained how an injury was caused, the real explanation must be a sinister one.

Where it is alleged that a person has lied, the court must approach this allegation with considerable care, as highlighted in R v Lucas [1981] QB 720. First, having identified the alleged lie in issue, it must ask itself whether the LA has proved, on the simple balance of probabilities, that the alleged lie has been told. The court must accordingly seek to distinguish a lie from, for example, “story creep”, mistake, confusion, memory failure or distortion arising from impairment.

Once the court has undertaken that analysis it will move to the second stage, by which it will consider why the proven lie has been told. This is important because people may lie for many different reasons - embarrassment, a sense of shame for having caused an injury accidentally, a desire to hide some other wrong-doing or a mistaken belief that lying might improve their position.

If a lie is proven, then the relevance of the lie to the court’s enquiry must always be carefully considered. Some lies, irrespective of how unpalatable they may be, will have absolutely nothing to do with the ultimate facts in issue of the case, save perhaps assisting the court with an analysis of the person’s general credibility.

Finally, it is also imperative that the court reminds itself that just because a person lies about one issue, it does not automatically follow that they have lied about everything.

I do not need to set out the position of the parties in great detail. The LA submits that I should find:

The LA does not seek findings of actual injury by the M.

The LA seeks a finding of failure to protect by the M and I will refer to the evidence in this regard in my conclusions.

The LA does not now seek formal findings of failure to protect against either M or MGF. However, the LA and the Guardian seek for me to deal in this judgment with the evidence that goes to MGM’s and MGF’s conduct both before 8 May and in the period since.

The M denies causing any of the injuries and, in her closing submissions, now supports a finding that the F caused the injuries. Ms Burnell on behalf of the M accepts that the M has grossly failed to protect P. She accepts that P was presenting with more and more bruising and the M ought to have considered whether P was being harmed, or at least handled inappropriately, by the F. She accepts that the M did have concerns. She accepts that the M had seen P with injuries after he had been cared for by the F and fed by the F.

In his closing submissions on behalf of the F Mr Hadley accepts:

Although in his closing submission the F maintains his denial of knowingly having caused any of the further injuries, he accepts that he has never seen the M mishandling P in any way. He cannot offer any explanation for the other injuries.

Mr Fraser on behalf of M and MGF submits that I should make no findings that they failed to protect P. Mr Fraser sets out in detail the limited occasions upon which either M or MGF saw P before 8 May. He also submits that some of the photographs may paint a somewhat misleading picture of the prominence of the bruises.

In respect of the period since 8 May, Mr Fraser sets out a detailed chronology of both the dates when M and MGF were provided with particular information and also, importantly, the degree to which M in particular was concerned with her own parents. I note that in January 2025 the maternal great-grandfather was diagnosed with terminal cancer and sadly died at the end of March 2025, and the maternal great-grandmother has been diagnosed with dementia.

Mr Fraser also relies on the fact that leading counsel, through their submissions, may have led M and MGF to believe that there was an alternative explanation for P’s injuries.

The Guardian concurs with the LA on the factual findings of injuries, save that Ms Hughes argues the bite mark should be found to be caused by the F on P. She concurs with the LA on the M’s failure to protect. She is perhaps even more critical of M and MGF than the LA.

This is not a difficult or complicated case. The evidence that the F caused virtually all the injuries to P is overwhelming. The medical evidence is clear and there is no difference or inconsistency between any of the expert evidence. There is no genetic or clinical cause for any of P’s injuries.

The subdural haemorrhage is highly likely to have been caused by shaking. There is no other medical explanation, and the F puts forward no other explanation.

Similarly, the fractures, other than that to the clavicle, have no other explanation advanced apart from shaking or very rough handling.

In respect of the bruising, it is possible that P had some propensity to bruise easily, given that both his parents have hypermobility. However, there are two strong indicators against this. Firstly, he has shown no propensity to bruise since being in foster care, even though as a mobile child he would be much more likely to get bruises now. Secondly, the M said that he never injured himself in a way that caused a bruise when in her care. The M, PA, M and MGF said that P frequently flailed his arms, but none of them said that they had seen that happen and then seen marks that led to bruises.

Professor Fleming’s evidence, which entirely accords with commonsense observation, is that an infant of P’s age is highly unlikely to have the strength to injure himself in the way shown on the photographs. Further, the bruises to the jaw area and the side of the forehead are virtually impossible to have been self inflicted.

The mouth injuries are equally obviously inflicted injuries. The nature of the injuries, including the bruise/abrasion on the lip, indicate extremely strongly that they were the result of rough handling with the bottle being forced into P’s mouth.

The only injuries which I find, on the balance of probabilities, were not inflicted were the clavicle fracture which could have been birth related, and the scratch to the cheek, where on balance I accept the M’s evidence that P did it in the bath. It seems an unlikely injury for her to have inflicted, and she accepts that it happened when she had care of P.

It is, in my view, equally obvious that the F inflicted the injures. There is copious evidence that he struggled to look after P and became frustrated with him when he cried or would not take the bottle. The F has accepted that he was rough with P at least twice, once when he forced the bottle into his mouth and once with the finger bruises to the jawline. In my view he accepted those two injuries, albeit saying they were not deliberate, and he did not realise at the time he was being inappropriate because he had no choice but to do so in the light of Professor Fleming’s evidence. In my view, the F was quite strategic in what he chose to accept and not accept.

The F accepted that he had lied about the Firestick incident, but again only after Professor Fleming had made clear that his explanation was unsustainable. However, in my view, the X-Box controller explanation is almost equally unlikely. The mechanism seems somewhat implausible given that P was said to be lying flat on his back with his head by the cushion. The F would have had to throw the controller down and it hit P on the forehead and side of his head. But more importantly it is very hard to see why the F would have gone on lying about this if it had been a genuine accident once he realised how serious the overall case was. The F might have been embarrassed at first but once the police were involved, if he had just dropped the controller, and had not caused the other injuries, then the benefit of telling the truth would have been manifest.

The evidence that the F caused the bruises is overwhelming. They all appeared after P had been in his care, and he does not suggest otherwise. The idea that P caused them to himself is contrary to the medical evidence, contrary to the M’s evidence that P never bruised himself in her care, and contrary to the fact that P didn’t bruise himself when removed from the parents’ care.

The F conceded, eventually, that he had shaken P on the night of 8 May, but said he had done so only after P had had some form of collapse. There was no medical cause of P’s collapse. On the other hand, the nature of the subdural haemorrhage is highly consistent with a shaking injury. I have no doubt that the F shook P and caused the injury. This is reinforced by the fact that there was a 5 minute gap between the F speaking to the M, who told him to ring for an ambulance, and him doing so. It is utterly implausible that the F would have been asking the M if P had had a similar episode earlier in the day, which she had failed to mention to him, rather than just call an ambulance. In my view the F delayed calling an ambulance because he knew he had caused P a very serious injury.

I do not find that the M caused any of the injuries. The mouth injury on 19 March, the Firestick incident, and the index event on 8 May all happened when it is accepted P was in his father’s care. Nobody suggests that the M was rough or inappropriate with P. I accept the M’s explanation for the scratch to his cheek. Therefore I do not find that the M caused any of the injuries.

For all those reasons I find that the F caused the injuries save for the clavicle fracture and the scratch to the cheek.

The only alleged injury which causes me any forensic difficulty is the bite mark. There is no explanation as to why it is on the F’s phone. Sometimes photos might appear because of some group or website the user has been on. But there is no explanation such as that from the F. In my view the photo shows a bite mark on a white infant of about P’s age. The M says he was not wearing a white vest like that shown in the photo on that day, but there are other photos of a similar top. The M and F both hotly deny seeing the bite marks. However, the importance of the bite mark is that it would be clear evidence of deliberate injury. I therefore put little weight on the M and the F’s denials. However, M and MGF also say they saw no bite mark when they saw P on the following days. The bruise could however have faded. There is also no sign of the bite mark on subsequent photos, although there are no photos of that area.

Ms Hughes urges me to make the finding on the balance of probability. I have decided not to do so given the burden of proof is on the LA and the LA, whilst inviting me to consider making a finding, is much more cautious on the issue than the Guardian. It does however remain a matter of considerable concern.

The next issue, and one that is in my view straightforward, is the M’s failure to protect. The M was in the house at times when the F was looking after P. She was in the kitchen on 19 March when the F was trying to feed P in the next room. I find that she knew the F had been feeding P much too forcefully and caused his lip and mouth to bleed. She kept referring to his frenulum splitting but I find that it split because the F forced the bottle into P’s mouth. In cross examination the M effectively conceded she knew the F was being too forceful.

In relation to the Firestick incident, the M knew the F had initially lied to her saying it “just happened”. So she knew, at least by then, that the F was capable of lying and covering up his actions.

The M also knew that she had never seen P bruise himself when his arms were flailing. There was therefore only one other explanation. Even if the M thought P had a propensity to bruise, he only bruised after the F had looked after him.

The M also knew the F got very stressed looking after P and struggled to feed him. This was a small house and I have no doubt that the M knew that the F got cross and frustrated with P.

The M seems to have taken the attitude that because she did not think the F was deliberately injuring P it somehow mattered less, or was acceptable to stay with him. This may be obvious, but from P’s viewpoint, which is the only one that matters, it is irrelevant whether the F intended to injure him or not. He was being repeatedly seriously injured by his father and his mother was not acting to prevent that happening.

I find that by at least mid-April the M knew that P was becoming injured because of the F’s handling. She said herself that she tried to leave P in his care less. However, despite this knowledge, she did not remove P from the risk by leaving the F. Further, she left P with the F on his own in the house for long periods, on 21 April for over four hours and then on 8 May when she went out. On 21 April this was after a really serious argument with the F, when she knew he was angry and very heightened. The only protective choice was to have taken P with her that day and she failed to do so.

The M, in Closing, accepted that she “grossly failed to protect P”. I have to say that she reached this realisation exceptionally late, and doubtless in the full knowledge of my likely findings. For the benefit of any future assessment, my view is that the M has given little cause for confidence in either her insight or her ability to prioritise P.

The M could have sought help and support from her parents, but she chose not to do so. Instead, she did not tell her parents the truth about the relationship, or about what was happening in the house. Perhaps that was because she wanted to protect her parents, but again it was plainly not protecting P. The M said that she could not afford to move out, but I am afraid, in circumstances where she was aware that P was regularly being injured in his father’s care, that is not a good enough excuse.

I make entirely clear this is not a “bolt-on” finding. The M had the clearest possible warnings that P, a very young and vulnerable child, was at serious risk and she failed to take reasonable steps to protect him.

The next issue is MGM’s and MGF’s failure to protect P. With the benefit of the photograph bundle, MGM’s failure to realise, or even seriously question, what was happening to P seems very surprising. However, the photograph bundle brings together the most troubling photos, and there were a mass of other photos that suggest a normal baby. I think that M showed a striking lack of curiosity, and indeed insight into what was happening to P. However, it is important not to judge with hindsight, and also not to judge with the eye of a childcare professional who is astute to see signs of abusive injuries. I accept that for most people to conclude that their daughter’s partner is abusing a baby, and their daughter is turning a blind eye to this, is a very difficult thing to do.

It is surprising that M did not confront the M and ask more searching questions. However, I accept that she was preoccupied with caring for her own parents. I also suspect that she and the M do not have a relationship where the M tells M everything. It was notable that M had no idea the M regularly took cannabis or that there had been issues with the F drinking too much before P was born.

MGF’s failure to realise what was happening was less surprising. He did not see P very often during the 11 week period. The M never confided in him and that may just be a function of their relationship.

In terms of P’s future, I am deeply concerned about MGM’s and MGF’s failure to accept or even seriously contemplate that the F was injuring P, and the M actively misleading them, until they heard the oral evidence of the experts on the first two days of the hearing. As I have set out above, this is not a difficult or complicated case. The medical evidence is overwhelming and the evidence pointing to the F equally so.

I note that even during oral evidence MGF was keen to say that some of the photos were “misleading”, rather than focus on the overwhelming evidence since at least January 2025 that one of the parents had been injuring the child.

I am worried about the M’s ability to apparently manipulate MGM, and MGM’s gullibility in believing what the M says. I do not accept that the M was simply trying to protect her parents, and to show that she could cope without them. The M chose to actively mislead her parents about what was happening, and not to protect P by asking them for help. The fact that MGM’s and MGF’s acceptance of what the M said continued right up to the second day of the trial gives me real concern about their ability to protect P from the M’s lies and exceptionally poor choices.

Even during their evidence M and MGF were trying to excuse the M’s conduct, and said she was trying to “protect them”, rather than accepting that she was actively misleading them to cover up the fact that her partner was seriously abusing N, and she was letting it happen.

I make clear that I do not think a stated reliance on whatever advice they received from criminal solicitors, or whatever hope they pinned on the submissions of leading counsel for the parents at the Case Management Hearing in January 2025, to be sufficient to absolve them of the need to have questioned the M’s explanations much more critically.

However, these are matters which I would expect any assessment of M and MGF to fully consider if they continue to put themselves forward to care for P.