Starting the child safeguarding examination and not accepting Ms W’s explanation for the bruising
12. Ms W says the Trust would not accept her explanation that the markings were caused by a Guthrie test (a heel prick test to collect blood samples from newborn babies) on 22 February 2021 and it also did not look at her photos to support her explanation.
13. The Trust explained it was acting in line with the relevant child health protection guidelines by starting the child protection enquiries when there was ‘unexplained bruising’ on a baby. It says it considered Ms W’s explanation but felt this could not explain the bruising.
14. The Trust accepted the safeguarding process can be distressful for any parent or family, but it was necessary. It apologised for the upset caused.
15. NICE guidance says:
‘1.1.2 Suspect child maltreatment if there is bruising or petechiae (tiny red or purple spots) that are not caused by a medical condition (for example, a causative coagulation disorder) and if the explanation for the bruising is unsuitable.
Examples include: • bruising in a child who is not independently mobile • multiple bruises or bruises in clusters • bruises of a similar shape and size • bruises on any non-bony part of the body or face including the eyes, ears and buttocks • bruises on the neck that look like attempted strangulation • bruises on the ankles and wrists that look like ligature marks.’
16. The guidance defines ‘unsuitable explanation’ as follows:
‘An unsuitable explanation for an injury or presentation is one that is implausible, inadequate or inconsistent: • with the child or young person's • presentation • normal activities • existing medical condition • age or developmental stage • account compared to that given by parent and carers • between parents or carers • between accounts over time.’
17. The Derbyshire and Derby City practice guidance on bruising in babies and children says:
• ‘Research shows it is very unusual for non-mobile babies to have any bruises. Minor bruising to non-mobile babies can be a pre-curser to serious or life-threatening injuries.
• Practitioner noting non-mobile baby/child with a bruise or suspicious mark should seek explanation • Avoid leading questions, do not offer options or suggestions. The explanation for the injury may or may not be plausible but given the vulnerability of a premobile child, further assessment is always needed to ensure the child’s safety.
• Practitioner to make immediate referral to Children’s Social Care via Derbyshire Starting Point or Derby City Initial Response Team as appropriate or Out of Hours/Careline.’
18. Our view is the Trust acted in line with guidance by starting the safeguarding process and taking the baby in for assessment to make sure of his safety.
19. The remaining question is whether the Trust should have accepted Ms W’s explanation and accepted there was a medical cause for the bruising, without investigating further.
20. We can see Ms W and her partner gave several explanations suggesting the bruising could have been caused by the heel prick test, or during the emergency caesarean section. The Trust complaint response says the paediatrician considered those explanations and felt they could not fully explain the bruising so more tests were needed.
21. About the heel prick test, the Trust says there was no evidence of there being attempts to draw blood or to use both heels for sampling. It explains they found the heel pricks had healed which is why they needed to investigate further. It says the paediatrician could not remember if they had looked at Ms W’s photographs, but they examined her son in person and this was more reliable than photographic evidence.
22. The Trust says no forceps were used during the birth. It says the newborn examination records did not show bruising so it felt this also could not explain the bruising on the baby’s heels.
23. We fully understand Ms W would have been upset at any suspicion that her son’s bruising might have been caused by harm. In line with NICE guidance, the paediatrician must consider whether the explanations given for the bruising were consistent with the child’s presentation (how they looked) and the treatment they had already received.
24. The Trust guidance says given the vulnerability of a child who is too young to walk, even if an explanation seems logical, staff should do further tests to rule out the possibility of harm.
25. Our view is the Trust acted in line with guidance by doing further tests instead of accepting the parents’ explanations without checking. If the Trust had not done the X-ray and scans, this may have been a failing in keeping to child protection standards.
Unprofessional comments from nurses
26. The Trust said the lead nurse had spoken to staff, who did not remember making any comments. The lead nurse sent a reminder to the nurses that conversations like this would not be helpful and they should not comment on the supervision of the parent or carers while the child protection examination was ongoing. This is because the process is handled by social services and not the hospital.
27. The Trust apologised for any additional distress this may have caused.
28. We cannot add more to the Trust’s explanation by investigating further. Given the amount of time that has passed, we would not be able to cross-examine the nursing staff to see if they remember making those comments. As such, we do not think it would be practical to investigate this issue.
29. We understand Ms W and her family have gone through an upsetting experience. We consider the Trust was acting with best intentions to protect her child and make sure he was not in any danger. We hope this provides some reassurance to Ms W.