Child Abuse or Parent Abuse?
Kenneth P. Carlson, MD, FAAPCook Children’s Physician Network Arlington, TX 76015, USA
To the Editor.—
A 5-week-old female infant was brought to the office by her parents for fussiness. Physical examination revealed no abnormalities, and the parents were reassured that the child appeared normal. Follow-up phone calls on subsequent days confirmed that the child was doing better. This little girl was born into a loving Vietnamese family by cesarean section. No problems were noted in the immediate postpartum period nor at the 1-week visit.
Both parents brought the child to the office when she was 6 weeks old, again with fussiness but also because of diminished appetite. She was afebrile and had no vomiting or diarrhea but had not gained weight. My partner, who saw her at that visit, was concerned enough to send her to the children’s hospital. The emergency department doctor could find nothing wrong, and, as the family was leaving, the mom asked about a swelling of the child’s leg. A radiograph revealed a fractured femur. Subsequent radiographs revealed 14 fractures (fingers, radius, tibiae, etc) in at least two stages of healing. Child Protective Services (CPS) removed her and her 3-year-old sibling from the family.
I have known this family since the birth of their first child and felt that the parents were caring, loving, and always appropriately concerned with the health and well-being of their girls. Immunizations were up to date, and illnesses were attended to in a timely manner. Needless to say, the family was devastated when their children were placed in foster care.
I made every effort to find an organic cause for the multiple fractures. Two genetic consults and an analysis of cultured fibroblasts ruled out osteogenesis imperfecta; she did not have blue sclerae. All blood tests were normal, and CPS and the geneticists felt that child abuse was the only explanation for the multiple fractures.
The child did well with the aunt and uncle (the court-assigned foster parents). The parents denied wrong-doing and/or knowledge of wrong-doing, but CPS refused their and my entreaties to return the children to a normal environment. The parents paid a lawyer $20 000 to help them.
The mother came from Vietnam 4 years ago and speaks very little English. The father has been here 7 years, speaks English well, works for a computer company, and has been a good provider. They are Buddhists and do not believe in harming an insect. CPS never made a home visit to these gentle people.
Both children, as is the custom in Vietnam, sleep on floor mats. The 3-year-old weighs 40 lbs and is quite aggressive. I made the assumption (actually my wife, who is more intuitive than I, deduced) that the older child, on at least two occasions, pulled the baby by the hands and jumped on her arms and legs, causing the multiple fractures.
This is exactly what I testified to in court in front of a full jury panel, and I was backed up by a sympathetic orthopedic surgeon. The children were returned to their parents after the parents were exonerated, and they are both thriving. The infant is now 18 months old, and the family is indeed a happy one. My wife and I had the pleasure of corroborating this when we visited their home.
Nothing is always as obvious as it seems. My geneticist colleagues were too hasty in calling these parents child abusers. The CPS was too superficial in their examination of the facts, and our system of justice played havoc with an immigrant family trying to do its best in a strange new culture. The lawyer who fleeced them should be brought up on charges. I feel comfortable in having helped to vindicate parents whose only fault was not realizing that what works in the old country, with many family members at hand, can be dangerous in a new environment.
PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics
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