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Broken Bones, Broken Families
December 20, 2011 permalink
When a child has a broken bone and the parents do not have an immediate explanation they usually lose the child. Today's article discusses one cause: rickets. Nearly wiped out a generation ago in the developed world, it is returning. Aggravating factors are less outdoor activity and the migration of dark-skinned people to high latitudes.
The disturbing reason why a growing number of parents are being falsely accused of shaking their babies to death
Standing together in the dock of the world’s most famous criminal court stood two confused and sobbing parents, accused of the worst offence imaginable: beating and shaking their own baby to death.
According to prosecutors, four-month-old Jayden Wray was gripped and twisted so brutally that bones throughout his body shattered, while vicious blows to his head damaged his brain.
The injured baby was rushed to hospital where doctors said he could not survive. Three days later, paediatricians at Great Ormond Street Children’s Hospital in London switched off his life-support machine.
So certain were doctors and police that Jayden had been hurt by his parents that the couple were barred from their son’s bedside before he died.
They were not allowed to attend his hospital christening and lost the chance to say their last goodbyes.
This horrific story unfolded over six weeks in a panelled courtroom of London’s Old Bailey. Yet today, Jayden’s father and mother — Rohan, 22, and 19-year-old Chana — are free. The case against them was thrown out ten days ago after 60 medical and forensic experts at their murder trial disagreed over what really killed their son.
Finally, the judge told the jury to find the couple not guilty because Jayden’s post-mortem revealed he had rickets, a serious childhood bone disease which had once been eradicated in this country nearly a century ago.
Rickets is linked to a lack of vitamin D, which the body synthesises from sunlight or absorbs from eating foods such as oily fish and eggs.
The disease causes the skulls of children to weaken and their bones to easily break — symptoms which closely mimic those of a deliberately shaken baby.
Hospital doctors in Jayden’s case, it transpired, had missed a vital clue when the baby got sick and then died: his mother, Chana, had so little vitamin D in her body that Jayden did not receive the vitamin while inside her womb or when she breastfed him.
After the case, the Wrays’ lawyer Jenny Wiltshire said: ‘These parents have been through hell. They can now grieve for the son they loved and cherished.’
Yet theirs is a case which has profound implications for all families. For it serves to highlight a growing medical problem — one which is not only leading to false allegations of abuse against innocent parents, but which is endangering the health of children right across Britain.
As Jenny Wiltshire said: ‘The real criminality here is that if the money spent on bringing this case had been used to tell all breastfeeding mothers to take vitamin D supplements, Jayden’s death wouldn’t have occurred.
‘Rickets, which is now back to epidemic proportions, would have been wiped out.’
Indeed, a growing number of experts believe that Britain is in the grip of a childhood rickets crisis on a scale not seen since Victorian times, when children working long hours in the factories and the mines were particularly vulnerable to the ailment.
The condition was largely eliminated after World War II, when the government provided free orange juice enriched with vitamin D and cod liver oil for every child in the country.
The difference today is that it is not only a disease of the poor. Those living in middle-class homes are just as likely to suffer from the condition — notorious for causing bowed legs and knock-knees — as those from the poorest inner-city estates.
Doctors at Southampton General Hospital recently found 40 per cent of children from all backgrounds being treated in the orthopaedic department had a shortage of vitamin D in their bodies — and were, therefore, prone to rickets.
The crisis, said orthopaedic consultant Nicholas Clarke, was ‘reminiscent of 17th-century England.’
The statistics speak for themselves: cases of childhood rickets have increased five-fold in 15 years.
Last year, more than 760 babies and youngsters were admitted to hospital showing signs of the condition. At the same time, recent research among primary care trusts found that the number of children under ten admitted to hospital with rickets leapt by 140 per cent between 2001 and 2009.
Doctors say the alarming rise is often due to today’s children spending large periods of time indoors playing computer games and watching television.
At the same time, many parents worry about exposing their children to sunlight — due to the repeated warnings about skin cancer — and cover them in high-protection creams, which impede the body’s ability to produce vitamin D and, in turn, to grow strong bones.
If children are deprived of the vitamin, they are at great risk of developing rickets and their immune system is weakened. A diet of junk food, instead of vitamin D‑rich meat, liver, eggs and oily fish, is also blamed for the crisis.
As Gillian Killiner, of the British Dietetic Association, said recently: ‘We have taken it for granted that skin cancer is the big problem and overlooked the vitamin D side of things.
‘Children are covered up with sunblock, T-shirts and hats, and that can be important — but it can go too far. We don’t have a lot of sun in this country, and in winter you are likely to be lacking vitamin D. If you haven’t built up enough in the summer, that’s going to be a certainty.’
But until now, few have pointed out one of the most worrying aspects of the crisis: babies with a vitamin D deficiency display remarkably similar symptoms to those who have been deliberately shaken by their parents or carers. This may have led to other controversial criminal trials of parents accused of harming their children when — like the Wrays — they were completely innocent.
Earlier this year, Nafisa and Mohammed Karolia, of Blackburn, Lancashire, were imprisoned for child cruelty despite their defence team arguing that vitamin D depletion led to their baby daughter’s injuries and subsequent death from broncho-pneumonia, aged seven months, in 2009.
The Karolias were accused of inflicting many terrible injuries on the child, including breaking her leg, her arm, and her rib. The police and prosecution lawyers said they had been caused by twisting, shaking and rotating the child’s limbs.
However, a very senior paediatric consultant who has examined evidence given at the trial has told the Mail: ‘It is very likely that there was an issue here with low levels of vitamin D in the mother and her daughter. But it appears that when it was mentioned in court, the prosecution nearly had a fit because they insisted this child had been shaken and abused.’
Now one coroner has become so alarmed by the rise of rickets that he has demanded the Government take action.
North London Coroner Andrew Walker sent a written notice to the Department of Health, under Rule 43 of the Coroner’s Rules, saying mothers must be warned of the dangers of not taking the vitamin D supplements.
The notice requires the Health Secretary Andrew Lansley to respond within 56 days, detailing what action his department plans to take.
Mr Walker acted after presiding over the inquest into the death of three-month-old Milind Agarwal. The baby was taken to the doctor this summer with a suspected viral infection and was sent home with saline nasal drops. A later call to another doctor by his parents resulted in them being told to give him paracetamol.
When Milind became critically ill at 10pm one evening in July this year, his parents called an ambulance and he was taken to Northwick Park Hospital in North London. A few hours later, he died of septic inflammation of the heart and associated problems.
An eminent paediatric pathologist and a leading authority on signs of child abuse, Dr Irene Scheimberg, who conducted a post-mortem examination on baby Milind, told the inquest that vitamin D deficiency may have accelerated the baby’s illness because his immune system was weakened.
She said afterwards: ‘In the 21st century, in a civilised country, this is outrageous. It is only the tip of the iceberg.’
The highly respected Dr Scheimberg, based at the Royal London Hospital, added: ‘I hope that the doctors treating sick children now open their eyes to this vitamin deficiency and the problems it causes. It is a really serious issue and a matter of justice for parents who are accused of abusing their children.’
The parents of Milind, who live in Wembley, London, agreed to talk to the Mail about what happened. They do not want their real first names used in this article to protect their family’s privacy. Both parents, whom we have called Gayen and Shrina, were born in India.
Research has shown that those with darker complexions process vitamin D from sunlight much more slowly than people with paler skin and are, therefore, prone to deficiency — and more likely to pass it on to their babies.
When I met the bereaved couple this week at their small flat, they were still raw with grief about their baby’s death. He was born in March, a wonderful first son.
A slight muscle weakness in his heart, discovered soon after his birth, was corrected with a simple procedure, and in June, Milind was given a clean bill of health.
‘We are talking about him now because it is important for other families,’ says Gayen, a computer engineer, aged 34.
‘We had no idea that the legacy of Milind would be to help spread the word that vitamin D is essential for all mothers and their babies.’ Gayen and Shrina sit on the sofa in their neat sitting room. On one shelf are the cuddly toys that lay in the cot beside Milind during his short life.
They show me his picture, a bright-eyed and smiling child looking straight at the camera. Then they remember his last hours with tears in their eyes. Says Gayen: ‘He had had a cold, but was sleeping well on the night he died. It was very sudden when he became so ill.
‘Now we know from the coroner that he had an infection, and that the lack of vitamin D in his body meant he could not fight it properly.’
By tragic coincidence, Shrina, 29, had been told she had a vitamin D deficiency two years before Milind was born. She had a pain in her right knee and her local GP put her on vitamin D tablets. However, as she explains: ‘I had stopped taking them well before I became pregnant. No one, including the GP, the midwife or doctors at Northwick Park Hospital, ever told me to take the pills while I was pregnant or my new son would be in danger.’
Since Milind’s death, she has revisited her GP and had blood tests. They show that she has very low levels of the crucial vitamin. ‘I am now taking pills all the time and trying to get out in the sunshine,’ she explains.
By coincidence, the child pathologist Dr Scheimberg, who unravelled the truth about Milind’s death, also helped clear the parents of Jayden Wray.
The prosecution insisted that Jayden’s injuries to his skull, knee, elbow, shoulder, hip, ankle and wrist could only have been caused by him being intentionally shaken and having his head hit against something hard.
However, a post-mortem examination by Dr Scheimberg discovered Jayden’s ‘obvious sign of rickets. It would have left the baby with weak bones, including a weak skull, and led to a series of fractures’.
She is appalled at the way that these innocent parents have been treated. ‘Some people should be hanging their heads,’ she said.
‘These young parents were stopped from even saying goodbye to their child before he died, and then accused of murdering him.’
One can only hope that their cases will lead to a growing realisation among all parents — and some in the medical profession — about the return of a condition that can be prevented by a simple pill or exposure to sunshine.
Source: Daily Mail