For those in the UK - TONIGHT ON BBC Radio 4
"Fractured" is broadcast at 8 pm on Monday 20 December on BBC Radio 4. 

http://news.bbc.co.uk/1/hi/health/4102341.stm

Monday, 20 December, 2004, 00:03 GMT 

 E-mail this to a friend   Printable version 
 
Bone disease taken for child abuse 
By Hugh Levinson 


 
Fractures can be misinterpreted

Babies suffering from brittle bone disease have been taken into care -
because the symptoms resemble those of child abuse.

Eight years ago, Annette Deane took her baby son to hospital because he
wasn't feeding well.

Tests showed that he had several broken bones that were now healing.

Annette and her partner were suspected of abusing their son, who was taken
into foster care.

"He was my first child," said Annette.

"He was so precious to me, and the thought that I might lose him - all I
could do was cry. Sit and cry."

After four months in care, their son was found to have a broken ankle, and
two other fractures. He was diagnosed with brittle bone disease and
eventually returned to Annette.

Rare disease

  People get a medical diagnosis that says it's child abuse and then they
go looking for evidence to support that.

Dave Endicott 
Brittle bone disease, or osteogenesis imperfecta, is a rare, incurable,
genetic condition, caused by a mutation in collagen proteins in the bones.

It can be inherited but can also occur spontaneously.

The most obvious symptom is that bones fracture easily.

In its severe form it is fatal or severely disabling. But the milder forms
of the disease - like Annette's son's condition - can be difficult to spot.

The problem is that the symptoms can resemble those of babies who have been
subjected to violence or rough handling.

Professor Nick Bishop of Sheffield Childrens Hospital is considered one of
Britain's leading experts on childhood bone illnesses.

He told a BBC Radio 4 documentary that there are probably between 40 and 60
babies born each year with the condition in Britain.

Perhaps 10 to 20 of them do not have a family history of bone disease.

These cases are at "significant risk" of being misdiagnosed, he said.

Time not on our side

The symptoms of brittle bone disease become clearer with age, but as
Professor Bishop notes, "time is not on our side."

He has seen two cases where abuse was suspected, but the child turned out
to have brittle bones and was returned to his family.

Dave Endicott, a social worker with 30 years of experience in child
protection, says things can go wrong because of an unwillingness to
challenge initial medical opinions.

"The medical profession is the dominant profession and we look to it to
give us guidance on child protection," he said.

"What people do is they get a medical diagnosis that says it's child abuse
and then they go looking for evidence to support that theory or diagnosis."

However, these cases are generally considered rare - especially when set
against the 5,000 or so cases of babies under the age of one who arrive at
British hospitals with broken bones each year.

As most of these babies can't walk, the vast majority of these 5,000 cases
will be considered as non-accidental injury, at least initially, according
to Professor Bishop.

Keeping an open mind

Annie Hudson, a member of the childrens' committee of the Association of
Directors of Social Services, said social workers are aware of the
possibility of rare diseases - and are encouraged to keep an open mind
during child protection investigations.

However, she points out that if a social worker fails to spot and prevent
abuse of a young baby, that baby could end up being injured again, or even
killed.

For Annette Deane, though, the child protection system itself caused harm.
She says her son's time in foster care left him with permanent
psychological damage.

"They've finished their part in it, but for me and my son it's ongoing. I
see something in him every day."


"Fractured" is broadcast at 8 pm on Monday 20 December on BBC Radio 4.