Child Abuse Often Erroneously Diagnosed

Original Article

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.

Dr. Robert J. Cihak, M.D.

Robert J. Cihak, M.D., was born in Yankton, South Dakota. He received his Bachelor's Degree from the University of Notre Dame, Indiana, where he studied under the philosopher Eric Voegelin. He earned an M.D. degree at Harvard Medical School (1962-66), and did postgraduate medical training and academic work as a surgical intern at Stanford Medical Center (1966-67), diagnostic radiology resident at the Massachusetts General Hospital (MGH) in Boston (1967-70) and Assistant Professor of Radiology, U. New Mexico Medical School, Albuquerque, (1970-71). He then practiced diagnostic radiology in Aberdeen Washington until his retirement in 1994.

Michael Arnold Glueck, M.D.

Michael Arnold Glueck, M.D., of Newport Beach, Calif., writes extensively on medical, legal, disability and mental health reform.