Classic text book case of baby shaking childminder trial told

- Declan Brennan - 

A consultant paediatrician has told the trial of a childminder charged with assaulting a baby that some of the baby's injuries represented a “classic text book case” of baby shaking.

Registered childminder Sandra Higgins (34) is alleged to have caused the injuries to the 10-month-old baby she was minding at her home.

Ms Higgins of The Beeches, Drumgola Wood, Cavan Town, has pleaded not guilty at Dublin Circuit Criminal Court to intentionally or recklessly causing serious harm to the baby on March 28, 2012.

On day four of the trial Dr Christopher James Hobbs told Sean Gillane SC, prosecuting, that he specialises in child protection and child abuse cases.

He said he agreed with the findings of Dr Alan Finan, who treated the child and concluded that the mechanism of injury was “likely to be violent shaking”.

“I felt the assessment of child had been thorough very. I couldn’t see any obvious gaps in the information. I felt that the conclusions drawn are those I would have drawn with that information,” he said.

He said the child had unusual bruises, such as those to the buttocks, the back and ear.

“In an infant of that age the bruises to the back are most unusual. Bruising in the ear really in any age of a child is very worrying because it’s a protected part.

“Ear bruises are unusual in accidental injury but are quite common in non-accidental injury,” he said.

Asked about finger tip bruising on the child's back he said: “This is the classic textbook picture. You would see the bruises of the back in cases of shaken baby. You don’t actually see it all that often.”

He told Remy Farrell SC, defending, that the ability to age bruises was very unpredictable.

Prof Alf Nicholson, a paediatrician at Temple St. Children's Hospital, told the court that he examined the infant when she was brought to Dublin days after the injuries.

He said the collection of injuries on the child “were really quite consistent with abusive head trauma or shaken baby syndrome”. 

He added: “We’ve a lot of experience of dealing with these children. It’s a very difficult issue. It’s an emotive issue. I’ve been down this road many times.”

Giving evidence from the US via video-link Dr Julie Mack said that the bleeding she identified on brain scans of the child was too small to represent the rupture of larger blood vessels associated with baby shaking.

She said that the bleeding did not indicate a massive rupture of a large vessel.

“These are the veins thought to be ruptured when you shake a baby and in this case there is simply not enough blood for a large vessel tear. It came from a smaller vessel,” the defence witness told the jury.

She said the bleeding on the membranes just above the brain could have been caused by bruising resulting from a bump on the head.

She told Remy Farrell SC, defending, that the scans show the possibility of a re-bleeding of an earlier injury or pre-existing problem.

“I don't believe that. The fixed view I have is based on anatomy and also on the forces generated with a shake. I disagree with the standard hypothesis,” she said.

She disagreed that she was an outlier in terms of the majority of medical experts and said that fewer people now held that view. Mr Gillane put it to her that her view was unshakeable regardless of the evidence.

She said that she had not read the medical report from Dr Alan Finan, the consultant paediatrician who treated the infant. She said she was unaware the child had bruising on both sides of her forehead.

Mr Gillane asked: “In terms of deciding whether a baby was assaulted or not, are you telling us it's an irrelevance that the child had bruises on both sides of her head which you weren’t aware of?”

Dr Mack replied: “It doesn’t affect the way I can help the court. My job is to help the court understand the imaging”

Mr Gillane said it would be wrong for a physician to rush to judgement and say an injury is accidental or historic without considering all the information.

'I did not say it was accidental, I said the evidence on the imaging is associated with impact. I cannot say if it was accidental or inflicted,' Dr Mack said.

Dealing with the possibility that the injury was earlier than the date in question and was followed by a “lucid interval” when the child not exhibit any symptoms of injury, Dr Hobbs told Mr Gillane that: “In the case of a shaking injury, the brain is injured from the moment.”

The trial at Dublin Circuit Criminal Court continues before Judge Patricia Ryan and a jury of eight men and four women. There is a court order prohibiting publication of the child's name.