Unearthing neglect and safeguarding issues in an infant with spina bifida

Abstract

BACKGROUND: An infant with spina bifida and a ventriculoperitoneal (VP) shunt presented with swelling over the shunt. Initial investigations revealed a depressed occipital fracture and a small subdural haemorrhage, raising concerns about potential non-accidental injury (NAI) due to inconsistencies in the parents’ account of the injury. A thorough literature review was done, however, there is paucity of literature on NAI in children with spina bifida.

CLINICAL FINDINGS: Local protocols for investigating NAI and abusive head trauma (AHT) were followed, uncovering a metaphyseal fracture of the left femur and an old proximal right tibial fracture. The infant had missed several follow-up appointments. During the hospital stay, the mother's poor interaction and inability to provide basic care were noted, evidenced by an incident where the infant sustained a lacero-contused wound to the ear secondary to inappropriate garment choice and rough handling.

CONCLUSION: In this case, NAI was eventually excluded but there remained significant concerns about physical neglect, emotional neglect, and medical neglect. In view of these significant concerns, a Care Order was later issued for this infant. Despite this case was not an NAI case, it demonstrated the subtle but serious nature of neglect, particularly in children with medical conditions like spina bifida, where clinical findings might be misattributed to the condition rather than parental neglect.