The Court of Appeal has overturned a Family Court decision that tibia fractures sustained by a 10-month-old girl had been inflicted deliberately or recklessly by one of her parents.

The parents were in a long-standing, stable relationship. The girl had been born prematurely and remained in neonatal intensive care for three weeks. She was subsequently prescribed omeprazole, a medication used to treat indigestion and acid reflux, for more than seven months.

When she was 10 months old she rolled off a sofa while in her step-grandfather’s care. She was distressed and had clearly hurt her leg. She was taken to hospital, where X-rays revealed that she had fractured her right femur. A skeletal survey showed that she also had fractures to her left and right tibia that pre-dated the femur fracture. This raised concerns about the possibility of inflicted injury. The local authority issued care proceedings and the girl was made the subject of an interim care order and placed into foster care.

The Family Court found that the girl did not have bone fragility, and that she would have shown distress after sustaining the tibia fractures, although those caring for her had not described any signs of distress. The Court concluded that the injuries were inflicted by either the mother or the father.

On appeal, the Court of Appeal found that the Family Court had considered the evidence in its component parts without putting together the whole evidential picture. While acknowledging that premature birth, feeding issues and being prescribed omeprazole were all possible causes of bone fragility, the Court had failed to consider their cumulative impact. The fact that the girl had sustained a highly unusual accidental femur fracture should also have been taken into account in considering whether she suffered from bone fragility.

The Court had also attached too much weight to the issue of whether the girl would have shown a pain response to the tibia fractures. The assessment of the parents’ presentation was limited and speculative, and the Court had only considered the evidence of the grandparents, including that the girl had shown no signs of distress or discomfort, after reaching the conclusion that the tibia fractures had been inflicted.

The Court of Appeal was satisfied that a proper analysis of the case would have led to the conclusion that the local authority had not proved, on the balance of probabilities, that the tibia fractures had been inflicted. It was therefore not necessary to remit the case for a retrial. The care order was discharged.