The child had 26 clinic appointments, 28 hospital admissions and discharges, 13 operations, 44 imaging tests and more than 1000 lab tests – but no one knew what was wrong. Photo / 123rf
A specialist children’s doctor said despite the best efforts of many medical experts, it remained a mystery why an infant child failed to thrive and remained thin and unwell.
The doctor gave evidence this afternoon on the second day of a trial described as a “complex medical case” in which a mother is accused of medically abusing her child.
She said, despite 26 clinic appointments, 28 hospital admissions and discharges, 13 operations, 44 imaging tests and more than 1000 lab tests, specialists struggled to get to the bottom of what was going on.
The mother has denied all charges against her in a trial that opened this week before Justice Lisa Preston in the High Court at Nelson.
The Crown alleged the offending constituted “medical child abuse”, which was a diagnosis from a doctor when the child was discharged from a North Island hospital in January 2021.
The defence case was built around what was described as a “medically fragile child living with complicated medical devices” and the actions of a desperate mother trying to help her child.
The mother, who has name suppression to protect the child’s identity, has pleaded not guilty to four charges of ill-treatment of a child and three charges of infecting with disease.
The alleged mistreatment was raised after hospital and medical treatment over 19 months.
Crown prosecutor Mark O’Donoghue said in his opening statement the series of hospital admissions followed a doctor’s appointment because the child was not gaining weight.
The doctor who gave evidence today was the specialist paediatrician who first saw the child, then an infant, at the hospital where she worked at the time in a South Island town.
She said the child’s mother was concerned the infant was failing to thrive. They presented at the outpatient clinic with a reported fever, reflux, blood and mucus in the infant’s stools.
The doctor said a long and detailed investigation process began to find out what might be medically wrong, which included specialists from tertiary hospitals around the country.
She said she first looked into whether an inflammatory gut problem might be causing the issue.
She said the child initially had a “flattening weight curve” and the mother reported the child was unable to tolerate solids, and that she was getting up at three-hour intervals to feed the infant.
The child would “scream” when offered fruit, which the doctor thought unusual.
She suggested a dietitian but months later the mother had the same complaints.
“I did blood tests to check for coeliac markers and [the child] was negative to everything,” the doctor said.
She said there were no markers for an inflammatory gut disease.
“I had in front of me a child who couldn’t gain weight, who was otherwise normal.”
The doctor had the child admitted to hospital so they could be fed via a tube to bypass the swallowing mechanism.
However, that didn’t work either.
The doctor said each time she tried to increase the volume of liquid food, even a fraction, the mother would say her child was in distress and in pain, and not sleeping at night.
The child was then sent to radiology to investigate how its stomach was emptied, but the infant continued to lose weight.
“I tried hard to find something medically that explained the symptoms. I sought advice on something I might have missed,” she said.
No one she consulted could offer a medical opinion. The spectre of medical child abuse was then raised.
The doctor said an MRI scan was done of the child’s brain and abdomen when the mother complained of a sudden “drop of face”.
“I was taking the mum’s word as fact, I thought [the child] might have been having an anorexia phase – the brain telling the stomach it’s not hungry – but the MRI was normal.”
The doctor recommended total nutrition into a vein, but to do that the child needed to go to a larger hospital because they had lost so much weight.
“We transferred the child, because despite our best efforts [the child] was thin and unwell.”
She said the child’s state of malnourishment by then meant even a winter bug could be severe and potentially fatal because the youngster didn’t have the energy to fight it.
There was further intensive intervention, by which stage the doctor noticed the mother had become familiar with medical terms and phrases, and was eager to hear explanations of terms and descriptions.
The doctor also noticed a lot of “breakages and infections” during central line insertions in the larger hospital where the child had been admitted.
She said it was “unusual” in such a short space of time.
The doctor said a second opinion was sought from another tertiary hospital, but despite intensive testing they could not trace the source of weight loss and pain.
She said by then she wanted the child protection team included, which was “common practice when things don’t add up”.
She said the hospital did not report anything suspicious, but the child’s anaemia was not medically explainable.
Later on, when the doctor responded to the mother’s concerns the child had a fever, she requested a blood culture.
The lab test revealed bacteria growth in the child’s blood.
The child was admitted back to the local hospital, “growing so much bacteria it was like a jungle”.
The child was then flown by medical emergency in a febrile state back to the tertiary hospital, where the diagnosis of medical child abuse was made.
A police investigation followed.
The Crown case aimed to prove the child’s illnesses, including sepsis, were the result of deliberate contamination and deliberate tampering of the child’s feeding tubes and IV medicine lines.
Marie Dyhrberg, KC, said the defence would focus on the interpretation of past events, hindsight and what someone might expect to find, and how that might influence recollections of what happened.
The trial continues.
Tracy Neal is a Nelson-based Open Justice reporter at NZME. She was previously RNZ’s regional reporter in Nelson-Marlborough and has covered general news, including court and local government for the Nelson Mail.