Another missed diagnosis of rickets leads to tragic consequences

The case of Karissa Cox and Richard Carter in the UK has been widely covered. Their baby (due to legal reasons the baby’s name and gender have not been revealed) was adopted after being taken when they were charged with child abuse. The couple have since had the charges dropped against them.

Much of the discussion is around the problems caused by the differing legal processes of the criminal courts and the family courts. The criminal court moves extremely slowly, so by the time they got to the stage when the charges were dropped, the baby had already been taken from the parents, put with foster parents and then adopted. Now the baby has been adopted, the legal view is that it will be almost impossible to have the baby returned to its natural parents, even though they have been found innocent.

However, perhaps this most tragic case is not really due to the way the legal system functions; this all could have been avoided if it weren’t for yet another case of misdiagnosis.

I wrote on the equally tragic case of Jayden Wray only 3 years ago. When will clinicians and the medical industry as a whole learn from their mistakes and understand the tragic and life changing cascade of events that can be started by an avoidable misdiagnosis?

Initial Diagnosis

There was no sign that the parents were bad parents - apparently they rushed their baby to the hospital emergency department at night after the baby started bleeding from its mouth. The clinicians could only see that baby’s frenulum (skin around upper gum) was torn. They also saw that the baby had minor bruising over its body. X rays showed ‘healing fractures’ on the baby’s limbs. This seemed to be enough for the clinicians to lock onto a diagnosis of child abuse and think of nothing else. Although it is hard to get all the clinical details from the press, it appears that it was only later they realised that the baby had von Willebrand’s disease, which explained the bruising.

The Court Case

In the subsequent court case which took place 3 years after the couple initially took their baby to hospital, the defence lawyers and expert witnesses demonstrated that the x-rays did not show fractures resulting from child abuse, but they could be healing fractures as a result of rickets. An expert witness said he was doubtful there were even any fractures at all.  A blood sample taken from the baby’s Guthrie card at 5 days old and a blood test at seven weeks old showed the baby was vitamin D deficient supporting the diagnosis of rickets.  All in all three diseases were missed in this baby:

• Von Willebrand disease
• Vitamin D deficiency
• Infantile rickets

How many more cases like this do we need before we learn? I am not saying that child abuse should not be seriously considered when infants present with signs of abuse, but it appears that the clinicians had nothing else in their differential, and failed to ask ‘what else could it be?’ With a significant number of reported cases of rickets being misdiagnosed as child abuse, why do the admitting clinicians not appear to include rickets in their differential?

There should be national outrage at more lives being destroyed through medical arrogance like this.

The Isabel Diagnosis Checklist helps doctors broaden their differential diagnosis: