The loss of a child is one of life's most painful experiences regardless of
the cause, whether illness, accident, or injury. Parents say it's almost
unbearable to have a child die.
But how about having your child forcibly removed from your home on suspicion
of a crime you didn't commit? Adding insult to injury, the accusations in
question are based on an irrational medical diagnosis. This is a reality
faced by far too many parents accused of child abuse.
Yes, some parents do abuse their children. However, the medical profession
and government officials often abuse the diagnosis of child abuse.
Since our column, " Healing Fractures, Broken Families: A Complication of an
'Intrauterine Confinement Syndrome'" appeared in 2005, dozens of
grandparents, attorneys, public defenders, other family members, friends and
the parents themselves have contacted us about apparently false child abuse
accusations.
These correspondents often present convincing stories of loving parents who
would not abuse their children. They describe medical professionals and
government officials instigating false charges, causing infants to be ripped
from their mother's arms, essentially at the point of a gun.
In one such case, in January, a mother described how her youngest, a
four-month-old daughter, had multiple unexplained fractures. Because of
suspicion of child abuse, government agents took all three of her children
out of their home. The doctors found no bruising or other signs of trauma
during eight previous well-baby medical visits.
In another case, also presented in January, a grandfather wrote us about his
four-month-old grandson who was found to have multiple fractures with pretty
much the same medical history as above. At that time, the parents had
custody of the infant but government agents were threatening to take the
infant away.
In our 2005 article, we briefly described the clinical observations and
research leading to the temporary brittle bone disease (TBBD) hypothesis.
While in their mother's womb, babies grow and develop at astonishing rates.
Dr. Colin R. Paterson of Scotland discovered that some babies were born with
bones prone to fracture during the few months of life outside the womb but
without anything else to suggest child abuse, such as bruises or internal
injuries. Dr. Paterson hypothesized that these babies had a temporary form
of brittle bone disease, different from osteogenesis imperfecta and other
known causes producing weak bones and multiple fractures.
Dr. Marvin Miller, professor of Pediatrics and Obstetrics and Gynecology at
Wright State School of Medicine in Dayton, Ohio, recently reported 65
infants with a similar pattern of medical findings in the journal "Medical
Hypotheses" (2005 65, 880-886). He hypothesized that these babies were
tightly confined in the womb and weren't getting enough exercise to produce
normal bone strength. Such confinement can be due to a number of causes,
such as large fibroids, twins, or a shortage of fluid around the baby.
After birth, these babies start to exercise more normally. Their bones grow
even more rapidly than normal babies' bones, to catch up with the new
demands of living outside the womb. This rapid growth can produce new bone
in multiple layers and simulate healing fractures. In addition, some of the
weak bones actually do break during normal care, such as during diapers
changes.
About 50 years ago, diagnosing child abuse from X-ray images alone became
popular. In medical jargon, these X-ray findings were said to be
"pathognomonic" of child abuse.
But medical science hasn't yet discovered everything. It is therefore
illogical to imply that infants with multiple unexplained fractures not
having an underlying cause diagnosable by current medical science could only
be due to child abuse. Medical scientists continue to discover new medical
conditions, previously unknown and therefore impossible to diagnose or
identify the day before discovery of the new condition.
For example, less than two years ago, Dr. Roy Morello of the Department of
Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas,
and others described a new genetic cause for brittle bones. We do not know
if any parents were accused of child abuse of children with this same,
previously unknown condition.
The diagnosis by excluding everything else known to science, diagnosis by
exclusion, is a logically false approach simply because doctors and medical
science don't know everything.
Yet this false logic is the basis for the diagnosis of child abuse by X-ray
appearance alone. We expect bureaucrats to abuse us. As doctors, we're
grieved when medical professionals abuse children by making diagnoses
leading to unjust and false accusations.
In addition, some government social service workers face "bounty hunter"
incentives. When they take children from their parents, the government
agents benefit from publicity about child abuse, even when the charges are
false. The agencies then use this publicity when they ask the state
legislature for more money so they can investigate, harass, and prosecute
even more families. These perverse incentives also need to be corrected.
All other factors being equal, children thrive best when they grow up in
their own parents' home.
We therefore ask medical, social service, legal and law enforcement
professionals to review the problem of false accusations harming children
and their families. Applying scientific advances and simple logic should
result in new procedures for evaluating infants with healing bones.
We doctors, especially radiologists, must earn the trust of our patients by
not making irrational diagnoses, such as the diagnosis of child abuse based
on X-ray appearances alone.
Because doctors and medical science cannot be presumed to be perfect,
parents and other people taking care of children must be presumed to be
innocent, until proven guilty. Justice must take precedence over the rush to
convict.
Robert J. Cihak, M.D., is a senior fellow and board member of the Discovery
Institute and a past president of the Association of American Physicians and
Surgeons. Michael Arnold Glueck, M.D., is a multiple-award-winning writer
who comments on medical-legal issues. Both are board-certified diagnostic
radiologists.
