SIDS: New Zealand: co-sleeping infant death

A Porirua infant was found dead in the bed he shared with a four-year-old sibling, sparking renewed warnings about the dangers of co-sleeping arrangements for babies.
A coroner's decision released today said five-and-a-half-month-old Roretana Holland died of sudden infant death syndrome on July 27, 2010 in his parents' home.
Wellington regional coroner Ian Smith said the baby, one of four children aged under-five, co-slept with his four-year-old sister. All four children shared the same bedroom because they relied on a single oil heater for warmth.
"Bedding consisted of a duvet cover acting as a mattress protector with a sheet over the top with a queen sized mink blanket (this was an unzipped sleeping bag). The children each had their own pillow."
On the night Roretana died he was given formula and pureed food before being put to bed at 7pm. He usually settled immediately but did not on this occasion.
"About midnight the deceased's mother heard him making a noise and went to check him. She noticed that both children were asleep but that the older sibling had her hand on Roretana's ear (she had a habit of pinching his ears in her sleep). The mother removed her arm and went back to her bedroom to sleep."
Roretana usually awoke at 5am. But when he remained silent the mother assumed he needed a "lie in" and fell back to sleep.
About 8am she woke up. The older sibling told her mother she had put Roretana back to sleep. But when the mother checked on the baby she noticed he was in the same position, his face was a pale yellow colour and he was "freezing cold'".
Emergency services were called but Roretana was pronounced dead.
Dr Kerry Thornbury of the Ora Toa Cannons Creek Medical Centre said the baby had been developing well, though had suffered skin infections, which were treated with Penicillin. There had been some concern about possible family violence but attempts to engage the Tamariki Well child nurse had been unsuccessful.
The coroner's decision stated that the mother had smoked throughout her pregnancy and drank alcohol, though gave up the latter when she found out she was pregnant after two months.
Forensic pathologist John Rutherford ruled the death was the result of sudden infant death syndrome, "which he explained as being a condition of unknown cause but is known to be associated with certain environmental factors, such as social deprivation, smoking in a household, excess alcohol consumption and co-sleeping".
Coroner Smith said the case was another tragedy involving co-sleeping arrangements for infants as well as other matters highlighted by the pathologist.

"This is a subject well traversed by myself and other coroners."

He repeated earlier recommendations that public health advice around safe infant care and safe infant sleeping practices be strengthened to avoid similar tragedies.
- The Dominion Post
http://www.stuff.co.nz/national/health/5326393/Infant-died-in-bed-with-sibling

SBS: New Zealand: Backlash against Kahui twins book

Hayden Donnell and NZPA Jun 28, 2011

 

Amid an ongoing inquest into the twins' killing this week, mother Macsyna King has announced she is releasing a 'tell-all' book co-written with Ian Wishart. Photo / Brett Phibbs

More than 1000 people have signed up to a Facebook group urging the mass boycott of a book written in collaboration with the mother of murdered babies Chris and Cru Kahui.
Chris Kahui Snr was accused and acquitted of inflicting fatal injuries on the three-month-old Kahui twins in 2008.
His legal team contended Macsyna King, the boys' mother and Kahui's partner, carried out the murders.
Amid an ongoing inquest into the twins' killing this week, King announced she was releasing a "tell-all" book co-written with Ian Wishart.
It would give her version of circumstances surrounding the twins' deaths and name who she thought the killer was.
A Facebook group set up today said the book was King's attempt to "profit from her attrocious deeds".
It urged people to boycott it, along with all other Ian Wishart books, until it was pulled from shelves.
By 7:15pm, the group had attracted more than 7400 supporters, many of whom left angry messages accusing King of profiting from the death of her sons.
Author Ian Wishart previously told TV3 the book was a story of "horror from the streets of South Auckland".
He agreed to write the book after King approached last year asking him to tell her side of the story.
It would provide new information on a case that still provokes anger across New Zealand, he said.
"There's a huge sense of outrage that two twins could be killed and no-one could actually be pinned for their murder.
"The back cover of the book says it makes Once Were Warriors look like kindergarten - it really does."
Mr Wishart said he had already started getting hate mail for writing the book.
Health workers needed to stop similar cases
Meanwhile, one of the country's preeminent experts on child abuse says the child health workforce needs to be transformed so it is also a child protection workforce in order to prevent further cases like that of the Kahui twins.
Dr Patrick Kelly, clinical director of the child protection team at Auckland's Starship Hospital, was speaking at the inquest into the deaths of the babies.
He said the incidence of child abuse in New Zealand is "at least as high and in some cases higher" than other parts of the world.
"For example, if you look at cases of abusive head injuries, as were suffered by the Kahuis, our rates seem higher than in the United Kingdom. If you look at the World Health Organisation study on sexual abuse, the rates in New Zealand were among the highest in all the countries that were looked at.
"Although it's hard to be sure about prevalence figures, comparatively speaking, New Zealand's record is not good."
Dr Kelly said it was clear that there needed to be dedicated child protection teams working in every district health board in the country made up of staff from police, Child, Youth and Family, and the primary health sector. At the moment there were only teams in Auckland, Canterbury and Waikato.
"Currently, even when you combine information from all three agencies, because they didn't collect their data in any kind of uniformed, systematic way,.. we still can't answer the question: in New Zealand, what particular constellation of risk puts children in a hospital with a head injury?"
Healthcare workers also needed to be encouraged to ask the hard questions when confronted with possible cases of child abuse.
To illustrate this, Dr Kelly told the court of an eight-month-old boy who was admitted to hospital with severe head injuries.
His caregiver had told doctors the baby fell from a high-chair which had became entangled in a vacuum cleaner chord, and no investigation was conducted.
Two months later the baby was dead from multiple blows to the head. A clear diagnosis was that he had been murdered by his caregiver.
"I think in retrospect it's fairly clear that this first head injury was unlikely to have happened from a fall from a high-chair. It may have, but what was needed was a much more comprehensive assessment at the time of that first presentation."
There was also a lack of training for healthcare workers in identifying the subtle signs of abuse, he said.
"I think most doctors you can expect to manage the obvious things, but it's the subtle things that aren't missed. If a child comes in with a massive black eye and an obvious strap mark from being struck, most GPs aren't going to miss it, even if they've had no training. But most pre-verbal children don't present like that."
There should be a statutory requirement on the health, and also education, systems to make them responsible child protection, along with Child, Youth and Family, which had a "huge" workload, he said.
"I think if one had an entire health workforce committed to that degree of quality secondary prevention it would also have an affect on primary prevention because they would be working with families, talking to families about violence, hitting children, keeping children safe and all the other things that come out of good parenting practice."
The inquest will hear evidence from Mr Kahui's sister, Mona, tomorrow.
http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10735049

SBS: New Zealamd: End right to silence, Kahui inquest told

 Edward Gay  Jun 29, 2011

 

 

 Babies Chris and Cru Kahui died of head injuries at Starship in 2006. File photo / Supplied

The country's leading authority on child protection has questioned the right to silence for defendants in some child-abuse cases.
Starship hospital's director of child protection, Dr Patrick Kelly, told the inquest into the death of the Kahui twins yesterday that he was disappointed new legislation from the Government did not include some limitations on the right to silence.
"I know it is the Holy Grail in criminal law and I mention it with temerity."
Since the trial, the Government has drafted its new Crime Amendment Bill Number Two which could see extended family and close friends of child abusers face up to 10 years in prison if they turn a blind eye to abuse and do not report it.
Dr Kelly said the Law Commission in Britain had recommended that the right to silence be removed in child-abuse cases where the accused is a caregiver of the child.
The document Dr Kelly was referring to, Children: Their non-accidental death or serious injury, recommends that jurors should be allowed to make inferences when defendants remain silent in some cases.
Babies Chris and Cru Kahui died of head injuries at Starship in 2006. Their father, Chris Kahui, was acquitted of their murders two years later in the High Court at Auckland.
His defence lawyers said the injuries were caused by their mother, Macsyna King. She denied the killings.
Dr Kelly said it was difficult to cross the threshold of "beyond reasonable doubt" unless a healthy baby was left in the house with one person, or there was a confession.
"If the way the criminal system operates is the best it can be then the media outcry is unjustified. The outcome is to be expected and it is just unfair ... If, on the other hand, we could do better, then we should."
He was also asked how the new bill might have affected the Kahui case.
Dr Kelly said there were four adults in the house when baby Cru stopped breathing momentarily and none of them chose to call an ambulance.
He said that while the new bill was unlikely to have changed their actions, it could give police more ability to act.
Under cross-examination from Mr Kahui's lawyer, Michele Wilkinson-Smith, Dr Kelly confirmed that he was aware that Mr Kahui had spoken to the police before he was arrested.
University of Auckland law professor Warren Brookbanks said the right to silence was a part of New Zealand law but there had been talk about the Government removing it in child-abuse cases. He would not be surprised if the Government did "bend".
He said at present jurors were directed not to make inferences if an accused chose not to speak to police or give evidence at trial.
CHILD PROTECTION
Dr Kelly's recommendations:
* More training for family doctors to recognise signs of abuse. Currently they get only two hours during their five-year undergraduate degree.
* Mandatory reporting of suspected child abuse by health professionals.
* Specialist child protection teams set up in every District Health Board.
* A statutory requirement for health and education workers to treat child safety as part of their responsibility.
http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10735139

SBS: New Zealand: Diagnosis Questions

20 May 2011,
A single firm shake has long been thought to be able to cause serious damage to a baby's brain. But an article published in the Journal of Primary Health Care (JPHC) suggests it might not be so clear cut, and that babies thought to have died because of being shaken may have actually died from other causes.
Both sides of the debate are presented. Dr Lucy B Rorke-Adams, who holds numerous neuropathology posts and is the Clinical Professor of Pathology, Neurology and Pediatrics at the University of Pennsylvania School of Medicine, suggests that shaking is indeed why the babies have died.
She points out that there is a "high frequency of association between the [three features that indicate central nervous system trauma] and shaken impact syndrome" before moving on to demonstrate the flaws in possible alternate explanations.
She backs up her argument with reference to the body of knowledge about shaken baby syndrome that has built up over the years.
"The scientific base for shaken impact syndrome has accumulated over a period of at least 150 years, although sporadic writings of physicians, anatomists and writers commenting about effects of CNS trauma, in particular concussion, appeared long before that time."
Dr Rorke-Adams finishes her discussion with a warning that "Those who offer untested hypotheses to defend individuals who have harmed infants do considerable disservice to science and to the victims."

On the other side of the debate is Consultant Paediatric Neuropathologist Dr Waney Squier, from the John Radcliffe Hospital in Oxford, UK.
While stating that "We can all agree that it is never safe to shake a baby", she also points out three major arguments against the shaken baby hypothesis.
In the first, Dr Squier states that, "In nearly 40 years [since the syndrome was recognised], no one has ever witnessed shaking to cause the collapse of a well baby."
Dr Squier describes the second argument as appealing to common sense. Violent shaking would cause neck injuries, which are seldom seen.
A third argument is more complex. To paraphrase Dr Squier, shaking a baby would not cause one of the symptoms seen in shaken baby syndrome. The symptom is "thin-film subdural bleeding"; shaking a baby may well cause bleeding, but because of the anatomy of the central nervous system, it would have a very different pattern.
Like Dr Rorke-Adams, Dr Squier also finishes with a warning.
"Failure to look beyond the simplistic and increasingly untenable shaking hypothesis risks incalculable damage by wrongfully removing children from loving parents or incarcerating innocent people.
"Further, by focusing on shaking or inflicted trauma to the exclusion of accidental and natural causes, we are almost certainly missing opportunities to save babies through prevention, early diagnosis and treatment."

Journal Editor Professor Felicity Goodyear-Smith says, "Both failure to act in cases of genuine child abuse, and unnecessarily separating children from their parents do irrevocable harm, so this is an important debate that needs to be had."

Both sides of the debate can be found in the June 2011 issue of the JPHC, which is a scientific journal published by the Royal New Zealand College of General Practitioners

http://www.nzdoctor.co.nz/un-doctored/2011/may-2011/20/does-shaken-baby-syndrome-really-exist-.aspx

AHT: New Zealand: Serenity Jay Scott-Dinningham died in Auckland's Starship Hospital last month

19 May 2011
Police investigating the violent death of a six-month-old baby in Ngaruawahia, north of Hamilton, last month have gone back to the public for more help.
Serenity Jay Scott-Dinningham died in Auckland's Starship Hospital last month.
Police said her fatal head injuries were not accidental and medical staff later told relatives the injuries were similar to shaken-baby syndrome.
The homicide team working on the baby's death was being helped by members of the community, Detective Senior Sergeant Mark Greene, of Waikato police, said.
Police were still awaiting the results of forensic tests done during Serenity's post-mortem to give them a better picture of what had happened.
A public campaign for information was launched today, with CrimeStoppers pamphlets distributed by NZ Post to every house, business and community group in Ngaruawahia.
Mr Greene said he preferred to speak to someone face to face but sometimes that was not possible and the anonymity of CrimeStoppers was great.
"We want to know what you know, not who you are."
http://www.stuff.co.nz/national/crime/5027628/Police-hunt-more-clues-after-babys-violent-death

SIDS: New Zealand: Police investigate drugs in dead baby's stomach

10 May 2011

Police are investigating the death of a seven-month-old Waikato girl after she was found to have adult medication in her stomach.

The girl from Morrinsville, 32km northeast of Hamilton, was initially believed to have died of Sudden Infant Death Syndrome, formerly known as cot death, when she died in March.
But the investigation was widened after forensic toxicology results found the adult medication in her stomach.
The girl's 22-month-old sister was also treated in hospital after it was suspected she had also ingested medication.
"We're focusing on how the seven-month-old ingested the medication," Detective Senior Sergeant Karl Thornton said.
"We're trying to confirm if the older sister swallowed similar pills. At this stage we are keeping an open mind as to what might have happened.
"We are not in a position to confirm any details about either incident at the moment."
The girls were living with their mother and an older sibling at the time but have since been placed in the care of Child, Youth and Family as an interim measure, Mr Thornton said.
Police were interviewing immediate and extended family members.
http://www.3news.co.nz/Police-investigate-drugs-in-dead-babys-stomach/tabid/423/articleID/210515/Default.aspx

SIDS: New Zealand: Poverty and infant mortality

MARYANNE TWENTYMAN :  28/04/2011

The number of Waikato children admitted to hospital with low-income related medical conditions is on the rise with the situation described as "shocking and dire" by one Hamilton budget adviser.
Kit Buckley runs a Mum's Matter group once a week through Christian social services agency Te Whanau Putahi and said the report's findings come as no surprise.
"The biggest problem is that parents have no money left for things like good nutrition and healthcare so conditions aren't being picked up soon enough – or in some cases until it's too late," she said.
The nine-year study into the Health of Children and Young People with Chronic Conditions and Disabilities was commissioned by Waikato District Health Board in conjunction with the Paediatric Society of New Zealand.
The study is based on data recorded between 2000 and 2009 into children and young people in the Waikato who had accessed secondary health services – such as hospitals.
It showed that in April last year 24,743 Waikato children and young people were reliant on a benefit or benefit recipient and that while hospital admissions and deaths had declined for that group between 2000 and 2007, the trend had risen since then, with the largest increases being Maori and Pacific children.
The study is the third in a series of reports into the health of Waikato children and young people published by Elizabeth Craig, director of New Zealand Child and Youth Epidemiology Service from the Dunedin School of Medicine.
Waikato DHB senior portfolio manager of planning and funding Ruth Rhodes said the report was invaluable.
"The information is specific to the Waikato, and it helps us not only better serve Waikato families and children, but it supports us in talking to service providers," Mrs Rhodes said.
The data showed that Waikato children had lower rates for hospital admissions for those with congenital anomalies at birth (such as Down syndrome and cardiovascular anomalies), developmental delays, epilepsy and autism, compared to other regions.
Admissions for cerebral palsy and cystic fibrosis were similar to the national average.
The leading causes of death for Waikato infants were extreme prematurity, sudden infant death syndrome and congenital anomalies –- all similar to the national average.
http://www.stuff.co.nz/waikato-times/news/4936782/Poor-kids-in-hospital-more-often

SBS: New Zealand: Adam Lock

Sun, 19 Dec 2010

By Brook Sabin

A mother whose five-week-old baby was shaken to death by her former partner has spoken out - exclusively to 3 News - hoping her message will affect every parent and save lives.
It's estimated around 3000 New Zealand babies are shaken each year - a number officials are trying to reduce with a major new campaign.
Shannel Tata asked that we black out her face for the interview, it's a big thing for her to talk to us about her son Jayhris.
Six photos are all she has left of him after he was shaken to death by her former partner.
“My son was only five-weeks-old, he was innocent - he was helpless,” she says before speaking about her partner. “I hate - I just hate him.”
In October, 22-year-old Adam Lock was jailed for seven years for Jayhris's manslaughter.
Infants are so vulnerable to being shaken because their neck muscles are too weak to support their disproportionately large heads and their young brain tissue and blood vessels are extremely fragile.
It's a problem which experts say is grossly unrecognised.
“The most concerning fact is that in New Zealand, among Maori children particularly, the rate is arguably the highest in the world,” says Dr Patrick Kelly, a Paediatrician at Starship Children’s Hospital.
Around 20 shaken infants are admitted to hospitals with serious or fatal injuries each year.
But international research indicates the true number of New Zealand children being shaken is around 3000.
Dr Kelly says many parents don't seek medical help - thinking they haven't caused any damage.
“What people don't realise of course is the damage that they cause from that head injury might be still with the baby and have an affect on them for life,” he says.
Auckland Hospital is spearheading a major new campaign which involves a meeting of all new parents to educate them about the risks.
The programme has been a huge success in New York state, where it first started, reducing rates there by almost 50 percent.
It's welcome news for Mrs Tata, who never wants to see another parent go through the turmoil she has.
http://www.3news.co.nz/Shaking-babies-still-a-major-concern-for-NZ/tabid/423/articleID/191568/Default.aspx

SBS: New Zealand: Starship: 'All hell broke loose'

TONY WALL - Sunday Star Times  05/12/2010

  Karen and Ron Hawkless: foster parents of more than 50 children.

 

The information pamphlet for parents being investigated.

 

Last week's Sunday-Star Times investigation about parents who took sick children to Starship Children's Hospital, only to be suspected of abuse, has prompted others to share their stories. Tony Wall reports. 

KAREN AND Ron Hawkless just wanted to provide a loving home for a baby boy who'd had an atrocious start to life, but found themselves under investigation at Starship for suspected abuse.
The Taumarunui couple, who run a tourism business and have fostered about 50 children over the past five years, took in the baby, David, when he was just two days old. His mother had taken drugs and alcohol throughout her pregnancy and David was left with fetal alcohol syndrome.
Karen and Ron fell in love with David and decided to adopt him.
He became ill a few days before his first birthday in July of last year, with a swollen, bulging fontanelle (the soft spot on a baby's head). Karen says she took David to Taumarunui and Waikato Hospitals but was told not to worry, and to take him home.
"I said I did not want to go home, that I was worried he was lethargic, not drinking as much as he should and very sleepy. When I looked up the symptoms on the internet, with the bulging fontanelle... hydrocephalus [fluid on the brain] came up."
Karen says she insisted on a scan and, when that was finally done, there was a sudden change in the doctors' attitudes and she was referred to Starship, where "all hell broke loose".
Starship's paediatricians concluded that David had a subdural haematoma that could not have occurred accidentally or through a medical condition – someone had either thrown him on the ground or struck him with an instrument.
A 24-hour watch was placed on David, and the watching nurse took a note of everything Karen did. "Every word I said on the phone they wrote down. Every time I cried – and I did a lot of crying – they would write that down. I used to go and sit in the toilet and turn the hair dryer on so I could talk on the phone. This went on for 10 days – 10 days of hell."
Karen says there was debate over when the "injuries" happened and whether they could have resulted from a minor fall David had had two weeks earlier.

Karen was initially told she could stay at Ronald McDonald House, but says when she arrived there late at night was told that parents suspected of abuse were not allowed there. Staff at Child, Youth and Family's Taumarunui office, who Karen says were "amazing", organised a motel.

David was discharged, but was put with another carer for a month while further investigations were carried out. Eventually he was returned to Karen and Ron, who are continuing with their application to adopt him.
Tuakeu Pilato, manager of the Taumarunui CYF office, says it was unfortunate a couple who wanted to provide a loving home for a child like David had been through such an experience.
"We [CYF] never did have concerns, but when unexplained medical injuries occur, [medical experts] need to explore that as fully as possible, both for the child's best interests and also for the carers."
Pilato says he is now "absolutely satisfied" that David's symptoms were not caused by any deliberately inflicted injury. "The child's problems are medical, there are a number of contributing factors to that, certainly fetal alcohol is not to be ruled out."
He describes Karen and Ron as "committed caregivers" who have always been open with CYF.
Karen says the fallout from the experience continues, as she now finds it difficult to get David the ongoing medical treatment he needs.
"The sad thing is, David is still having problems and no one wants to help him. I'm finding it difficult to have him properly diagnosed. His shunt keeps blocking, his head bulging at times and he is now getting bleeding noses. I can't get any help because to get help would be for them to admit that I did not hit him and throw him on the floor."
She describes the Starship experience as "horrific" and says she felt that some of its doctors seemed more interested in looking for evidence of abuse than curing David. "It's changed our lives forever, we're not very trusting of doctors any more."
Scott Macfarlane, acting head of child health at the Auckland health board, says he can't discuss individual cases, but says Starship clinicians are "acutely aware that the sensitive nature of their investigations carry the potential to offend parents".
He says Starship's procedures are designed to protect the interests of the child while keeping parents informed as investigations unfold. In many cases, he says, abuse will be ruled out.
"That does not mean Starship doctors were wrong; it simply means appropriate precautions were taken while the possibility of non-accidental injury was eliminated.
"In cases where charges are not laid, it does not mean Starship `got it wrong'; it means we provided advice based on the medical evidence and, for any one of a range of potential reasons, police or Child Youth and Family Services took a different view."
A Sunday Star-Times investigation into Starship hospital's child protection unit has revealed concerns including:
Claims the unit has become like a police station, treating good parents as guilty until proven innocent, causing ongoing trauma for families.
Claims doctors rush to judgement and are unwilling to consider alternative explanations.
Concerns that children are being made to undergo expensive, unnecessary and potentially risky scans in the search for evidence of abuse.
Claims that children are not getting the ongoing medical help they need because doctors refuse to accept it is not an abuse case.
Concerns about medical evidence given in court, particularly in shaken baby cases.
A district court judge has criticised Starship doctors for having closed minds and not considering all the evidence in one case.
Criticisms that Starship does not profile families to determine the likelihood of abuse.
Criticisms over a lack of written protocols.
 
STARSHIP RESPONDS
Its procedures represent "world's best practice''.
It has the interests of the child at heart and sometimes investigations will be "uncomfortable'' for parents.
It does not rush to judgement, but carefully considers the evidence before making further inquiries about potential abuse.
It does further testing, including scans, only when needed.
It concedes information given to parents has been lacking and has prepared written material.
Just because charges are not laid or a person is acquitted, does not necessarily mean Starship "got it wrong''.
Starship does not profile families because child abuse can happen in any family.

YOUR FEEDBACK
A selection of letters from readers who have been investigated for abuse at Starship and other hospitals.
I IMPLORE YOU to continue your investigations into the child abuse unit attached to Starship hospital. A close family member is going through exactly the same thing.
I feel that some members of the child abuse team at Starship are conducting themselves with the mindset that everyone is guilty until proven innocent. We were treated as ignorant to the facts and volatile. We were being accused collectively of not accepting the child had been abused. The professionals repeatedly used the term "non-accidental injury" as if they had seen it occur with their own eyes. The prejudice was alarming.
A quick rundown of our case: Early 2010, the baby becomes ill over a couple of days and parent takes to doctor. Doctor realises baby is in real trouble and parent rushes baby to Starship. Temporary pediatrician at Starship makes claim of "non-accidental injury" based on medical reports. Te Puaruruhau becomes involved and calls police. Police follow instructions and file charges. CYF take over care of all the children through the courts. Paediatrician goes back home overseas. Child still ill.
No independent pediatrician will reassess in New Zealand. CYF cannot return children until after court case. Police cannot drop charges because of medical evidence. Te Puaruruhau and Starship prevent all reassessments and testing to search for alternative explanations even when presented with possible causes including known genetic disorders in the family. Child still ill.
Starship and Te Puaruruhau have devastated all our lives and the lives of the children involved. It is going to take years to get to criminal trial, the children will remain in care throughout. The biggest tragedy of all is that at the centre of this is an infant whose underlying medical condition has yet to be diagnosed.
– name suppression applies
I TOOK MY daughter when almost two to Kenepuru hospital with a sore arm. I had held her hand while we were out shopping as she had been pulling items off shelves. She didn't like it and kept pulling away. Eventually she pulled hard enough that her arm was dislocated. The doctor we saw refused to consider that a child could dislocate their own arm in such a way, and therefore virtually accused me of lying and really put me through the wringer. It was a truly horrible time.
– name witheld
WE HAVE recently been through the ordeal of being investigated after our eight-month-old broke her arm when she got it tangled in her cot slats. After two months of investigations by medical staff, CYF and police, it was found that there was no abuse. The investigation was not started until three weeks after it happened.
We have made a formal complaint to Hutt Hospital and the health and disability commisioner about the process used in investigating child abuse. We strongly believe that doctors are so worried about missing a case of child abuse that they are too eager to refer to agencies and remove the responsibilities from themselves.
I am a registered nurse and find it insulting that people could think that we could harm our baby. It felt like a witch hunt on the part of the medical team. CYF and the police were great and showed a lot more commonsense.
Our baby endured 40 minutes of full body x-rays which I consider abuse. CYF had completed its investigations within two weeks but the police were unable to close theirs until the medical team had made a decision on the x-ray which took two months! In the end they sent it to an expert in the US who confirmed our version of events.
We are terrified that should we ever have to present at the hospital, we will be judged in the same way again.
– name witheld
HELPING OTHER 'TRAUMATISED' FAMILIES
The concern of a wrongly accused father prompted Starship's child protection unit to clarify things.
IT TOOK Starship's child protection unit more than seven years to develop an information pamphlet for parents being investigated for abuse, and only after a wrongly accused father drafted a set of guidelines he hoped would help families in his position.
The Sunday Star-Times has learned information pamphlets developed in December last year were based on those written by Orewa software project manager Michael Beaumont, investigated in July last year after accidentally dropping his baby. The child protection unit, known as Te Puaruruhau, was set up in 2002 to provide better co-ordination between Child, Youth and Family, Starship and police.
Earlier in 2009 former health and disability commissioner Robyn Stent had met with hospital staff to voice her family's concerns at practices in the unit, after her stepdaughter was investigated for suspected abuse.
The Auckland District Health Board says changes were made after consultations with Stent's family, and better information provided to families as a result. But documents show it was not until after Beaumont was investigated that written material was produced. Beaumont was told he was the inspiration for the brochures, after years "on the to-do list".
Beaumont developed guidelines for parents outlining the various tests and scans involved in the investigation process, explaining the steps taken to protect children and investigate the cause of injuries, and why such inquiries need to be made.
The Starship version of the brochure states "in all this, no one is jumping to any conclusions, everyone is trying to do the right thing to ensure your child is safe".
Many of the families who have contacted the Star-Times say it felt as though doctors rushed to judgement and often refused to accept alternative explanations.
Beaumont says while he was "full of anger" when investigated, he has since "done a 180" and accepts the need for such inquiries.
"I respect that they should be able to do it, but think they should handle it better," he says, adding doctors who initially dealt with his child on arrival at the hospital were particularly bad. "They really do think you are guilty and look scornfully on you."
He said parents suspected of abuse were slapped with a "section 42" notice – the section of the Children, Young Persons and Their Families Act which allows CYF to take custody of children without a warrant.
"It's a legal document saying your children are no longer safe with you and have to be removed from your care, it's a really heavy, scary document... you realise you could lose your children at any stage."
Health board spokesman Scott Macfarlane confirmed Starship's information brochures were developed "with the assistance of a family who felt traumatised by their experience".
"We hope that making this resource available will inform parents and reassure them that the process is working in the best interests of their child."
http://www.stuff.co.nz/sunday-star-times/features/4421242/Starship-All-hell-broke-loose

SBS: Battle of the experts

TONY WALL - Sunday Star Times

28/11/2010

Photo: Dominion Post

Dr Patrick Kelly's approach has come in for criticism.

Medical evidence in child-abuse cases in this country has come down to a good old-fashioned stoush between Australia and New Zealand, with a couple of notable victories for the Aussies.  

BECAUSE STARSHIP'S child protection team, led by Patrick Kelly – considered New Zealand's leading child-abuse expert – appears only for the Crown, defence lawyers are forced to go elsewhere. Many turn to Terry Donald, a forensic paediatrician and senior consultant in child protection services at Adelaide's Women's and Children's Hospital, who most often gives evidence for the prosecution in Australia.
But he doesn't come cheap – his fee is around $20,000.
Donald gave evidence in the Kahui murder trial in 2008, challenging Kelly's evidence of the timing of the assaults on the twins. Their father, Chris Kahui, was acquitted. Last year Donald appeared for the defence in the trial of Abhinesh Sharma, charged with murdering his 16-month-old nephew by violently shaking him and slamming his head against a wall.
Kelly concluded it was child abuse and that the injuries could not have been sustained by a fall from a couch, but Donald testified they could have. Sharma was also acquitted.
In a similar case this year, Donald gave evidence in the trial of Famaile Lino, testifying that his baby daughter's injuries could have been sustained in a fall from a chair. The judge criticised Starship doctors who concluded abuse, saying they had not considered all the evidence.
Kelly declined interview requests, saying it would be inappropriate to debate information relating to a specific child, including evidence he had given in court, through the media. In a statement he said the health board had a complaints process and he welcomed feedback from it. "Formal complaints are treated with respect, and lessons learned are used to guide clinical practice."
Donald says it is worrying that there are not enough specialists in New Zealand prepared to help defence teams, partly out of deference to Starship. "It's an important issue that no one in New Zealand will give the defence any time. Defence lawyers risk going to people who are seen as extreme, who aren't even sometimes people who've ever assessed children clinically. I've tried to give them a balanced perspective."
He believes New Zealanders should be concerned that defence lawyers are having to look overseas for experts, not just for cost reasons.
"There's a lot of rivalry between Australia and New Zealand, and New Zealand would generally be regarded as an impressive country but what's it doing with child protection? It's having to defer questions to Australia."
He says there's a danger in rushing to judgement in child head injury cases. "The issue of inflicted head injury is a major problem. It's not a matter of identifying retinal haemorrhages in association with subdural haematoma (as in the Lino case) and then deciding the child has been shaken. It's much more complicated."
England's Appeal Court recently issued guidelines on how judges and juries should deal with expert evidence in shaken-baby cases. If there's a realistic prospect of an unknown cause for the injuries, judges must remind juries of that.

Some defence lawyers criticise Kelly for allegedly being unwilling to consider alternative explanations for injuries.

Kahui defence team member Michele Wilkinson-Smith says Kelly is a "wonderful" doctor who cares for the children he treats, but she wonders if that may sometimes prevent him being objective.
"In court you've got to be utterly objective and forget about your advocacy role for the child. That's where I have a problem with some of the evidence he's given."
She said in her view it appears that he "has definitely reassessed the way he gives evidence since Kahui. I've had more cases with him and his reports are less dogmatic."
Wilkinson-Smith says that because Australia has a much bigger peer group of forensic paediatricians, doctors are challenged more often, and are used to having to ensure their opinions stand up to challenge.
"Here, until Kahui, no one was challenging Dr Kelly."
Sharma's lawyer, Maria Pecotic, believes treating clinicians should not give expert evidence. "I don't think they are open-minded enough."
Auckland Crown Solicitor Simon Moore says a meeting was held with Kelly and his team after the Lino judgement. Recommendations included ensuring expert witnesses are provided with all the relevant evidence to help formulate their opinions, and considering engaging overseas experts to review the opinions of local experts.
"In a case like Lino, there are always going to be ramifications that arise out of that sort of judicial criticism," Moore says. "It means those agencies responsible for the prosecution need to take stock and review their processes."
He says it's important to note that most suspected abuse cases are referred to the child protection unit by other medical professionals. "This is not a stand-alone unit that's some kind of roving forensic paediatric police force."
Moore says it is notoriously difficult to prosecute child-abuse cases. "If you have an expert who comes along and is prepared to say: `I think it's possible the explanation could be something else', even if he doesn't favour it, then we haven't proven our case. That's why internationally only 20% of these cases succeed."
He says Kelly attends all the same conferences as Donald and other experts.
"He is internationally regarded as one of the most talented and able paediatricians in the world. We should be extremely proud of what that man has achieved."
http://www.stuff.co.nz/sunday-star-times/features/4395246/Battle-of-the-experts

SBS: New Zealand: Starship Hospital: Guilty until proven innocent?

TONY WALL - Sunday Star Times
28/11/2010
You take your sick child to Starship hospital and suddenly you are accused of abuse. Tony Wall investigates claims the hospital's child protection unit has become a police station treating good parents like criminals, and why there's concern at some of the expert evidence Starship doctors are giving in court. 
WHEN JANE* found herself under investigation at Starship Hospital for suspected child abuse she turned to her stepmother Robyn Stent, the country's first health and disability commissioner, who literally wrote the book on patient rights.
But Stent's involvement hardly helped.
Starship doctors were adamant the haematoma on the baby's head was no accident and that it had no medical explanation. Despite it eventually being accepted the haematoma was caused during a difficult caesarean birth – something that's relatively common – they have still not apologised for getting it so wrong.
"It was really tough to deal with these people. It's got to be tough if I, as ex-commissioner, can come out of there without even an apology for the errors made," Stent says.
She is full of praise for the work Starship does but is concerned its Te Puaruruhau specialist care and protection unit, a multi-agency centre including police and Child, Youth and Family, is "out of control".
The unit was set up in 2002 to bring a co-ordinated approach to child abuse investigations. Whenever abuse is suspected, a child ends up under its umbrella.
But Stent, who wrote the code of rights for health and disability consumers in the mid 90s, says the team appears "fanatical" about abuse, and in her experience treated an unexplained head injury as abuse, and the child's parents as guilty.
That type of reaction could cause families trauma, she says, and could lead to unnecessary and costly medical procedures as doctors looked for evidence of abuse.
She is scathing of the unit for not profiling parents to determine whether they are likely abusers, for having no proper written protocols for dealing with families in suspected abuse cases, and for effectively detaining parents in breach of their human rights.
"There is no doubt we have excessive numbers of child deaths as a result of abuse," Stent says. "But that doesn't mean you treat every person as a criminal." She felt that "they are treating this unit like a police station. It's just appalling."

Starship says it has made changes as a result of talks with Stent and her family.

Auckland District Health Board women's and children's health clincial services general manager Kay Hyman says better information is now provided to families going through an investigation and she rejects the suggestion everyone is being treated as a criminal, saying only a small number of the thousands of families who go through Starship each year are investigated.
"We make no apology for investigating the possibility of non-accidental injuries. Our primary obligation is to the child and, in some cases, that requires investigations that are uncomfortable for parents," she says.
But there is concern in medical and legal circles about the unit's practices and the medical opinions the child protection team, led by paediatrician Patrick Kelly, have given in court.
The Sunday Star-Times reported this month on a decision by Auckland District Court judge David McNaughton, who acquitted Onehunga machine operator Famaile Lino on charges of causing grievous bodily harm to his six-month-old daughter, Mere.
The judgment said it was "regrettable" Starship doctors had not considered all of the evidence before reaching their conclusions.
Judge McNaughton said the two doctors, who had concluded it was a shaken baby case, would not have altered their views no matter what explanation Lino gave – he said Mere fell from a chair – and to that extent the decision to prosecute was a foregone conclusion.
He has also expressed concern in court that assault charges against another father could be "another Lino". In that case, a family is fighting to prove bleeding on the brain of a five-month-old girl was caused by a medical condition or accidental injuries, not shaking as advised by Kelly and his team.
The family is consulting Adelaide forensic paediatrician Terry Donald, who appeared for the defence in the Lino case, and who is increasingly being called to give evidence in New Zealand (see story on facing page).
The Sunday Star-Times has spoken to several families who complain about the way they were treated at Starship and by CYF. One family alleges their child's health was compromised in the pursuit of evidence of abuse – in that case a girl's broken arm was incorrectly set, something not picked up because the medical records were misplaced (see story, below).
Others had their children – including uninjured siblings – taken from them by CYF, and had to fight to get them back even after being found to have no case to answer.
Those facing accusations say it was difficult to find doctors willing to take the stand against Kelly and his team, and in some cases families were unable to get further treatment for a child because paediatricians did not want to be seen to be "going against" Starship.
The Paediatric Society issued a "position statement" to the Star-Times backing Te Puaruruhau's procedures and saying paediatricians held the unit in high regard.
But one senior paediatrician, who asked not to be identified, says too many good parents are getting caught in the protection unit's net.
"I see their dilemma – they don't want to be caught out saying it was an accident, then something much worse happens.
"I can understand the caution, but they can lack a degree of scepticism and common sense. They need to ask `is abuse likely in this case?'
"Their attitude is you can never tell, whereas I think you can. They don't profile, which means they throw the book at everybody, which is not a very efficient use of resources. It also means all the power is in their hands. They see monsters all the time, but part of the problem is that they seem to think everyone's a monster."
IN JANE'S case she went to Starship in a panic when a blister-like protrusion developed on her three-month-old son's head.
Scans were done, and Jane was told it was nothing serious, that an expert would look at the scans and get back to her. Then she got a call that it was urgent she come in.
"When she got there, they were waiting for her," Stent says. "The baby was put under 24-hour surveillance, she (Jane) was effectively detained and an assessment was done saying they were really concerned... that maybe she had abused the baby."
The clinicians told Jane they wanted to do an MRI scan to look for other injuries, which in babies has to be done under general anaesthetic. Jane refused consent, and at that point, police were called.
"She said: `I want to go and I want to take my baby', and they [hospital staff] said: `No, if you go the baby stays'. She really couldn't leave."
Eventually, after more than two days of investigations, Jane was allowed to take her son home. Stent says it remains a mystery why Starship treated it as abuse because a key report is missing.
"It was just one big false alarm from beginning to end," Stent says.
She began her own investigation into the protection unit's practices and asked to be sent the written protocols staff follow. She was sent some material, but it did not make sense, and the hospital eventually conceded staff did not follow set procedures.
"They are actually deciding they will put people within the child protection unit without anything in writing about how to make that decision."
Stent took part in several meetings with Kelly and other staff. "They had a lawyer taking notes of everything because I turned up, the ex-commissioner. They were very worried about me being there."
Stent says her stepdaughter has been traumatised, and is particularly concerned a letter saying she was refusing treatment for her son and may have abused him made its way on to a CYF file.
"They promised they'd get it withdrawn but they never did. They just made mistake after mistake, and yet they would not apologise.
"I was concerned at the effect they were having on families. They believe they know better than families about the baby, and they have more concern about the baby than the parents."
The senior paediatrician, who has given medical evidence in support of wrongly accused parents, agrees.
"I tell parents to get a lawyer. But if you don't have the money you can't follow that advice." Instead he now tells people to avoid Starship if their child has only minor injuries, something Stent says is sad. "Starship's a hallowed place," she says. "It should be, it's a very special place, and I think you've now got people who won't be going there as a result of all this."
 
SUGGEST TO Hyman that Starship should undertake profiling to determine which are abuse cases, and she dismisses it as unrealistic.
"We don't profile because non-accidental injury occurs in all parts of society. There is no profile. It would be wonderful if all families came with a tag that could tell us one thing or another, but they don't."
Does she accept that good parents are being caught up in Starship's determination to ferret out abusers?
"We are conscious that this is a difficult issue to raise with anyone. We do try and ensure we are investigating those families where there is the strongest suspicion.
"I acknowledge that these situations are stressful for families and that they need to be kept well-informed."
Hyman says Starship has a close working relationship with international paediatricians and its processes "represent world's best practice".
She says doctors maintain open minds and consult carefully before making inquiries about possible abuse.
The child protection team works closely with other clinical paediatric services within Starship, she says, and not in isolation.
Improvements have been made including enhancing the on-call testing service to ensure timely results, and improving information provided to parents about timeframes.
Starship has also invested "significant energy" in investigating other potential conditions that could explain a child's injuries, and in obtaining children's health histories to determine if there are possible accidental causes.
She says Starship has robust complaints procedures and "welcomes" scrutiny, including that of the Health and Disability Commissioner, who investigates cases as he sees fit.
Hyman points out that most of the families who spoke to the Star-Times went through Starship a year or more ago, and since then changes have been made.
"It's a difficult area. There will be times when we don't get it right. We try and err on the right side of the balance in a way that minimises the impact for families, and we have learned how to do that better over time.
"If some of the families you spoke to were to go through the process now, hopefully they wouldn't be raising some of these issues.
"We hear from a number of people who go through it and at the end thank us, saying they understand it was something that had to happen."
http://www.stuff.co.nz/sunday-star-times/features/4395244/Guilty-until-proven-innocent

SBS: New Zealand: Tatana: Home detention for shaking daughter

BELINDA FEEK - Waikato Times

30/11/2010

 

A Cambridge man who severely injured his daughter shaking her in frustration after she soiled herself has avoided prison after being sentenced in the Hamilton District Court this evening.
Jacob Patrick Tatana, 21, had earlier admitted a charge of injuring by unlawful act after he caused severe haemorrhaging to the left side of her brain and eye after the incident at his home on March 1 this year.
The court heard Tatana - exhausted after a weekend of smoking cannabis and drinking - was charged with looking after his daughter on the Monday night while his partner was at work.
About 9pm while getting her ready for bed and changing her, she soiled herself and messed on a blanket she was lying on.
Tatana lost his temper, picked her up, shook her violently then thrust her down onto an air mattress which was on the floor.
An hour later she became unresponsive and floppy. A CT scan at Waikato Hospital revealed a 3mm thick layer of actue subdural haemorrhaging on most of the left cerebral hempisphere - trauma consistent with shaken baby syndrome.
Tatana was convicted and sentenced to three months' home detention and 150 hours' community work.
http://www.stuff.co.nz/waikato-times/news/4407565/Home-detention-for-shaking-daughter

SBS: New Zealand: Tatana receives non-jail sentence

BELINDA FEEK AND NICOLA BRENNAN-TUPARA - Waikato Times

 01/12/2010

   Waikato Times: IN THE DOCK: Jacob Tatana, 21, of Cambridge, says he was tired after a weekend of drinking and drug use when he shook his baby daughter.

 

A Cambridge man who severely injured his baby daughter by shaking her has avoided prison.
The sentence has angered child advocates who say the country should be ashamed of its record of child abuse.
Jacob Patrick Tatana, 21, was yesterday sentenced to three months' home detention and 150 hours' community work when he appeared in the Hamilton District Court.
He earlier pleaded guilty to a charge of injuring by unlawful act related to shaking his three-month-old daughter Kayla Anne Tatana.
Judge Glen Marshall originally considered a sentence of seven months in jail - the maximum penalty is three years - but reduced it due to mitigating factors.
Sensible Sentencing Trust national spokesman Garth McVicar said the starting point should have been five years, and judges should focus on deterrence, not just the circumstances of individual cases.
"We are very high in world standards now with assaults on babies and deaths of babies," Mr McVicar said.
"We should be absolutely ashamed of it and our judges should consider it."
The court heard Tatana caused severe haemorrhaging to the left side of Kayla's brain and eye after violently shaking her at his home on March 1 this year.
Tatana - exhausted after a weekend of smoking cannabis and drinking - was looking after Kayla while his partner, Gina Hodges, was at work.
About 9pm, while Tatana was getting Kayla ready for bed and changing her, she soiled herself and messed on a blanket she was lying on.
Tatana lost his temper, picked up Kayla, shook her violently then thrust her down on to an air mattress which was on the floor.
An hour later she became unresponsive and floppy.
Kayla suffered temporary paralysis to her left side and subsequent seizures, which she had now outgrown.
The haemorrhage behind her left eye still hampered vision, but doctors were optimistic her eyesight could be restored in part or whole.
The couple had since split and Miss Hodges now lives in Levin with Kayla.
Tatana was assessed as being at a low risk of reoffending and had shown genuine remorse for his actions. Miss Hodge confirmed the behaviour was out of character for him. Tatana had also lost his job as a result of the charge.
Judge Marshall said Tatana had shown a great deal of insight into what happened, however it was still horrific for his daughter.
"She could do or say nothing that could stop or affect your actions - she must suffer what violence is dished out to her; she is completely helpless."

Mr Tatana's family declined to make any comment when approached after sentencing.

Anthea Simcock, chief executive of Hamilton-based child protection agency Child Matters, said the case should serve as a wake-up call for stressed-out parents.
While Kayla's prognosis was good, it might not be the same in other cases.
"You don't know the outcome when you're doing it," she said.
Help and advice was available 24/7 through the Plunket hotline (0800 933 922) and Mrs Simcock suggested parents should use that first when they felt the pressure building.
Family First national director Bob McCoskrie said: "This outcome sends all the wrong messages about the communities' stand against violence, and sets a dangerous precedent for future cases."
http://www.stuff.co.nz/national/crime/4409586/Non-jail-shaken-baby-sentence-angers-child-advocates

SIDS: Māori breastfeeding practices under spotlight

23 November 2010, University of Auckland

Māori breastfeeding practices under spotlight in new book
The baby formula industry has been likened to the tobacco industry, for its serious effects on Māori health in a new book co-authored by a University of Auckland academic.
Dr Marewa Glover from the University’s School of Population Health contributed a chapter on Māori breastfeeding in a new resource book for researchers and health practitioners – Infant feeding practice: A cross-cultural perspective.

Dr Glover says the practice of breastfeeding has undergone a huge ideological shift since colonisation, resulting in fewer Māori women breastfeeding.

“The actual contribution of the artificial baby milk industry to Māori babies having the lowest rates of breastfeeding in New Zealand has yet to be studied, but traditional Māori infant care practices have been lost as the ‘benefits’ of western and modern practices have been sold to Māori mothers,” said Dr Glover.
“Sudden Infant Death Syndrome (SIDS) rates are higher and have been known to be higher for some decades, bedsharing and its attendant risks are more frequently seen for Māori, yet the knowledge and practice of Māori traditions by contemporary Māori mothers is poor.”
Dr Glover’s chapter looks at the growth of the baby formula industry in New Zealand, the destruction of Māori traditions, influences which divert Māori women from breastfeeding, and smoking as a significant barrier to breastfeeding.
http://www.scoop.co.nz/stories/GE1011/S00123/maori-breastfeeding-practices-under-spotlight.htm

J Paediatr Child Health. 1994 Apr;30(2):140-3.

Well health care and the sudden infant death syndrome.

Ford RP, Mitchell EA, Taylor BJ.

Community Paediatric Unit, Healthlink South, Christchurch, New Zealand.

Abstract

The aim of this study was to examine whether poor attendance at routine antenatal and postnatal 'well child' health services was associated with a higher risk of sudden infant death syndrome (SIDS, or cot death). A nationwide case-control study of SIDS in New Zealand enrolled 485 postneonatal deaths due to SIDS and 1800 control infants who were selected randomly. The risk for SIDS was found to be higher for infants whose mothers attended their first antenatal check later than 3 months into the pregnancy, made fewer antenatal visits, and did not go to antenatal education classes. However, this increased risk was largely explained by high parity, maternal smoking, the mother not being married, mother being < 20 years old at the birth of her first child, and delivery during the winter months. Infants not attending a 6 week postnatal check had an almost three-fold increased risk of SIDS compared with those who did attend (odds ratio [OR] 2.86; 95% confidence interval [CI] 1.93, 4.24). Similarly, infants not attending well child clinics were at increased risk of SIDS (OR 2.75; 95% CI 2.09, 3.62). These differences persisted when adjusted for likely confounders. This study demonstrates that infants who miss child health nurse clinics are those most at risk for SIDS and are those who warrant increased surveillance.
http://www.ncbi.nlm.nih.gov/pubmed/8198848

SIDS: Antenatal and intrapartum factors associated with sudden infant death syndrome in the New Zealand Cot Death Study.

J Paediatr Child Health. 1995 Oct;31(5):473-8.

Stewart AJ, Williams SM, Mitchell EA, Taylor BJ, Ford RP, Allen EM.

Department of Nursing and Midwifery, Otago Polytechnic, Dunedin, New Zealand.

Abstract

OBJECTIVE: To describe the relationship between antenatal and intrapartum factors and sudden infant death syndrome (SIDS).
METHODOLOGY: The New Zealand Cot Death Study was a 3 year case-control study, with 485 infants who died from SIDS in the postneonatal period and 1800 randomly selected control infants. Data were obtained from obstetric records, parental interview and community nursing records.
RESULTS: This study confirms many of the antenatal and intrapartum risk factors for SIDS noted in studies from both the southern and northern hemispheres. After controlling for potential confounders, such as occupational group and marital status, significant inverse effects were noted for interpregnancy interval, birthweight and gestation. Other factors that retained a significantly increased risk of SIDS were: increasing parity, bacteriological evidence of urinary tract infection (UTI) (adjusted odds ratio 1.73, 95% CI 1.10-2.73); smoking antenatally (AdjOR 2.14, 95% CI 1.61-2.84); less than six antenatal checks attended (AdjOR 1.84, 95% CI 1.19-2.84); second stage of labour less than 16 min (AdjOR 2.06, 95% CI 1.35-3.14) and multiple birth (AdjOR 3.23, 95% CI 1.70-6.02). No interaction was observed between maternal haemoglobin and antenatal smoking. Interactions were tested for and not found between antenatal smoking and three antenatal risk factors (UTI, short second stage of labour and number of antenatal appointments). The only significant interaction between these three factors and three modifiable postnatal risk factors (prone sleeping, bed sharing and bottle feeding) was between bed sharing and fewer antenatal appointments. The risk of SIDS associated with bed sharing was greater among those whose mothers had fewer antenatal appointments.
CONCLUSIONS: Although many of the previously identified antenatal and intrapartum risk factors for SIDS are confirmed, the risks of SIDS associated with obstetric factors are in general considerably lower than the risks associated with the four modifiable postnatal risk factors.
http://www.ncbi.nlm.nih.gov/pubmed/8554873

SIDS: Risk factors for sudden infant death syndrome following the prevention campaign in New Zealand: a prospective study.

Pediatrics. 1997 Nov;100(5):835-40.

Mitchell EA, Tuohy PG, Brunt JM, Thompson JM, Clements MS, Stewart AW, Ford RP, Taylor BJ.

Department of Paediatrics, University of Auckland, Auckland, New Zealand.

Abstract

OBJECTIVES: To identify the risk factors for sudden infant death syndrome (SIDS) following a national campaign to prevent SIDS.
METHODS: For 2 years (October 1, 1991 through September 30, 1993) data were collected by community child health nurses on all infants born in New Zealand at initial contact and at 2 months.
RESULTS: There were 232 SIDS cases in the postneonatal age group (2.0/1000 live births) and these were compared with 1200 randomly selected control subjects. Information was available for 127 cases (54.7%) and 922 (76.8%) of controls. The previously identified modifiable risk factors were examined. The prevalence of prone sleeping position of the infant was very low (0.7% at initial contact and 3. 0% at 2 months), but was still associated with an increased risk of SIDS. In addition, the side sleeping position was also found to have an increased risk of SIDS compared with the supine sleeping position (at 2 months: adjusted odds ratio (OR) = 6.57; 95% confidence interval (CI) = 1.71, 25.23). Maternal smoking was found to be the major risk factor for SIDS. Bed sharing was also associated with an increased risk of SIDS. There was an interaction between maternal smoking and bed sharing on the risk of SIDS. Compared with infants not exposed to either bed sharing or maternal smoking, the adjusted OR for infants of mothers who smoked was 5.01 (95% CI = 2.01, 12.46) for bed sharing at the initial contact and 5.02 (95% CI = 1.05, 24. 05) for bed sharing at 2 months. In this study breastfeeding was not associated with a statistically significant reduction in the risk of SIDS. The other risk factors for SIDS identified were: unmarried mother, leaving school at a younger age, young mother, greater number of previous pregnancies, late attendance for antenatal care, smoking in pregnancy, male infant, Maori ethnicity, low birth weight, and shorter gestation.
CONCLUSIONS: After adjustment for potential confounders, prone and side sleeping positions, maternal smoking, and the joint exposure to bed sharing and maternal smoking were associated with statistically significant increased risk of SIDS. A change from the side to the supine sleeping position could result in a substantial reduction in SIDS. Maternal smoking is common in New Zealand and with the reduction in the prevalence of prone sleeping position is now the major risk factor in this country. However, smoking behavior has been difficult to change. Bed sharing is also a major factor but appears only to be a risk to infants of mothers who smoke. Addressing bed sharing among mothers who smoke could reduce SIDS by at least one third. Breastfeeding did not appear to offer a statistically significant reduction in SIDS risk after adjustment of potential confounders, but as breastfeeding rates are comparatively good in New Zealand, this result should be interpreted with caution as the power of this study to detect a benefit is small.
http://www.ncbi.nlm.nih.gov/pubmed/9346984

SBS: New Zealand doctors accused by judge

Judge slams Starship Hospital doctors

TONY WALL - Sunday Star Times

31/10/2010

Photo: Grahame Cox

Starship Children's Hospital management will meet with the Crown Solicitor.

A district court judge has criticised doctors at Starship Children's Hospital who concluded that a father had assaulted his baby daughter, saying they failed to consider all the evidence and had closed minds on whether her head injuries were accidental.
The case has raised concerns about the way medical staff differentiate between accidental and non-accidental head injuries in children and has sparked a high-level meeting between Starship management and the Crown Solicitor to further discuss the "potentially far-reaching" implications of the verdict.
Famaile Lino, a machine operator from Onehunga, was charged with causing grievous bodily harm with reckless disregard for his six-month-old daughter, Mere. He told police her injuries were the result of her falling from a La-Z-Boy chair.
After a judge-alone trial in the Auckland District Court, Judge David McNaughton found Lino not guilty and said it was "regrettable" the doctors at Starship did not review all of the evidence before reaching their conclusions. They had failed to take into account Lino's interviews with police and witness statements before forming their views, he said in a written decision.
Judge McNaughton said the doctors would not have altered their views no matter what explanation Lino gave, "and to that extent the decision to prosecute... was a foregone conclusion".
The judge said he was satisfied there was at least a reasonable possibility that Mere suffered her injuries as a result of a fall. After the incident Child, Youth and Family took Mere and the couple's other two children into care. The two oldest children have been returned to their parents and the couple is now trying to overturn a court order granting interim custody of Mere to a relative. She has ongoing physical and possibly intellectual disabilities.
Lino's lawyer, Charles Cato, said it was one of the most concerning cases he had been involved with in 30-plus years of law, because of the deficiencies in the evidence of the Starship experts, who had rushed to judgement.
"When expert evidence gets to that state, it becomes dangerous in the criminal courts," Cato said. He was concerned there might be other similar cases and said it was imperative that police consulted experts independent of Starship.
The only thing that prevented what could have been a "gross miscarriage of justice", Cato said, was a legal aid grant which allowed him to call an internationally respected paediatrician to give evidence.
Mere was admitted to Starship on May 11, 2009. According to her father, he had placed her on the chair and then fell asleep – he was working nightshifts and caring for his two younger children during the day – and was woken by the sound of Mere thumping on to the floor. Her breathing became laboured and he threw her into the air, slapped her face and performed CPR in an effort to revive her. An ambulance was called straight away, which the judge noted was not typical in cases of child abuse.
But two Starship doctors who examined Mere concluded that her injuries, including a subdural haemorrhage, could not have occurred by falling such a short distance, and that the injuries were usually seen in high impact car crashes or falls from buildings.
One doctor said that haemorrhaging seen in Mere's eyes was, according to international studies, "highly specific of non-accidental injury" and in the absence of some other major trauma, "considered as diagnostic of child abuse".
But Judge McNaughton said he preferred the evidence of Terrence Donald, senior consultant in child protection services at the Women and Children's Hospital in Adelaide. Donald was also called by the defence in the Kahui twins murder case – challenging the evidence of Starship paediatrician Patrick Kelly on the timing of those assaults.
Donald told the court in the Lino case there was a lot of debate about how such retinal haemorrhaging was caused. Until 2000 it was considered characteristic of shaken baby syndrome, but more recent opinion had moved away from that.
Judge McNaughton wrote: "Like Dr Donald, I have a nagging doubt that the scientific position could be quite different in another 10 or 20 years' time."
Donald told the court he would never write a report until he had read all of the interviews conducted by police, and he was surprised the Starship doctors had not reviewed the police interviews and did not know that the Linos' older son had also provided witness evidence.
He was also concerned a bone scan on Mere was only carried out a week after admission to hospital, and there was no observation of the progress of the one possible impact mark on her forehead.
Kay Hyman, the Auckland District Health Board's general manager of clinical services for women's and children's health, said hospital management would meet with the Crown Solicitor for Auckland to discuss the case.
"We want to understand the implications of the decision, which are potentially far-reaching." She would not elaborate on the implications.
Hyman said the hospital had a robust clinical process for handling potential child abuse cases and she stood by the assessment of its doctors. "Our view was not formed without a comprehensive process of independent expert advice and review," she said.
She said the primary interest of Starship staff was protecting vulnerable children and staff did not question whether abuse had occurred without good reason.
The decision on whether to bring charges was up to police, not doctors.
Cato described the Linos as hard-working "battlers" who had not only suffered the trauma of having their baby seriously injured, but faced Famaile Lino doing a lengthy jail stint.
"It's a very important case. It shows how suddenly a person can be at home with their feet up looking after their children, and a nightmare commences."
http://www.stuff.co.nz/national/4291035/Judge-slams-Starship-Hospital-doctors

SBS: Lock, New Zealand

A Taupo man has been jailed for seven years and two months after he shook his baby son so violently after an argument with his partner that the boy died from his injuries.
In the High Court at Rotorua today Adam Christopher Lock, 22, was sentenced for the manslaughter of five-week-old Jayrhis Lock-Tata.
He was given an additional two years' jail for a series of charges relating to serious assaults on his partner and the child.
This is to be served concurrently with the manslaughter sentence. He was convicted and discharged on a count of intentionally damaging a police cell.
Outside the court Lock's former partner Shannel Tata said she had hoped he'd be jailed for a lot longer.
"I can never forgive him... I am not able to watch my baby grow up... my heart hurts so much," she said.
Her aunt Phalan Houpapa said she prayed Lock would do as the judge had urged him to and get help while inside.

Justice Peter Woodhouse noted a post-mortem had uncovered earlier-inflicted injuries caused by Jayrhis' ribcage being squeezed so hard he would have suffered pain and discomfort. The infant's death had been caused by a brain bleed consistent with being shaken violently. His body was bruised and some ribs freshly broken.
The court heard that Lock panicked and immediately sought help from a friend who arrived at this home. They performed CPR and Lock called an ambulance but Jayrhis died on March 7 last year, when his life support was switched off two days after his admission to Starship Hospital .
Lock had repeatedly denied his involvement in the baby's death, claiming his daughter had jumped on the baby. Initially he pleaded not guilty to murdering him but when his trial was about to begin last month he pleaded guilty to a substituted manslaughter charge. Jayrhis was one of two children Lock and Tata had together.
Justice Woodhouse said Lock and Tata had had a stormy relationship which involved violence towards each other and tensions between them. Lock had assaulted her during her pregnancy and shortly after Jayrhis' birth.
On one occasion he had been angry because he considered she'd been too long at a neighbour's where she was doing the family's washing. At other times he had accused her of drinking alcohol and having sex with other men.
Justice Woodhouse noted Lock had a difficult, "possibly dreadful", childhood during which he was physically abused. He had been separated early from his father who had committed suicide and had no contact with his mother.
Lock's "own path" had led to him accruing a long list of convictions. His drug abuse was serious - he admitted smoking up to five cannabis joints a day.
Defence counsel Michele Wilkinson-Smith submitted Lock had not brutally bashed or thrown his son, who had shown classic "shaken baby" symptoms.
She asked for a jail term of between five to seven years.
Crown prosecutor Fletcher Pilditch submitted the sentence should be in the vicinity of eight years.
A non-parole period of 3-1/2 years was imposed.
http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10677149

SIDS: New Zealand

Sandra Conchie |

17th September 2010

Sudden unexpected death is extremely rare for babies protected by the safety formula. Photo: File.

The tragic deaths of two Tauranga babies have prompted the coroner to warn parents of the risk of sharing a bed with their infant.

The inquests of the 4-month-old babies, who died within a month of each other last year, were held at Tauranga yesterday.

The names of the babies and their parents were suppressed.

Coroner Dr Wallace Bain said it was important to get the warning out about the risks of bed-sharing.

In the first case, the baby had been sleeping between its teenage mother and the mother's younger sibling.

But when the mother woke in the morning, her son was not breathing. She immediately started CPR and an ambulance was called, but the baby could not be saved.

The court heard evidence that the baby had been wheezing, and only a month earlier had spent a few days in hospital being treated for a respiratory virus.

The pathologist said the post-mortem findings were consistent with an "asphyxial mode of death", and consistent with consideration of a sudden infant death syndrome.

The baby's parents were not present in court.

In the second case, the baby's father had placed his son into his wife's arms while she was lying in bed.

All three went to sleep.

But when the mother woke at 4am, she found her baby lying face up between her and her husband. He was not breathing, was cold to the touch, and had no pulse.

She immediately started CPR and an ambulance was called.

The pathologist who performed the post-mortem examination said the baby's death was consistent with asphyxia.

The baby's mother told the coroner that sleeping with her baby was a cultural practice.

But she had since had another child, and her new baby slept in its own cot with a monitor.

The coroner applauded that decision, and said it was important to tell other parents about the need for separate, safe sleeping places for little babies. The mother, who attended with the baby's father, agreed.

It's not the first time the risks of parents bed-sharing with babies has been highlighted.

Dr Bain said he and the Wellington coroner dealt with at least a dozen similar co-sleeping deaths in 2008, and there continued to be cases all around the country.

Dr Bain reserved his decision in relation to the cause of death of both infants.

The issue of safe sleeping practices has also been raised by health officials in Christchurch following the destructive earthquake two weeks ago.

Dr Pat Tuohy, Ministry of Health chief adviser child and youth health, said many babies are sleeping in makeshift beds away from their own homes - and this meant some might be placed to sleep in dangerous places. Dr Tuohy said there were three things parents and caregivers should remember wherever and whenever baby sleeps.

"They should be face-up, face-clear and smoke-free."

The doctor also warned parents who were tired, or had consumed alcohol, not to share a bed with their baby, because it put the baby at high risk of being suffocated.

"Sudden unexpected death is extremely rare for babies protected by this safety formula."

 

SAFETY FORMULA
The Ministry of Health is recommending its "Safety formula" to reduce the chances of babies dying in their sleep:

FACE UP: Babies should sleep on their back. In this position it's easier for them to breathe and allows their strong gag and swallow reflexes to protect them if they spill. A clear face protects babies from suffocation.

FACE CLEAR: Babies need to be in a safe place, and shouldn't sleep on a couch or a bed with bedding or pillows that could block breathing.

SMOKE-FREE: All smoking harms babies, especially in pregnancy. Smoking takes oxygen and weakens vital systems as babies develop. When born, babies need extra protection, especially those born early.

Risks of sharing a bed with your baby 

Plunket advises parents on its website that bed-sharing increases the risk of sudden infant death syndrome (SIDS). If a parent wants to share a bed with their baby, it was important to:
* Have a smoke free pregnancy and home.
* Make sure that your baby sleeps on its back.
* Ensure that the adults in the bed have not been using alcohol or drugs, or are particularly tired.
Plunket also advises ensuring that bedding does not cover the baby's face or bed, the baby can't become wedged between or under others, and the baby doesn't get too heated or cold.
The risks of bed sharing are greater for premature and low birth weight babies and those who have been exposed to smoke, Plunket says.
"Most babies who die of SIDS share a bed with others, and have been exposed to smoke during pregnancy and after birth."
La Leche League New Zealand spokeswoman Lisa Manning said many New Zealand parents from different cultural backgrounds shared sleep with their babies, for all or part of the night.
"Rather than condemning what is an important strategy used by some to make parenting easier and more pleasurable, accurate messages on how to safely share sleep and when to avoid it need to be given."
Ms Manning said British research by Helen Ball had found that mothers who slept next to their breastfed babies were sensitive to their baby's presence during the night.
They maintained a safe sleeping position which protected the baby's from over-lying. 

 

http://www.bayofplentytimes.co.nz/local/news/double-tragedy-sparks-warning-from-coroner/3922981/